Effects of patient-, environment- and medication-related factors on high-alert medication incidents.

OBJECTIVE To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents. DESIGN A retrospective chart audit design was conducted of medical records for patient admissions from 1 January 2010 to 31 December 2010. SETTING Five practice settings (cardiac care, emergency care, intensive care, oncology care and perioperative care) at a public teaching hospital in Melbourne, Australia. PARTICIPANTS Patients were considered for inclusion if they were prescribed at least one high-alert medication and if they were admitted to one of five practice settings. MAIN OUTCOME MEASURES High-alert prescribing and administering incidents were measured in each of the five practice settings. Generalized linear mixed modeling was used for data analysis. RESULTS There were 6984 opportunities for high-alert medication incidents across the five clinical settings. The overall medication incident rate was 1934/6984 (27.69%). There were 1176 prescribing incidents (16.84%) and 758 administering incidents (10.85%). Statistical modeling showed that, in each of the five clinical settings, an increased number of ward transfers was associated with increased odds of prescribing incidents. In addition, statistical modeling demonstrated that an increased number of ward transfers was associated with increased odds of administering incidents in emergency care and perioperative care. CONCLUSIONS Complex relationships were found in managing high-alert medications in specialty clinical settings. Employing measures to address patients' movements across ward settings can reduce high-alert medication incidents and improve quality of care.