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      Reducing number entry errors: solving a widespread, serious problem

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          Number entry is ubiquitous: it is required in many fields including science, healthcare, education, government, mathematics and finance. People entering numbers are to be expected to make errors, but shockingly few systems make any effort to detect, block or otherwise manage errors. Worse, errors may be ignored but processed in arbitrary ways, with unintended results. A standard class of error (defined in the paper) is an ‘out by 10 error’, which is easily made by miskeying a decimal point or a zero. In safety-critical domains, such as drug delivery, out by 10 errors generally have adverse consequences. Here, we expose the extent of the problem of numeric errors in a very wide range of systems. An analysis of better error management is presented: under reasonable assumptions, we show that the probability of out by 10 errors can be halved by better user interface design. We provide a demonstration user interface to show that the approach is practical.

          To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact.

          (Charles Darwin 1879 [2008], p. 229)

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          Tenfold medication dose prescribing errors.

           T Lesar (2002)
          Tenfold errors in medication dosing continue to occur despite being a well-recognized risk, particularly to pediatric patients. Few systematic evaluations of the characteristics and causes of tenfold medication dosage prescribing errors have been performed. To identify and quantify the characteristics of tenfold medication dosage prescribing errors. Evaluation of 200 consecutively detected medication orders with tenfold errors in dosing in a 631-bed tertiary-care teaching hospital. Type, frequency, characteristics, causes, enabling factors, and potential for adverse effects of tenfold medication dosage prescribing errors. Two hundred cases of tenfold prescribing errors were detected over an 18-month period. Overdoses were prescribed in 61% of the cases and underdoses in 39% of the cases. Ninety (45%) of the errors were rated as potentially serious or severe; 19.5% of the errors ocurred in pediatric patients. Levothyroxine accounted for 19% of all errors. As a class, antimicrobials, cardiovascular agents, and central nervous system agents each accounted for > or =15% of errors. Errors were associated with multiple zeroes in the dose (45%), use of equations or calculations to determine dose (27% total cases, 92.3% of pediatric cases), dose amount less than 1 (25%), and expression of measure conversion (23%). The tenfold errors were produced by a misplaced decimal point in 87 cases (43.5%), adding an extra zero in 63 cases (31.5%), and omitting a zero in 50 cases (25%). Factors identified as enabling a tenfold error to be carried out as ordered were a wide dose range for the drug (76.5%), medication ordered and able to be given by injection (42%), ability to give ordered dose as < or =5 solid oral dosage forms (36%), and availability of an oral liquid dose form (15%). Prescribing of tenfold medication dose errors is common and is associated with identifiable risk factors. Implementing commonly recommended medication safety processes are likely to reduce risk to patients from such errors. This information should be considered in the development of strategies to prevent adverse patient outcomes resulting from such errors.

            Author and article information

            J R Soc Interface
            Journal of the Royal Society Interface
            The Royal Society
            6 October 2010
            7 April 2010
            7 April 2010
            : 7
            : 51
            : 1429-1439
            [1 ]Future Interaction Technology Laboratory, simpleSwansea University , Swansea SA2 8PP, UK
            [2 ]Department of Computer Science, simpleUniversity of York , York YO10 5DD, UK
            Author notes
            [* ]Author for correspondence ( harold@ ).
            © 2010 The Royal Society

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Research Articles

            Life sciences

            user interfaces, number entry, human error, dependable systems


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