Challenge for Preventing Medication Errors -Learn from Errors- : What Is the Most Effective Label Display to Prevent Medication Error for Injectable Drug ?

Abstract

In the medical institutions, more than 50% of the error report is related to the administration of pharmaceuticals. And the half of the report is related to the administration of injectable drug.

By analyzing the error report, the inducing factor of medication error are not only the name similarity (sound alike) and the appearance similarity (look alike) of the preparations but also the display of the ingredient amount of the injectable drug which has 3 types (“X% YmL”, “Xmg/mL YmL”, and “Xmg/YmL”) .

The difficulty of the calculation seems to differ in these three types of display. Comparison of the right answer in these three types of display is tried for 6 subject groups which are three health care providers (physician, nurse and pharmacist) and their students. As a result, the calculation right answer percentage was high in "Xmg/YmL", "Xmg/mL YmL" and "X% YmL" in turn.