System and Process Factors That Contribute to Insulin Related Medication Errors in Pediatric and Adolescent Patients in Kenyatta National Hospital

Abstract

Introduction Insulin provides the greatest flexibility in the management of diabetes in hospital settings. It is categorized as a high risk medicine because of its low therapeutic index. Insulin medication errors can easily lead to patient harm and hence their prevalence in health care facilities should be established and suitable measures put into place to minimize their occurrence. Objectives The study aimed at determining the prevalence of insulin related medication errors among pediatric and adolescent patients in Kenyatta National Hospital and determination of the system and process factors that contributed to these problems. Methods The study was carried out in the pediatric and adolescent patients‟ wards and outpatient diabetic clinic of Kenyatta National Hospital. The study design comprised both quantitative and qualitative phases. The quantitative phase consisted of both cross-sectional and prospective aspects. The cross-sectional study entailed prescriptions, glucose recording logbooks and dispensing label reviews while the prospective aspect entailed the abstraction of data from patient files and treatment sheets to determine the prevalence of insulin prescribing, monitoring and dispensing errors. In the qualitative phase, interviews were carried out to explore gaps in patient safety systems that could contribute to insulin related medication problems. Descriptive data analysis was conducted using STATA version 13 software. Results There was at least one prescription error in most of the prescriptions (69%). In the outpatient department, 64 (70%) out of the 91 prescriptions reviewed had an error. In the inpatient department, 7 (58%) out of the total 12 treatment sheets reviewed had an error. The most common prescription error was the use of dangerous abbreviations with a frequency of 54 (61%). The medication error rate was high at 14.2%. All the dispensing labels analyzed had at least one error, with the majority having 4 errors per label (72%). The most common dispensing error was failure to indicate the frequency of insulin use 96 (23%). Interviews identified lack of standard insulin use guidelines, an inpatient diabetic care management team and failure by vii pharmacists to actively participate in the management of diabetes patients as some of the factors that contributed to insulin related medication problems. Conclusion There was at least one prescription error identified in 69% of records and all dispensing labels had at least one error. The hospital has inadequate patient safety systems in place to prevent occurrence of these errors. There is need for the hospital to put measures in place to minimize the occurrence of such errors.