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Zena Hilal Sulaiman

Detection and Evaluation of Medication errors at
Jordan University Hospital
Zena Hilal Sulaiman
A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of
Master of Science in Pharmaceutical Sciences
University of Petra,
Faculty of Pharmacy and Medical Sciences
June 2014
Detection and Evaluation of Medication errors at Jordan University
Zena Hilal Sulaiman
University of Petra, 2014
Under the supervision of Prof. Salim Hamadi and Dr. Iman Basheti
Aim: In view of the fact that medication errors in Jordan are under estimated, this study aims
to detect and evaluate medication errors. Main objectives of this study are to evaluate the
rate, frequency, and severity of detected medication errors, and to determine risk factors
associated with the occurrence of these errors.
Methodology: This cross-sectional prospective study of medication errors used two methods:
disguised direct observation and chart review methods. The study was conducted over 6
months (from June to December 2013) at the internal medicine ward (sixth floor) of Jordan
University Hospital. Up to 10 inpatients were selected for observation during medication
administration session on daily basis. The observation included only the nurse who
prepared/administered the medications. The chart reviewing verified if all prescriptions in the
medication chart were identical to the prescriptions in the transcribed labels.
Results: This study detected a total of 803 medication errors within 6396 opportunities for
errors (12.60%). During the 3667 observed administrations to 283 patients by 15 nurses, 739
administration errors were detected (20.20%), involving wrong time errors (18.20%),
omission errors (1.50%), wrong administration technique errors (0.20%), extra dose errors
(0.20%), unauthorized dose errors (0.10%), and wrong route errors (0.01%). Transcription
errors were the second errors detected (1.50%) among total 2729 screened prescriptions.
Errors in dispensing (0.80%) and prescribing stages (0.10%) were also identified in this
study. The majority of detected errors (92.50%) were categorized as 'C' (error reached the
patient with no harm). Risk factors associated with the total number of detected errors in this
study included: shorter nurse's experience in the ward (R2=0.456, p<0.042), higher no. of
doses given to the patient (R2=0.451, p<0.025), higher patient to nurse ratio (R2=0.409,
p<0.010), longer length of hospitalization (R2=0.399, p<0.049).
Conclusion: Medication errors are of concern in the Jordan University Hospital. This study
revealed that medication errors occurred mainly during the administration and transcription
stages of medication use process. Longer nurse experience and lower job pressure can lead to
lower rate of medication errors.
In The Name of Allah, the most Gracious, the most Merciful
Foremost, my thanks and gratitude for ALMIGHITY ALLAH, the Omnipotent, the
Omnipresent, the Compassionate, the Beneficent and the source of all knowledge and
wisdom, who gave the strength and courage to complete this work.
Thanks, gratitude and appreciation to my supervisor Prof. Salim Hamadi for his continuous
support during my master research, for his patience, motivation, enthusiasm, and immense
Wholehearted thanks and gratitude to my co-supervisor, Dr. Iman Basheti, for her support,
encouragement, and immense knowledge to help making the work enlightening.
For my advisors, actually words are not enough to express my feelings towards both of you,
your influence and recommendations will continue through my life and career as being my
role models.
To my family, no words can describe the love, affection, amiable attitude, advices, unceasing
prayers, support, and inspiration that showed me during my whole life. I would always be in
dept and grateful for my father, without him and his encouragement, trust, support, advices
and willingness to help me made this research in the best manner. My mother who stood
beside me step by step and always believed in me and pushed me to the limits so I can
achieve my goals. To my brothers and sister in low no words can describe my thanks and
love. Many thanks also to my extended family for their prayers.
My sincere thanks and gratitude goes to Mr. Haidar Rasheed for his support, advices and
willingness to help make my study analysis in the best manner.
My sincere thanks also go to Prof. Tawfiq Alhussainy for his helpful attitude, and support
throughout the research.
I would like to thank Dr. Nathir Obeidat for his endorsement to get the IRB permission of
Many sincere thanks to all the JUH internal medicine (sixth floor) ward staff (doctors,
pharmacists, and nurses) for their help during my data collection period.
To my best friend and soul mate Zahraa' Roudhan, thank you for standing by me in joy and
sorrow. I wanted to make sure you know that I appreciate the varieties of support you have
given me, whether emotional, informational, or tangible. I love you forever.
To my dearest friends (Zainab Alobaidy, Sarah Shubbar, Zahraa' Hassan, Sara Alani,
Aya Salah), deep sincere thanks for your support, encouragement and prayers, love you all.