Abstract
BackgroundMedication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.MethodsWe used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014.ResultsThe top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score.ConclusionsClinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0552-6) contains supplementary material, which is available to authorized users.
Highlights
Medication error is a frequent, harmful and costly patient safety incident
Preventable adverse drug events, i.e. injuries that arise from medication errors, are one of the most common and costly patient safety incidents, estimated to affect 2% of adult outpatients and 1.6% of adult inpatients [2]
We developed an open-ended questionnaire for clinicians to identify the main perceived problems and solutions relating to medication safety in primary care
Summary
Medication error is a frequent, harmful and costly patient safety incident. We aimed to identify the main causes of, and solutions to, medication error in primary care. Medication errors are preventable mistakes in prescribing, ordering, dispensing, administration and monitoring of drugs that can cause patient harm [1]. Preventable adverse drug events, i.e. injuries that arise from medication errors, are one of the most common and costly patient safety incidents, estimated to affect 2% of adult outpatients and 1.6% of adult inpatients [2]. A systematic review of 13 studies estimated the prevalence of hospital admissions due to medication errors was 3.7% with the majority of incidents judged to be preventable through simple improvements in prescribing [6]. Evaluating medication safety in primary care is more challenging as administration of medication is largely performed outside the more controlled environment of a healthcare facility [8, 9]
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