Abstract
ABSTRACTBackground: Drug treatment is an important clinical process in primary care that is associated with risk of error and adverse events.Objective: To review currently available research evidence on the topic and to develop a framework, which can help to guide improvement of medication safety.Methods: Systematic reviews were performed on adverse drug events (ADE), their preventability, and on available tools and methods to improve medication safety with a particular focus on information technology. Consensus methods were used to develop a framework to guide the improvement of medication safety based on the findings of our literature review.Results: The median prevalence rate of ADEs in primary care patients was 12.8%. Only a median of 16.5% of ADEs were preventable and thus could be classified as medication errors. Our review of information technology interventions found that only about half of the studies found a reduction of medication errors. In both reviews, the wide range between studies emphasizes the necessity of a validated medication error classification system. Another important aspect of medication safety appears to be a general lack of safety culture in primary care, which led us to the development of the Salzburg medication safety framework (SaMSaF), based on the MaPSaF tool to improve patient safety. The tool proved to be feasible and useful in a pilot study with several GP practices.Conclusion: A number of tools and interventions to investigate and enhance medication safety have been identified. Further research is necessary to implement and evaluate current concepts.
Highlights
Improving safety of medication use has become an important topic, in the hospital, and in primary care
We report on our review of the epidemiology of adverse drug events (ADE), the framework that we used to classify ADEs, interventions to improve medication safety and a measure to assess safety culture in relation to medication use
Improving medication safety 15 median rate of preventable events in all ADEs in ambulatory care-based studies was 16.5%, with a range from 11–27.5%. This rate of preventable ADEs decreased with age from a median of 15.8% in children to 13.6% in adults and 9.9% in older patients
Summary
Improving safety of medication use has become an important topic, in the hospital, and in primary care. Methods: Systematic reviews were performed on adverse drug events (ADE), their preventability, and on available tools and methods to improve medication safety with a particular focus on information technology. Our review of information technology interventions found that only about half of the studies found a reduction of medication errors. The wide range between studies emphasizes the necessity of a validated medication error classification system Another important aspect of medication safety appears to be a general lack of safety culture in primary care, which led us to the development of the Salzburg medication safety framework (SaMSaF), based on the MaPSaF tool to improve patient safety. The tool proved to be feasible and useful in a pilot study with several GP practices
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