Abstract
PurposeThe aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors.MethodsCINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason’s Accident Causation model.ResultsSearching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of ‘medication error’ were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per ‘total number of medication orders’/ ‘number of prescriptions’, the median across all studies was 10% (IQR 2–35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason’s model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9).ConclusionThere is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors’ prevalence, severity, outcomes and contributory factors is warranted.
Highlights
In 1999, the ‘Institute of Medicine’ published the seminal report ‘To Err Is Human: Building a Safer Health System’ quantifying the scale of harm associated with medical care in the United States (US) [1]
It called for action to reduce patient harm which occurs as a result of unsafe medication practices and medication errors
The aim is to ‘gain worldwide commitment and action to reduce severe, avoidable medication-related harm by 50% in the 5 years, Eur J Clin Pharmacol (2019) 75:1269–1282 by addressing harm resulting from medication errors or unsafe practices due to weaknesses in healthcare systems’
Summary
In 1999, the ‘Institute of Medicine’ ( the National Academy of Medicine) published the seminal report ‘To Err Is Human: Building a Safer Health System’ quantifying the scale of harm associated with medical care in the United States (US) [1]. The authors called for coordinated efforts by governments, healthcare providers and consumers and others to promote patient safety, setting a minimum goal of 50% reduction in medical errors by 2004. Despite global advances in healthcare practices, an estimated one in ten patients is still harmed while receiving care [2]. In March 2017, the World Health Organization (WHO) published ‘Medication Without Harm, WHO Global Patient Safety Challenge’ [3, 4]. It called for action to reduce patient harm which occurs as a result of unsafe medication practices and medication errors. The aim is to ‘gain worldwide commitment and action to reduce severe, avoidable medication-related harm by 50% in the 5 years, Eur J Clin Pharmacol (2019) 75:1269–1282 by addressing harm resulting from medication errors or unsafe practices due to weaknesses in healthcare systems’. One key objective is to ‘assess the scope and nature of avoidable harm and strengthen the monitoring systems to detect and track this harm’ [3, 4]
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