International Journal of Clinical Pharmacy

, Volume 39, Issue 3, pp 542–550 | Cite as

The frequency and nature of medication errors in hospitalized patients with acute coronary syndrome

  • Mostafa A. Sayed AliEmail author
  • Christina Milad Lobos
  • Mohamed Aboel-Kassem F. Abdelmegid
  • Ahmed Moustafa El-Sayed
Research Article


Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4–35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5–10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.


Acute coronary syndrome Cardiovascular drugs Coronary care unit Egypt Medication errors 



This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The authors declare no conflict of interest.


  1. 1.
    Aronson JK. Medication errors: what they are, how they happen, and how to avoid them. QJM. 2009;102(8):513–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Mansouri A, Ahmadvand A, Hadjibabaie M, Kargar M, Javadi M, Gholami K. Types and severity of medication errors in Iran; a review of the current literature. DARU J Pharm Sci. 2013;21(1):1–10.CrossRefGoogle Scholar
  3. 3.
    Cousins DH, Gerrett D, Warner B. A review of medication incidents reported to the National Reporting and Learning System in England and Wales over 6 years (2005–2010). British J Clin Pharmacol. 2012;74(4):597–604.CrossRefGoogle Scholar
  4. 4.
    Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother. 2013;47(2):237–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council; 2009. pp. 1–215.Google Scholar
  6. 6.
    Spinler SA, denus Sd. Cardiovascular disorders. In: Chisholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, et al. editors. Pharmacotherapy Principles and Practice. 3rd ed. New York: McGraw-Hill; (2013). pp. 133–160.Google Scholar
  7. 7.
    Overbaugh KJ. Acute coronary syndrome. Am J Nurs. 2009;109(5):42–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2095–128.CrossRefGoogle Scholar
  9. 9.
    Michaels AD, Spinler SA, Leeper B, Ohman EM, Alexander KP, Newby LK, et al. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American heart association. Circulation. 2010;121(14):1664–82.CrossRefPubMedGoogle Scholar
  10. 10.
    LaPointe NMA, Chen AY, Alexander KP, Roe MT, Pollack CV, Lytle BL, et al. Enoxaparin dosing and associated risk of in-hospital bleeding and death in patients with non–ST-segment elevation acute coronary syndromes. Arch Intern Med. 2007;167(14):1539–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Alexander D, Ou F-S, Roe MT, Pollack CV, Ohman EM, Cannon CP, et al. Use of and inhospital outcomes after early clopidogrel therapy in patients not undergoing an early invasive strategy for treatment of non–ST-segment elevation myocardial infarction: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines (CRUSADE). Am Heart J. 2008;156(3):606–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Freedman JE, Becker RC, Adams JE, Borzak S, Jesse RL, Newby LK, et al. Medication errors in acute cardiac care an american heart association scientific statement from the council on clinical cardiology subcommittee on acute cardiac care, council on cardiopulmonary and critical care, council on cardiovascular nursing, and council on stroke. Circulation. 2002;106(20):2623–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Brixey J, Johnson TR, Zhang J. Evaluating a medical error taxonomy. In: Proceedings of the AMIA Symposium. 2002. American Medical Informatics Association.Google Scholar
  14. 14.
    Schachter M. Common prescribing errors and how to prevent them. Medicine. 2012;40(7):394–6.CrossRefGoogle Scholar
  15. 15.
    Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897–903.CrossRefPubMedGoogle Scholar
  16. 16.
    Seden K, Kirkham JJ, Kennedy T, Lloyd M, James S, Mcmanus A, et al. Cross-sectional study of prescribing errors in patients admitted to nine hospitals across North West England. BMJ Open. 2013;3(1):e002036. doi: 10.1136/bmjopen-2012-002036.
  17. 17.
    Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619.CrossRefPubMedGoogle Scholar
  18. 18.
    Hamm CW, Bassand J-P, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2011;32(23):2999–3054.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams SD, Ashcroft DM. Medication errors: how reliable are the severity ratings reported to the national reporting and learning system? Int J Qual Health Care. 2009;21(5):316–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Ashcroft DM, Lewis PJ, Tully MP, Farragher TM, Taylor D, Wass V, et al. Prevalence, nature, severity and risk factors for prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug Saf. 2015;38(9):833–43.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Avery T, Barber N, Ghaleb M, Franklin BD, Armstrong S, Crowe S, et al. Investigating the prevalence and causes of prescribing errors in general practice. London: The General Medical Council: PRACtICe Study. 2012.Google Scholar
  22. 22.
    Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: a systematic review of the literature. Eur J Clin Pharmacol. 2013;69(4):995–1008.CrossRefPubMedGoogle Scholar
  23. 23.
    Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care. 2010;22(6):507–18.CrossRefPubMedGoogle Scholar
  24. 24.
    Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. Prevalence, incidence and nature of prescribing errors in hospital inpatients. Drug Saf. 2009;32(5):379–89.CrossRefPubMedGoogle Scholar
  25. 25.
    Al Khaja KA, Al-Ansari TM, Sequeira RP. An evaluation of prescribing errors in primary care in Bahrain. Int J Clin Pharmacol Ther. 2005;43(6):294–301.CrossRefPubMedGoogle Scholar
  26. 26.
    Al Khaja KA, Al Ansari TM, Damanhori AH, Sequeira RP. Evaluation of drug utilization and prescribing errors in infants: a primary care prescription-based study. Health Policy. 2007;81(2–3):350–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Al-Dhawailie AA. Inpatient prescribing errors and pharmacist intervention at a teaching hospital in Saudi Arabia. Saudi Pharm J. 2011;19(3):193–6.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ben-Yehuda A, Bitton Y, Sharon P, Rotfeld E, Armon T, Muszkat M. Risk factors for prescribing and transcribing medication errors among elderly patients during acute hospitalization. Drugs Aging. 2011;28(6):491–500.CrossRefPubMedGoogle Scholar
  29. 29.
    Sabry NA, Farid S, Aziz E. Role of the pharmacist in identification of medication related problems in the ICU: a preliminary screening study in an Egyptian teaching hospital. Aust J Basic Appl Sci. 2009;3:995–1003.Google Scholar
  30. 30.
    Brand DA, Newcomer LN, Freiburger A, Tian V. Cardiologists’ practices compared with practice guidelines: use of beta-blockade after acute myocardial infarction. J Am Coll Cardiol. 1995;26(6):1432–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Bradford WD, Chen J, Krumholz HM. Under-utilisation of b-blockers after acute myocardial infarction. Pharmacoeconomics. 1999;15(3):257–68.CrossRefPubMedGoogle Scholar
  32. 32.
    Rogers WJ, Bowlby LJ, Chandra NC, French WJ, Gore JM, Lambrew CT, et al. Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the national registry of myocardial infarction. Circulation. 1994;90(4):2103–14.CrossRefPubMedGoogle Scholar
  33. 33.
    Chertow GM, Lee J, Kuperman GJ, Burdick E, Horsky J, Seger DL, et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001;286(22):2839–44.CrossRefPubMedGoogle Scholar
  34. 34.
    Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW, et al. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160(18):2741–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Holloway RG, Tuttle D, Baird T, Skelton WK. The safety of hospital stroke care. Neurology. 2007;68(8):550–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277(4):301–6.CrossRefPubMedGoogle Scholar
  37. 37.
    LaPointe NMA, Jollis JG. Medication errors in hospitalized cardiovascular patients. Arch Intern Med. 2003;163(12):1461–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Mostafa A. Sayed Ali
    • 1
    Email author
  • Christina Milad Lobos
    • 1
  • Mohamed Aboel-Kassem F. Abdelmegid
    • 2
  • Ahmed Moustafa El-Sayed
    • 3
  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyAssiut UniversityAssiutEgypt
  2. 2.Department of Cardiovascular Medicine, Faculty of MedicineAssiut UniversityAssiutEgypt
  3. 3.Department of Pharmaceutics, Faculty of PharmacyAssiut UniversityAssiutEgypt

Personalised recommendations