An integrative review of method types used in the study of medication error during anaesthesia: implications for estimating incidence

Abstract

To meet the WHO vision of reducing medication errors by 50%, it is essential to know the current error rate. We undertook an integrative review of the literature, using a systematic search strategy. We included studies that provided an estimate of error rate (i.e. both numerator and denominator data), regardless of type of study (e.g. RCT or observational study). Under each method type, we categorised the error rate by type, by classification used by the primary studies (e.g. wrong drug, wrong dose, wrong time), and then pooled numerator and denominator data across studies to obtain an aggregate error rate for each method type. We included a total of 30 studies in this review. Of these, two studies were national audit projects containing relevant data, and for 28 studies we identified five discrete method types: retrospective recall (6), self-reporting (7), observational (5), large databases (7), and observing for drug calculation errors (3). Of these 28 studies we included 22 for a numerical analysis and used six to inform a narrative review. Drug error is recalled by~1 in 5 anaesthetists as something that happened over their career; in self-reports there is an admitted rate of~1 in 200 anaesthetics. In observed practice, error is seen in almost every anaesthetic. In large databases, drug error constitutes~10% of anaesthesia incidents reported. Wrong drug or dose form the most common type of error across all five study method types (especially dosing error in paediatric studies). We conclude that medication error is common in anaesthetic practice, although we were uncertain of the precise frequency or extent of harm. Studies concerning medication error are very heterogenous, and we recommend consideration of standardised reporting as in other research domains.

Medication administration errors during general anesthesia – a systematic review of prospective studies

“…(4,7,(32)(33)(34)(35)(36) To date, the literature examining the involved medications, patient outcomes, and contributing factors of these medication errors are limited. (20) Standardizing anesthetic procedures has often been suggested as a method of error reduction. The study completed by Maximous et al (37) Adding barcode labels to pre-filled syringes so computers can scan and "read out" labels, would provide the anesthesiologist information via audition, rather than simply reading the medication name.…”

“…(4,7,32–36) To date, the literature examining the involved medications, patient outcomes, and contributing factors of these medication errors are limited. (20)…”

“…Our study is the first to examine only prospective studies. In comparison to Bratch et al, (20) where a variety of study designs were analyzed, we examined prospective surveys to minimize recall bias and provide an accurate picture of the true incidence of medication errors. There are some limitations in this review.…”

“…To date, there have been minimal efforts to summarize the current evidence on this topic likely due to complexity and abundancy of the literature. A recent integrated review by Bratch et al, (20) included a variety of study designs to analyze the incidence and type of medication errors during anesthesia. The combination of diverse methodologies can lead to inaccurate results and difficulties in drawing conclusions in reviews.…”

Existing Knowledge of Medication Error Must Be Better Translated Into Improved Patient Safety

“…Anesthesia is widely considered to be a leader in patient safety in healthcare, and in last 20 years the reduction of medication error has been an active area of research in anesthesia ( 18 ). In 2021 two systematic reviews of medication safety interventions in anesthesia were published ( 19 , 20 ), and Table 1 summarizes the primary findings from each of the nine intervention studies included in these two reviews ( 21 – 29 ).…”