Analysis of Medical Errors: A Case Study

There are many hidden threats in government-run hospitals that affect the incidence of medical errors. The aim of the present study was to determine the frequency and types of medical errors in Taleghani Hospital affiliated to Shahid Beheshti University of Medical Sciences in 2014.
In this descriptive-analytical study, the voluntary error-reporting form was used for data collection in accordance with the standards of the patient-safety-friendly hospitals. Of the 300 forms distributed, 162 error reporting forms were collected during one year, and the data for each form was entered into the software by determining their Identification code. SPSS version 19 software was used for the quantitative tests, and the comments by 10 experts were drawn upon for causal analysis of the data.
Ethical Considerations: Completion of medical errors form report was carried out voluntarily, anonymously, without naming the error reporter, and the unit where the error had occurred.
Findings: The total number of errors reported was 158 errors in 2014. Frequency of the errors consisted of medication errors 38.6%, errors in treatment 36.1%, and errors in recording 25.3%, respectively. Events statistics was 33.5% for incident events, 15.2% for accident events, and 1.3% for sentinel events. Medication errors analysis based on the six principles of drug administration included wrong patient (32.14%), wrong drug (18.7%), wrong order (15.3%), wrong prescription (14.96%), wrong dosage (11.9%), and wrong time (7%).
Despite informing the people and holding educational sessions, there still remain some barriers to reporting errors in the health system. Hence, professional ethics education and error systematic management approaches are recommended.