Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

Abstract Background Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety. Methods Nine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted. Results In all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8–29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7–13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9–13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4–23). Administration technique errors represented 53% (IQR 52.7–67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1–46) of prescribed medication; 70.3% (Range 50–78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors. Conclusions Children are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.

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P54 Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-nppg.63 ◽

2020 ◽

Vol 105 (9) ◽

pp. e35.1-e35

Author(s):

Adam Sutherland ◽

Denham Phipps ◽

Steve Tomlin ◽

Darren Ashcroft

Keyword(s):

Systematic Review ◽

Medication Errors ◽

Adverse Drug Events ◽

Improve Patient Safety ◽

Medical Officer ◽

Cochrane Library ◽

List Type ◽

Drug Related Problems ◽

Prescribing Errors ◽

The Uk

AimsProblems with medication account for 10–20% of all adverse healthcare events in the NHS, costing between £200–400 million per year.1 Children are more likely to experience medication related harm.2 International reviews of the prevalence of drug-related problems are over ten years old.3 There is a need for a focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK to support the development and targeting of interventions to improve medication safety.4MethodsNine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to September 2018. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children, and quality appraisal of the studies was conducted.Results26 studies were included; none of which specifically reported on the prevalence of ADEs. Three ADR studies reported a median prevalence of 28.3% of patients (IQR 13); >70% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors and the median prescribing error rate in all paediatric contexts was 10.7% of prescriptions (IQR 6) Seven studies explored prescribing errors in PICU and the prevalence was twice that in non-ICU areas (11.1% prescriptions; IQR 2.9 versus 6.5% prescriptions; IQR 4.3). The median rate of dose prescribing errors was 11.1% doses prescribed (IQR 10.6). Four studies reported administration errors of which three used consistent methods. Across these three studies, a median prevalence of 12.4% of administrations (IQR 7.3) was found. Administration technique errors represented 53% of these errors (IQR 14.7). Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 33% (IQR 13) of prescribed medication with 70.3% (IQR 14) classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.ConclusionsChildren are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm, there is an urgent need for outcome-focussed research on preventable ADEs in paediatric hospital settings in the UK. A deeper understanding of medication processes for children in hospital from a systems and theoretical perspective will also support the development and tragetting of effective interventions to improve patient safety.ReferencesChief Medical Officer. An Organisation With a Memory. London; 2000.Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285:2114–2120.Ghaleb MA, Barber N, Franklin BD, Yeung VWS, Khaki ZF, Wong ICK. Systematic review of medication errors in pediatric patients. Ann Pharmacother 2006;40:1766–1776.

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Does electronic medication reconciliation at hospital discharge decrease prescription medication errors?

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-12-2014-0113 ◽

2015 ◽

Vol 28 (6) ◽

pp. 564-573 ◽

Cited By ~ 5

Author(s):

Geneve M. Allison ◽

Bernard Weigel ◽

Christina Holcroft

Keyword(s):

Patient Safety ◽

Hospital Discharge ◽

Medication Errors ◽

Medication Reconciliation ◽

Improve Patient Safety ◽

Safety Issue ◽

Inpatient Service ◽

Intravenous Antibiotic ◽

Content Type ◽

The Impact

Purpose – Medication errors are an important patient safety issue. Electronic medication reconciliation is a system designed to correct medication discrepancies at transitions in healthcare. The purpose of this paper is to measure types and prevalence of intravenous antibiotic errors at hospital discharge before and after the addition of an electronic discharge medication reconciliation tool (EDMRT). Design/methodology/approach – A retrospective study was conducted at a tertiary hospital where house officers order discharge medications. In total, 100 pre-EDMRT and 100 post-EDMRT subjects were randomly recruited from the study center’s clinical Outpatient Parenteral Antimicrobial Therapy (OPAT) program. Using infectious disease consultant recommendations as gold standard, each antibiotic listed in these consultant notes was compared to the hospital discharge orders to ascertain the primary outcome: presence of an intravenous antibiotic error in the discharge orders. The primary covariate of interest was pre- vs post-EDMRT group. After generating the crude prevalence of antibiotic errors, logistic regression accounted for potential confounding: discharge day (weekend vs weekday), average years of practice by prescribing physician, inpatient service (medicine vs surgery) and number of discharge mediations per patient. Findings – Prevalence of medication errors decreased from 30 percent (30/100) among pre-EDMRT subjects to 15 percent (15/100) errors among post-EDMRT subjects. Dosage errors were the most common type of medication error. The adjusted odds ratio of discharge with intravenous antibiotic error in the post-EDMRT era was 0.39 (0.18, 0.87) compared to the pre-EDMRT era. In the adjusted model, the total number of discharge medications was associated with increased OR of discharge error. Originality/value – To the authors’ knowledge, no other study has examined the impact of reconciliation on types and prevalence of medication errors at hospital discharge. The focus on intravenous antibiotics as a class of high-stakes medications with serious risks to patient safety during error events highlights the clinical importance of the findings. Electronic medication reconciliation may be an important tool in efforts to improve patient safety.

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Does UK medical education provide doctors with sufficient skills and knowledge to manage patients with eating disorders safely?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-135658 ◽

2018 ◽

Vol 94 (1113) ◽

pp. 374-380 ◽

Cited By ~ 7

Author(s):

Agnes Ayton ◽

Ali Ibrahim

Keyword(s):

Eating Disorders ◽

Patient Safety ◽

Eating Disorder ◽

Postgraduate Training ◽

Medical Training ◽

Improve Patient Safety ◽

Medical Schools ◽

Junior Doctors ◽

The Uk ◽

Improve Patient

BackgroundEating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety.ObjectiveTo review the teaching and assessment relating to eating disorders at all levels of medical training in the UK.MethodWe surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties.Main outcome measuresInclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements.ResultsThe medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is <2 hours. Postgraduate training adds little more, with the exception of child and adolescent psychiatry. The majority of doctors are never assessed on their knowledge of eating disorders during their entire training, and only a few medical students and trainees have the opportunity to choose a specialist placement to develop their clinical skills.ConclusionsEating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

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Improving patient safety through education: how visual recognition skills may reduce medication errors on surgical wards

Nursing Reports ◽

10.4081/nursrep.2012.e1 ◽

2011 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Christopher R. Davis ◽

Edward C. Toll ◽

Paul M. Bevis ◽

Helena P. Burden

Keyword(s):

Patient Safety ◽

Medication Errors ◽

Undergraduate Education ◽

Visual Recognition ◽

Healthcare Professionals ◽

Postgraduate Training ◽

Response Rate ◽

Recognition Rate ◽

Compromise Patient Safety ◽

The Uk

Medication errors compromise patient safety and cost £500m per annum in the UK. Patients who forget the name of their medication may describe the appearance to the doctor. Nurses use recognition skills to assist in safe administration of medications. This study quantifies healthcare professionals’ accuracy in visually identifying medications. Members of the multidisciplinary team were asked to identify five commonly prescribed medications. Mean recognition rate (MRR) was defined as the percentage of correct responses. Dunn’s multiple comparison tests quantified inter-professional variation. Fifty-six participants completed the study (93% response rate). MRRs were: pharmacists 61%; nurses 35%; doctors 19%; physiotherapists 11%. Pharmacists’ MRR were significantly higher than both doctors and physiotherapists (P<0.001). Nurses’ MRR was statistically comparable to pharmacists (P>0.05). The majority of healthcare professionals cannot accurately identify commonly prescribed medications on direct visualization. By increasing access to medication identification resources and improving undergraduate education and postgraduate training for all healthcare professionals, errors may be reduced and patient safety improved.

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Characteristics of medication errors and adverse drug events in hospitals participating in the California Pediatric Patient Safety Initiative

American Journal of Health-System Pharmacy ◽

10.2146/ajhp070557 ◽

2008 ◽

Vol 65 (21) ◽

pp. 2036-2044 ◽

Cited By ~ 25

Author(s):

Glenn S. Takata ◽

Carol K. Taketomo ◽

Steven Waite

Keyword(s):

Patient Safety ◽

Pediatric Patient ◽

Medication Errors ◽

Adverse Drug Events ◽

Safety Initiative

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Analysis of medication errors by RCA method and implementation of reducing strategies to ‎improve patient safety in Hujjat Kuh-Kamari Hospital in Marand - 2017‎

Journal of Injury and Violence Research ◽

10.5249/jivr.v11i2.1476 ◽

2019 ◽

Vol 11 (2) ◽

Keyword(s):

Patient Safety ◽

Medication Errors ◽

Improve Patient Safety ◽

Improve Patient

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THE IMPACT OF BARCODE MEDICATION ADMINISTRATION ON PATIENT SAFETY: A SYSTEMATIC REVIEW

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1951 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Seham Sahal Aloufi

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Medication Error ◽

Medication Errors ◽

Improve Patient Safety ◽

Hospital Setting ◽

Medication Administration ◽

Bar Code ◽

The Impact ◽

Improve Patient

Patient safety is considered as an essential feature of healthcare system. Many trials have been conducted in order to find ways to improve patient safety, and many reports indicate that medication errors pose a threat to patient safety. Thus, some studies have investigated the impact of bar code medication administration (BCMA) system on medication error reduction during the medication administration procedure. This systematic review (SR) reports the impact of BCMA system on reducing medication errors to improve patient safety; it also compares traditional medication administration with the BCMA system. The review concentrates on the effectiveness of BCMA technology on medication administration errors, and on the accuracy of medication administration. This review also focused on different designs of quantitative studies, as they are more effective at investigating the impact of the intervention than qualitative studies. The findings from this systematic review show various results depending on the nature of the hospital setting. Most of the studies agree that the BCMA system enhances compliance with the 'five rights’' requirement (right drug, right patient, right dose, right time and right route) of medication administration. In addition, BCMA technology identified medication error types that could not be identified with the traditional approach which is applying the 'five rights' of medication administration. The findings of this systematic review also confirm the impact of BCMA system in reducing medication error, preventing adverse events and increasing the accuracy of the medication administration rate. However, BCMA technology did not consistently reduce the overall errors of medication administration. Keyword: Patient Safety, Impact, BCMA, eMAR

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Parents’ Active Role and ENgagement in The review of their Stillbirth/perinatal death 2 (PARENTS 2) study: a mixed-methods study of implementation

BMJ Open ◽

10.1136/bmjopen-2020-044563 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044563

Author(s):

Christy Burden ◽

Danya Bakhbakhi ◽

Alexander Edward Heazell ◽

Mary Lynch ◽

Laura Timlin ◽

...

Keyword(s):

Patient Safety ◽

Mixed Methods ◽

Review Process ◽

Parent Engagement ◽

Improve Patient Safety ◽

Parental Engagement ◽

Mixed Methods Study ◽

Bereaved Parents ◽

The Uk ◽

Improve Patient

ObjectiveWhen a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation.DesignMixed-methods study of parents’ engagement in PNMR.SettingSingle tertiary maternity unit in the UK.ParticipantsBereaved parents and healthcare professionals (HCPs).InterventionsParent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK.OutcomesRecruitment rates, bereaved parents and HCPs’ perceptions.ResultsEighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby’s death were often only found in the parents’ recollections.ConclusionsParental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby’s death.

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Computer Physician Order Entry (CPOE)

Healthcare Administration ◽

10.4018/978-1-4666-6339-8.ch036 ◽

2015 ◽

pp. 726-742

Author(s):

Alberto Coustasse ◽

Joseph Shaffer ◽

David Conley ◽

Julia Coliflower ◽

Stacie Deslich ◽

...

Keyword(s):

Medication Errors ◽

Financial Incentives ◽

English Language ◽

Adverse Drug Events ◽

Improve Patient Safety ◽

Healthcare Providers ◽

The United States ◽

Order Entry ◽

Clerical Workers ◽

Physician Order Entry

In an effort to reduce Adverse Drug Events (ADEs) and to improve patient safety, funding has been earmarked to improve the rate of adoption of Computerized Physician Order Entry (CPOE) among healthcare providers. It has been shown that the ordering stage of medications is where most medication errors and preventable ADEs occur. The purpose of this study was to examine the implementation CPOE systems in hospitals to determine benefits and concerns of this technology in the United States healthcare system. A review of the literature published in the last 13 years (since 2000) in the English language was performed to complete this investigation. CPOE has emerged as a valuable tool to improve medical efficiency and to decrease medication errors and ADEs. Efficiencies were found to reduce the overall workload of nurses, clerical workers and pharmacists. CPOE has proven to be a secure way of transferring physician orders electronically thus helping hospitals and physicians practice a more effective and better quality of care with less medical errors which has led to decreased operating expenses. While barriers such as lack of professional buy in, and cost of implementation have hindered the widespread use and growth of CPOE systems, these barriers are being overcome with the financial incentives from the HITECH Act, and with the increased savings of CPOE implementation, which may motivate more healthcare systems to adopt CPOE.

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The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services

Global Journal of Health Science ◽

10.5539/gjhs.v8n8p243 ◽

2015 ◽

Vol 8 (8) ◽

pp. 243 ◽

Cited By ~ 12

Author(s):

Nesreen Mohamed Kamal Elden ◽

Amira Ismail

Keyword(s):

Patient Safety ◽

Medication Errors ◽

Error Detection ◽

Clinical Pharmacist ◽

Improve Patient Safety ◽

Clinical Care ◽

Error Rates ◽

Active Management ◽

Effective Interventions ◽

Post Test

INTRODUCTION: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices.OBJECTIVES: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies.METHODOLOGY: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted.RESULTS: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001).CONCLUSION: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions.

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