Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit

Abstract

Background Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. Methods A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. Results There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Conclusions Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.

Implementation of Patient Drug Prescription Services in Hospital Pharmacy Installations: Has It Been Managed Properly to Reduce Waiting Time?

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Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication

“…Informal modes of communication refer to opportunistic, unplanned, spontaneous, unstructured interactions that can take place at any time in different locations such as at the bedside, in corridors and in office spaces, and also involve self-initiated communication aids including handwritten notes or reminder scribbles. 6 Older patients' participation in medication communication can differ depending on the structure and the context of communication events that they are involved in as well as the severity of their cognitive impairment during hospitalization. 7,8 Although involving older patients with cognitive impairment in formal interactions is challenging for health professionals, a few strategies have been found to be helpful for patients with mild cognitive impairment such as simplifying decisions, holding the discussions in a quiet environment, using teach-back methods and using printed tools including decision aids.…”

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“…Informal modes of communication refer to opportunistic, unplanned, spontaneous, unstructured interactions that can take place at any time in different locations such as at the bedside, in corridors and in office spaces, and also involve self‐initiated communication aids including handwritten notes or reminder scribbles. 6 …”

More than a fleeting conversation: managing medication communication across transitions of care

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