Detecting Medication Errors and Adverse Drug Events: A Review of Current Methodologies

Abstract

To establish the scope of harm related to medications, and thus design harm-reduction measures, healthcare organizations are required to measure medication safety events. This chapter will investigate methodologies for detecting adverse drug events and medication errors, analyze what type of events they detect, and discuss their advantages and limitations. We conducted a scoping review, and identified studies that compared at least two detection methods directly. The review resulted in 13 studies, of which ten were conducted in hospitals, and three were from the outpatient setting. Methods used to detect medication safety events were: incident reporting, record review, computerized surveillance, direct observation, and interviews. The detection rate of adverse drug events and medication errors varied substantially depending on the method. Incident reporting detected small numbers of events, but detected events that were not identified by other methods. Record review detected more adverse drug events than incident reporting, but missed whole classes of events, such as medication administration errors and omissions. Direct observation detected most medication errors. Computerized surveillance has promising detection abilities and can be less resource and time-intensive compared with record review, after the initial implementation. Small numbers of events were detected using any one method alone, that is, none of the methods can serve as a gold standard, and each method described has its place in monitoring medication safety. The literature supports a combination of methods to be used to detect adverse drug events and medication errors. The 10 studies in this scoping review that are from hospitals, are also described and discussed in the PhD thesis of the first author(Mulac, 2022). The scoping review, however, resulted in a low number of studies (n = 3) from the outpatient setting, which highlights the research and knowledge gaps of detecting methods for adverse drug events in municipal health and care services.