Gestion des erreurs médicamenteuses en médecine générale : étude en maison de santé pluridisciplinaire

Abstract

Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care. The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures. The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares. During the 3months study 4712medical consultations were performed and we collected 64medication errors. Most of affected patients were at the extreme ages of life (9,4% before 9years and 64% after 70years). Medication errors occurred at home in 39,1% of cases, at pluriprofessionnal health care house (25,0%) or at drugstore (17,2%). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2% of cases. Drug induced adverse effects occurred in 5patients, 3of them needing hospitalization (1patient recovered, 1displayed sequelae and 1died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5%) and poor treatment adherence (18,75%). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent. Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care.