Views, experiences and contributory factors related to medication errors associated with direct oral anticoagulants: a qualitative study with physicians and nurses

Abstract

Background Direct oral anticoagulants (DOACs) have become preferable for the management of thromboembolic events. Recent publications have however identified high volume of medication errors related to DOACs. There is limited literature on why and how such errors occur or happen in clinical practice. Aim This study aimed to explore views, experiences, contributory factors related to DOACs medication errors from the perspectives of healthcare professionals. Method Semi-structured interviews using online videoconferencing were conducted with physicians and nurses from tertiary care hospitals in three different regions in Saudi Arabia. Questions included views, experiences and perceived factors contributing to errors. Interviews were transcribed verbatim and were thematically analyzed using MAXQDA Analytics Pro 2020 (VERBI Software). Results The semi-structured interviews (n = 34) included physicians (n = 20) and nurses (n = 14) until data saturation was achieved. The analysis identified five themes: Factors related to healthcare professionals (e.g. knowledge, confidence and access to guidelines); Factors related to patients (e.g. comorbidity, polypharmacy, medication review, and communication barriers); Factors related to organization (e.g. guidelines, safety culture and incidents reporting system); Factors related to the DOACs medications (e.g. lack of availability of antidotes and dosing issues); and Strategies for error prevention/mitigation (e.g. the need for professional training and routine medication review). Conclusion Healthcare professionals identified errors in relation to DOACs as multifactorial including their own and patient lack of knowledge, lack of clinical guidelines and organizational factors including safety culture. Medication review and reconciliation on discharge were key strategies suggested to reduce DOACs related errors. These strategies support the role of pharmacists as direct patients care providers to minimize DOACs errors.

Medication errors in relation to direct-acting oral anticoagulants: a qualitative study of pharmacists’ views and experiences

“…Moreover, our study participants revealed that the clinical pharmacist role was vital to improving patient care, especially for patients with chronic disease, comorbidities and receiving polypharmacy. Pharmacists' involvement in care with other HCPs was also emphasised by physicians and nurses in our previous study [ 12 ]. Physicians' views highlighted the pivotal role of multidisciplinary teamwork in preventing medication errors [ 19 ].…”

“…Reason's Accident Causation model distinguishes active failures, such as human mistakes and violations, from latent failures associated with system-related factors, such as lack of resources [ 10 ]. A previous study identified that lack of adequate knowledge and training of physicians and nurses about DOAC, lack of confidence in prescribing and administration and lack of access to clinical guidelines as key factors related to medication errors with DOAC [ 12 ]. However, pharmacists' perspectives on DOAC related errors and effective strategies to mitigate the contributory factors have not yet been investigated.…”

Patients’ views and experiences on the use and safety of directly acting oral anticoagulants: a qualitative study

“…In another study, DOACs were most commonly associated with severe harm, including 25% of all fatal errors, making it the most harmful therapeutic area in the reported incidents [ 5 ]. Other studies have shown that medication errors associated with DOAC’s resulted in high mortality and morbidity and cause a long stay in hospital [ 6 , 7 ]. A retrospective study by Piazza et al identified that the medication errors were the common root cause in 40% of anticoagulation-related adverse events [ 8 ].…”

Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study

“…Direct oral anticoagulants (DOACs) have been preferred over warfarin by clinical guidelines, due to their superior safety profile. They also provide practical advantages such as no need for prothrombin time (PT) or international normalized ratio (INR) monitoring, and fewer drug interactions, thus resulting in an increasing utilisation in clinical practice [ 16 ]. However, despite these advantages, there is still an alarming rate of prescribing errors, where almost 1 in 5 patients on DOACs have experienced a prescribing error such as under or overdosing, duplication of therapy and contraindications.…”