Establishment and application of medication error classification standards in nursing care based on the International Classification of Patient Safety

摘要

Objective To standardize the classification, reporting and analysis of medication errors in nursing in order to improve patient safety management by achieving real-time monitoring and systemic analysis. Methods A system of classifying nurse-related adverse drug effects into four category grades was developed based on the framework provided by the International Classification of Patient Safety. Three investigators used the system to classify 1343 nursing-related drug adverse events reported between January 2006 and December 2010 at 15 tertiary medical institutions in Shanghai. Results The classification standard incorporated all relevant information provided in the reporting system and revealed that the greatest frequency of drug adverse events resulted from staff-related factors. In particular, the largest number of events resulted from routine violations, followed by technology type errors of negligence and fault. Conclusion Application of this classification system will help nursing administrators to accurately detect system- and process-related defects leading to medication errors, and enable the factors to be targeted to improve the level of patient safety management.