Understanding system-focused barriers to the identification and reporting of medication errors and adverse drug events in emergency medical services

Abstract

Introduction Emergency medical services (EMS) represent an important and increasingly used entry point into the healthcare system. These services are often provided in the backdrop of challenging environments, with few diagnostic resources available, and for patients of varying acuity. As a result, the potential for medication errors (MEs) and adverse drug events (ADEs) is significant. However, the identification and reporting of these occurrences is poorly understood. Methods A healthcare failure mode and effects analysis was conducted at the Hamad Medical Corporation Ambulance Service, Qatar, to identify and mitigate potential system-focused barriers to the identification and reporting of ADEs and MEs in the EMS setting. Between May 2018 and July 2018, a process map and potential failure points were developed and identified. Probabilities, severity, and hazard scores were calculated for each failure point, and action items were developed to address these. Results In total, 110 potential failure points were identified among 22 sub-processes, divided between six major processes. In terms of severity, most were classified as either 'moderate' [n = 90 (80%)] or 'major' [n = 14 (13%)]. In terms of probability, failure points classified as 'frequent' [n = 39 (35%)] and 'occasional' [n = 38 (35%)] made up the majority. Through consensus, 76 failure points (69%) were deemed necessary for action. Five strategic-level, system-focused action items were identified to mitigate against the failure points meeting the criteria for action. Conclusions The unique circumstances that occur within the EMS setting dictate that bespoke solutions be developed to allow for ease of implementation and ongoing success of use. Strategies that also take advantage of mobile technology are crucial for a service that has mobility as one of its core functions.

Process mapping in healthcare: a systematic review

“…For example, PM has been found particularly useful to disaggregate care process and identify costs for each process step [ 90 – 95 ] as well as to understand interactions between different parts of healthcare systems. For example, in ICP projects the use of PM to understand systems helped to improve coordination of care across different settings and networks [ 86 , 87 , 101 ], while in FMEA projects it helped to identify potential systems failures [ 48 , 66 – 68 , 100 , 102 – 107 ]. Inform scope, design, development and evaluation of interventions.…”

An integrated HFMEA-DES model for performance improvement of general hospitals

“…Designing simulation model: As hospitals are complex and highly dynamic systems, here a simulation technique is helpful to assess the RPN because it does not require restrictive assumptions. DES allows studying the behavior of the hospital under various situations through the implementation of different suggested corrective actions (Howard et al , 2019). In this step, a simulation model is designed based on hospital situations, real data, and experts' knowledge.…”

Process Mapping in Healthcare: A Systematic Review

“…For example, in ICP projects the use of PM to understand systems helped to improve coordination of care across different settings and networks [79,81,95], while in FMEA projects it helped to identify potential systems failures. [64,94,[96][97][98][98][99][100][101][102][103][104] (ii) Inform scope, design, development and evaluation of interventions The identi cation of actual constraints and opportunities within local systems helped assessment of problem areas and development of improvement solutions grounded in research evidence and local knowledge. [68,72,74,80,86,90,[105][106][107] The use of PM before the implementation of information systems (IS) to help project members with diverse backgrounds achieve a shared understanding of the system has been reported as crucial for solving design challenges.…”