We recently pointed out that doctors may be unaware how often patients fail to follow their instructions.1 Errors seem no less likely to arise in hospital.2–5 One study2 revealed an error rate of about 5% of all drug administrations in long-stay patients under favourable nursing conditions; others reported rates up to 20% in hospitals where checking systems were less rigorous and the nursing staff changed more frequently. Faulty routines may delay starting or stopping treatment, apart from errors in the actual administration of drugs. However, elaboration of any system in order to minimise errors might pass a point of maximum efficiency. For example, drug checking and recording occupies as much as 40% of a nurse’s time in some American hospitals.6
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