• Aline S C Belela, Maria Angélica S Peterlini, and Mavilde L G Pedreira.
• Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil.
• Cancer Nurs. 2011 Sep 1;34(5):393-400.

BackgroundConsidering all sources of errors that may occur during healthcare, medication errors are the most common and also the most frequent cause of adverse events.ObjectiveThe objective of the study was to describe the medication errors reported in a pediatric intensive care unit for oncologic patients.MethodsThis is a descriptive and exploratory study. The errors were reported by the professionals involved in the medication system in a medication error report form developed for the study.ResultsThe sample consisted of 110 medication errors reported on 71 forms. The omission error was the most common error type reported (22.7%), followed by administration error (18.2%). No harm to patients was reported in 83.1% of the notifications.ConclusionThe analysis of the110 medication errors provides evidence of the context of their occurrence and the need to implement measures that can prevent or intercept these errors.Implications For PracticeIn an institution without adverse events report and a formal system to patient safety analysis, the implementation of a local nonpunitive approach to medication errors notification represented an important tool to patient safety promotion.

11 keywords...

hide…