Aim. The study aimed to identify the occurrence of medication administration errors in clinical practice.
Material and methods. This was a direct observational study. The study included observing the medication administration process over three years in four hospitals in the Czech Republic. STROBE was used as a checklist.
Results. A total of 18,370 medication administrations to hospitalized patients were observed and recorded, including morning, noon, and evening administrations. The most common MAE was substituting a prescribed medication without the doctor’s consent, especially among nurses aged 35-44 (p < 0.001). These MAEs involved giving a medication of diff erent strength than prescribed (p < 0.001), giving the wrong medication (p < 0.001), and giving a diff erent dose (p < 0.001). Substitutions of MAEs occurred most often during morning medication administration (p < 0.001).
Conclusions. A critical fi nding of this study was the substitution of medications without a doctor’s consent. It has been found that MAEs were not uncommon in clinical practice, and factors such as the nurse’s age, overall length of clinical practice, education, and workplace interruptions played a role.
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