The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland

Cassidy, Nicola; Duggan, Edel; Williams, David; Tracey, Joseph

doi:10.3109/15563650.2011.587193

Cited by 30 publications

(48 citation statements)

References 36 publications

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“…Other research further supports the findings that home MAEs are a significant issue. For example, of 2,348 medication errors reported to the National Poisons Information Centre in Ireland, 2,135 were caused by errors in the home setting, the majority of which were due to administration errors[69]. …”

Section: Discussionmentioning

confidence: 99%

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review

et al. 2016

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PurposeMedications are mostly taken in patients’ own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs) within the patient’s home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them.MethodsA narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment.ResultsThirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age), environmental factors (e.g. storage), medication factors (e.g. number of medicines), prescription communication factors (e.g. comprehensibility of instructions), psychosocial factors (e.g. carer-to-carer communication), and care-recipient factors (e.g. recipient age). The few interventions effective in preventing MAEs involved carer training and tailored equipment.ConclusionThis review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care setting should be a priority for the development of patient safety interventions.

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Section: Discussionmentioning

confidence: 99%

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review

et al. 2016

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“…Health literacy and errors have been associated [61], for example, with low-health-literacy parents' difficulties in correctly interpreting dosages [78]. Between 30 and 56% of PEs reported to Poison Centers because of unexpected complications correspond to children aged 6 or under whose parents have given them a drug on their own initiative [58,64,80]. The majority of such errors occur at night (60%).…”

Section: Authors Year Participants Principal Results Conclusionmentioning

confidence: 99%

“…The methods employed in the empirical studies were classified into three categories: i) retrospective studies of pointprevalence or period-prevalence of PEs carried out using the patient's clinical records, databases on adverse reactions or data on medication intoxication, which, in some cases, included checking or complementing the information through patient interviews, studies involving semi-structured or structured interviews or surveys with samples of adult patients ( Table 2) [25,28,35,[37][38][39][40]42,[45][46][47][48][49][52][53][54][55]60,65,69,71,77]; and with samples of parents' or caregivers' children ( Table 3) [22,23,27,30,32,33,36,43,63,66,68,75]; ii) studies based on adverse reactions to drugs registered in the databases of Poison Centers (Table 4) [58,64,80]; and iii) studies on intervention for reducing the number of errors (Table 5) [29,31,34,44,…”

Section: Methodological Approaches Of Studies On Pesmentioning

confidence: 99%

“…It is very common for parents to give medicines to their children without consulting a pediatrician [27,36]. It has been found that 70% of pre-schoolers are medicated by their parents or caregivers (anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the medicines most widely used in this manner) without a pediatrician's advice [27,36,64,74,80]. …”

Section: Types Of Pesmentioning

confidence: 99%

“…Prevalence of PEs causing harm has been calculated at around 4/1,000 [55]. The inappropriate use of analgesics, cough/cold medications, cardiovascular agents, insulin, antihistamines and antimicrobials lead to maximum AEs [58,64].…”

Section: Consequences Of Pesmentioning

confidence: 99%

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A systematic review of patient medication error on self-administering medication at home

Mira

Lorenzo

Guilabert

et al. 2015

Expert Opinion on Drug Safety

106

100

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The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.

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Identifying high‐risk medications and error types in Danish patient safety database using disproportionality analysis

Tchijevitch,

Birkeland,

Bogh

et al. 2024

Pharmacoepidemiology and Drug

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BackgroundMedication error (ME) surveillance in Danish healthcare relies on the mandatory national incident reporting system, the Danish Patient Safety Database (DPSD). Individual case reviews and descriptive statistics with frequency counts are the most often used approaches when analyzing MEs in incident reporting systems, including the DPSD. However, incident reporting systems often generate a large number of reports and may suffer from underreporting; consequently, additional approaches are needed to overcome these challenges. Disproportionality analysis (DPA) is a statistical tool used for signal detection of adverse drug reactions in pharmacovigilance reports, but the evidence for using DPA on ME analysis in safety reporting systems is limited.ObjectivesWe aimed to test the feasibility of DPA by analysing harmful MEs reported to DPSD 2014–2018.MethodsWe utilized proportional reporting ratios (PRR) to identify signals of diproportionality.ResultsWe identified well‐known high‐risk medicines, including anticoagulants, opioids, insulins, antiepileptic, and antipsychotic drugs, and their association with several ME types and stages in a medication process.ConclusionDPA might be suggested as an additional tool for screening MEs and identifying priority areas for further investigation in safety reporting systems.

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The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland

Cited by 30 publications

References 36 publications

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review

A systematic review of patient medication error on self-administering medication at home

Identifying high‐risk medications and error types in Danish patient safety database using disproportionality analysis

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