Causes of incidents | Site 1 (CPOE) | Site 2 (HWP) | Total | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. | % | Mean | 95% CI | Sig. (2-tailed) | No. | % | Mean | 95% CI | Sig. (2-tailed) | ||||
Lower | Upper | Â | Lower | Upper | |||||||||
Communication | 21 | 3.5 | 0.04 | 0.02 | 0.06 | 0.000 | 58 | 9.7 | 0.19 | 0.14 | 0.24 | 0.000 | 79 |
Name and Sound confusion | – | – | – | – | – | – | 1 | 0.2 | 0.00 | 0.00 | 0.01 | 0.318 | 1 |
Labeling | 8 | 1.4 | 0.01 | 0.00 | 0.02 | 0.005 | 28 | 4.6 | 0.05 | 0.03 | 0.07 | 0.000 | 36 |
Packaging or design | 6 | 1 | 0.01 | 0.00 | 0.02 | 0.014 | – | – | – | – | – | – | 6 |
Drug selection | 198 | 33.6 | 0.34 | 0.3 | 0.37 | 0.000 | 235 | 38.8 | 0.39 | 0.35 | 0.43 | 0.000 | 433 |
Inappropriate drug form | 54 | 9.2 | 0.09 | 0.07 | 0.12 | 0.000 | 27 | 4.5 | 0.05 | 0.03 | 0.06 | 0.000 | 81 |
Dose or dosage selection | 233 | 39.6 | 0.40 | 0.36 | 0.44 | 0.000 | 93 | 15.3 | 0.15 | 0.13 | 0.28 | 0.000 | 326 |
Inappropriate duration of therapy | 15 | 2.5 | 0.03 | 0.01 | 0.04 | 0.000 | 27 | 4.5 | 0.05 | 0.03 | 0.06 | 0.000 | 42 |
DRP*a with drug use in spite of instruction | – | – | – | – | – | – | 6 | 1 | 0.02 | 0.00 | 0.03 | 0.033 | 6 |
DRPs*a related to logistics | 2 | 0.3 | 0.00 | 0.00 | 0.01 | 0.157 | 66 | 10.9 | 0.10 | 0.08 | 0.13 | 0.000 | 68 |
DRPs*a related to the patient personality or behavior | 7 | 1.2 | 0.00 | 0.00 | 0.01 | 0.008 | 7 | 1.2 | 0.01 | 0.00 | 0.02 | 0.008 | 14 |
Human factors (breakup) | 369 | 62.6 | 0.63 | 0.59 | 0.67 | 0.000 | 438 | 72.3 | 0.72 | 0.68 | 0.75 | 0.000 | 807 |
    Knowledge deficit | 55 | 9.3 | 0.09 | 0.07 | 0.12 | 0.000 | 57 | 9.4 | 0.09 | 0.07 | 0.11 | 0.000 | 112 |
    Performance deficit | 137 | 23.3 | 0.23 | 0.20 | 0.27 | 0.000 | 162 | 26.7 | 0.29 | 0.25 | 0.33 | 0.000 | 299 |
    Dosage/rate Miscalculations | 108 | 18.3 | 0.18 | 0.15 | 0.21 | 0.000 | 42 | 6.9 | 0.08 | 0.05 | 0.1 | 0.000 | 150 |
    System error | 7 | 1.2 | 0.01 | 0.00 | 0.02 | 0.008 | 5 | 0.8 | 0.01 | 0.00 | 0.02 | 0.025 | 12 |
    Error in stocking | – | – | – | – | – | – | 28 | 4.6 | 0.05 | 0.03 | 0.06 | 0.000 | 28 |
    Drug preparation or dilution error | 5 | 0.8 | 0.01 | 0.00 | 0.02 | 0.025 | 14 | 2.3 | 0.02 | 0.01 | 0.03 | 0.000 | 19 |
    Transcription error | 26 | 4.4 | 0.04 | 0.03 | 0.06 | 0.000 | 51 | 8.4 | 0.08 | 0.06 | 0.1 | 0.000 | 77 |
    High Volume workload | 40 | 6.8 | 0.07 | 0.05 | 0.09 | 0.000 | 42 | 6.9 | 0.07 | 0.05 | 0.09 | 0.000 | 82 |
    Fatigue or lack of sleep | – | – | – | – | – | – | 8 | 1.3 | 0.01 | 0.00 | 0.02 | 0.005 | 8 |
    Confrontational or intimidating behavior | 43 | 7.3 | 0.07 | 0.05 | 0.09 | 0.000 | 135 | 22.3 | 0.21 | 0.18 | 0.25 | 0.000 | 178 |
Others (breakup) | 115 | 19.5 | 0.20 | 0.16 | 0.23 | 0.000 | 247 | 40.8 | 0.40 | 0.36 | 0.44 | 0.000 | 362 |
    Lack of monitoring or cross checking practices | 61 | 10.4 | 0.10 | 0.08 | 0.13 | 0.000 | 155 | 25.6 | 0.25 | 0.21 | 0.28 | 0.000 | 216 |
    Lack of all-time oncology pharmacist | 14 | 2.4 | 0.02 | 0.01 | 0.04 | 0.000 | 44 | 7.3 | 0.07 | 0.05 | 0.09 | 0.000 | 58 |
    Less knowledge of antibiotic stewardship | 27 | 4.6 | 0.05 | 0.03 | 0.06 | 0.000 | 18 | 3 | 0.03 | 0.02 | 0.05 | 0.000 | 45 |
   Unnecessary medicine/s | 30 | 5.1 | 0.05 | 0.03 | 0.07 | 0.000 | 45 | 7.4 | 0.07 | 0.05 | 0.1 | 0.000 | 75 |
   Wrong drug combination/s | 20 | 3.4 | 0.03 | 0.02 | 0.05 | 0.000 | 3 | 0.5 | 0.01 | 0.00 | 0.01 | 0.083 | 23 |
Total | 1601 | Â | Â | Â | Â | Â | 2042 | Â | Â | Â | Â | Â | 3643 |