Medication errors in the outpatient and ambulatory settings: an evidence synthesis approach

Naseralallah, Lina (2023). Medication errors in the outpatient and ambulatory settings: an evidence synthesis approach. University of Birmingham. M.Sc.

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Abstract

Background: Medication errors are preventable incidents that may occur at any stage of the medication use process. Despite their potential to cause severe harm, they are common in healthcare settings. Outpatient and ambulatory settings are known to enhance patient access to healthcare and promote continuity of care. Medication therapy remain key interventions offered in these settings. Currently, there is a dearth of literature on the prevalence and contributory factors to medication errors in the outpatient setting.

The program of work presented in this thesis firstly, through the use of an umbrella review, aims to systematically evaluate the contributory factors to medication errors in healthcare settings in terms of the nature of these factors; methodologies and theories used to classify them; and terminologies and definitions used to describe them. The second phase of the thesis aims to synthesize the literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings using a systematic review of research literature.

Methods: In the first phase, an umbrella review was conducted. Systematic reviews were searched using Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, and Google Scholar from inception to March 2022. The data extraction form was informed by the Joanna Briggs Institute (JBI) manual and critical appraisal was conducted using the JBI quality assessment tool. A narrative approach to data synthesis was adopted.

In the second phase, a systematic review was conducted. Literature was searched using Medline, Embase, CINAHL, and Google Scholar from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason’s Accident Causation Model.

Results: Twenty-seven systematic reviews were included, most of which focused on a specific healthcare setting or clinical area. Decision-making mistakes such as non-consideration for patient risk factors most commonly led to error, followed by organizational and environmental factors (e.g. understaffing and distractions). Only ten studies used a prespecified methodology to classify contributory factors, among which the use of theory, specifically Reason’s theory was most common. None of the reviews evaluated the effectiveness of interventions in preventing errors.

Twenty-four articles were included in the systematic review. Medication errors were common in outpatient and ambulatory settings. A wide range of prevalence of prescribing errors and dosing errors was reported with errors ranging from 0-91% and 0-41% respectively of all medications prescribed. Latent conditions largely due to inadequate knowledge were common contributory factors followed by active failures. The seven studies that described the use of interventions were of poor quality.

Conclusion: The findings of this program of work provides a comprehensive list of contributory factors to medication errors in healthcare settings. It also emphasizes on the need for consistent use of terminology and methodology in researching contributory factors. The systematic review reports the prevalence and contributory factors to errors in outpatient setting. This thesis overall, emphasizes the need for multifactorial theory-based interventions that incorporate system-level strategies, pharmacists, technology, and education to minimize medication errors in all healthcare settings.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):