Medical errors; causes, consequences, emotional response and resulting behavioral change

BackgroundIt is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions.MethodsRemote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June–November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol.ResultsA total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management.ConclusionThese findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

Medical errors cause disability and mortality in intensive care units (ICUs). We aimed to determine the occurrence and causes of medical errors in the ICUs of Iran. In this cross-sectional study, data from the family complaint files referred to The disciplinary authority of Iran Medical Council was retrospectively reviewed to explore the causes of medical errors. Statistical analysis was performed in SPSS Version 26.0. A total of 293 complaint files were referred to the disciplinary commission from 2014 to 2019, of which 95 files were related to medical errors in ICUs. The median age of patients was 62 years (46-74 years) and 52 (54.7%) patients were men. Also, 37 (38.9%) patients had decreased levels of consciousness and 42 (42.2%) patients had cardiovascular disease. A total of 40 (42.1%) patients experienced a single medical error and 55 (57.9%) patients experienced more than 1. Causes of medical errors in patients were physician's or nurse's negligence in 53 (55.8%) patients, weak interaction of physician and nurse with the patient and family members in 11 (11.6%) patients, weak interprofessional interaction among physicians in 7 (7.4%) patients, equipment and structure of ICUs in 7 (7.4 patients, nature of ICUs and patients in 6 (6.3%) patients, weak physician-nurse interprofessional interaction in 5 (5.2%) patients) patients, low attention of the physician and the nurse to medication safety in 6 (6.3%) patients. Patient safety is impacted by a variety of medical mistakes. Interprofessional strategies can be developed and put into action to mitigate medical errors in ICUs.

Background: The causes of medication errors can be associated to different factors and such factors include professional practices, healthcare products, procedures, communication problems (e.g., prescribing, product labelling, packaging, and nomenclature), education, monitoring and inappropriate use of medications. Aim and objectives: The objective of the study is to determine the role and influence of a clinical pharmacist in recognizing and investigating the causes of medication errors, and putting up strategies to avoid them by counselling patients in a tertiary care hospital. Methods: This is a prospective, observational and cross-sectional study, which was carried out in the General Medicine Department in the ESI Hospital of Indiranagar, Bangalore and over a period of 6 months. On the inclusion criteria, a total of 189 inpatients were selected based on the inclusion criteria which were that the patients had to be within the age range of 15-75 years of age and willing to participate. The patients who had acute or chronic illnesses and were reported to have made medication errors were also eligible to participate in the study. Results: There were 189 patients of whom 147 were male and 42 were females. Antibiotics took up the second place in the sample population in terms of the percentage of medication errors (31.7), then anti-hypertensives (16.9), and anti-diabetics (15.8), with the other categories of drugs making less percentage of errors. Among 189 patients approximately 185(97.8) patients survived medication errors outcome and approximately 4(2.1) patients died because of medication error. Conclusion: It is among the first systematic reviews of the medication errors in Karnataka. Patient safety is at risk due to medication errors, which can be prevented. The results indicate the significance of the effective strategies, such as regular monitoring and educating patients, to minimize medication-related problems and enhance patient care. Independent double-checks, persistent monitoring, and patient counselling are some of the roles that clinical pharmacists play in order to detect and deal with medication errors. Their work has a great impact on the improvement of the healthcare outcome and minimization of the medication errors development. Also, the research defines various medication errors types and their frequency, which can be used in the specific preventive programs.

Objective To understand and analyze the occurrence of medication errors with methotrexate tablets and their related factors in order to avoid or reduce the adverse events occurring. Methods All medication error reports in National Monitoring Network for Clinical Safe Medication from September 22, 2012 to September 21, 2017 were collected and the reports of medication errors with methotrexate tablets were selected. And the grading and content of medication errors with methotrexate tablets, the persons who found medication errors, and the triggering factors for medication errors were analyzed. Results A total of 25 119 reports of medication errors from the 204 hospitals of 25 provinces and municipalities in our country were collected by National Monitoring Network for Clinical Safe Medication between September 22, 2012 and September 21, 2017.The reports of medication errors with methotrexate tablets accounted for 0.14% (35 /25 119) of the total reports of medication errors. The reports of serious medication errors(E-I) with methotrexate tablets accounted for 3.18%(7/220) of the total reports of serious medication errors. The reports of medication errors with methotrexate tablets involved 34 patients, including 16 males and 18 females aged 25-87 years. The 34 patients included 20 cases of rheumatoid arthritis, 6 cases of psoriasis, 2 cases of systemic lupus erythematosus, 2 cases of leukemia, 1 case of connective tissue disease, 1 case of polymyositis, 1 case of hypertension, and 1 case of toxic diffuse goiter. Of the 35 cases of medication errors, 18 cases(51.43%) were classified as class B, 9 cases(25.71%) as class C, 1 case (2.86%) as class D, 1 case(2.86%) as class E, 5 cases(14.28%) as class F, and 1 case(2.86%) as class I. The serious medication errors accounted for 20.00% of medication errors with methotrexate tablets. Four patients had both wrong dose and wrong frequency of administration. Among the medication errors with methotrexate tablets, the frequency of administration errors ranked first, accounting for 53.85%(21/39) in total. All patients mistook once weekly for once daily . Wrong dose ranked the second, accounting for 30.77%(12/39) in total. Wrong drug class ranked the third, accounting for 7.69% (3/39) in total. The persons who triggered the medication errors with methotrexate tablets included doctors 74.29%(26/35), pharmacists 17.14%(6/35), and patients or their family members 8.57% (3/35). Twenty-six cases of medication errors with methotrexate tablets were triggered by doctors, of them, 24 were discovered and intercepted by pharmacists. Of the 6 cases of medication errors triggered by pharmacists, 3 cases were discovered and intercepted by pharmacists, and one case was discovered and intercepted by a doctor. These medication errors did not cause any harm to the patients. Four cases that were not intercepted and 3 cases triggered by patients or their families were all serious medication errors, of which 1 caused death. Of the persons who discovered the medication errors, pharmacists accounted for 77.14% (27/35), and doctors accounted for 22.86% (8/35). The main factors causing medication errors were lack of related pharmacologic knowledge(45.71%, 16/35), copying error(20%, 7/35), similar drug name or adjacent packing boxes (8.57%, 3/35). Conclusions Medication errors with methotrexate tablets often occurred in patients with autoimmune diseases. The content of medication errors with methotrexate tablets mainly due to wrong frequency of administration. The incidence of serious medication errors was high, it might cause death. The main cause of medication errors with methotrexate tablets in treating non-neoplastic diseases was lack of understanding of frequency administration once weekly . Pharmacists might play an important part in detecting and intercepting medication errors with methotrexate tablets. Key words: Methotrexate; Drug interaction; Medication errors; Primary prevention; Frequency of administration

Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology’s formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility.

BackgroundMedication errors are the most common cause of preventable adverse drug events at the emergency ward.ObjectivesThis study assessed medication errors and associated factors among adult patients admitted to the emergency ward at the University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.MethodsA cross-sectional study was conducted from June 1, 2022, to August 30, 2022. Data were entered into EpiData Manager 4.6.0.0 for clearing and exported to SPSS version 24 for analysis. Descriptive statistics such as frequencies, medians with an interquartile range and inferential statistics like binary logistic regression were used for data analysis. The level of significance was declared at a p value less than 0.05 with a 95% confidence interval.ResultsFrom 422 study participants, medication errors were found in three-fourths (74.4%) of study participants. The most frequent type of medication error was omitted dose (26.27%). From a total of 491 medication errors, 97.75% were not prevented before reaching patients. More than one-third (38.9%) of medication errors had potentially moderate harmful outcomes. More than half (55.15%) of possible causes of medication errors committed by staff are due to behavioral factors. Physicians accepted 99.16% and nurses accepted 98.71% of clinical pharmacist intervention. Hospital stay ≥ 6 days (AOR: 3.00 95% CI 1.65–5.45, p < 0.001), polypharmacy (AOR: 5.47, 95% CI 2.77–10.81 p < 0.001), and Charlson comorbidity index ≥ 3 (AOR: 1.94, 95% CI (1.02–3.68), p < 0.04) significantly associated with medication error.ConclusionsAbout three-fourths of adult patients admitted to the emergency ward experienced medication errors. A considerable amount of medication errors were potentially moderately harmful. Most medication errors were due to behavioral factors. Most clinical pharmacists’ interventions were accepted by physicians and nurses. Patients who stayed longer at the emergency ward, had a Charlson comorbidity index value of ≥ 3, and were on polypharmacy were at high risk of medication error. The hospital should strive to reduce medication errors at the emergency ward.

Medication error is the commonest cause of medical error and the consequences can be grave. This integrative review was undertaken to critically appraise recent literature to further define prevalence, most frequently-implicated drugs and effects on patient morbidity and mortality in the critical care environment. Forty studies were compared revealing a markedly heterogeneous data set with significant variability in reported incidence. There is an important differentiation to be made between medication error (incidence 5.1-967 per 1000 patient days) and adverse drug event (incidence 1-96.5 per 1000 patient days) with significant ramifications for patient outcome and cost. The most commonly implicated drugs were cardiovascular, gastrointestinal, antimicrobial and hypoglycaemic agents. Beneficial interventions to reduce such errors include computerised prescribing, education and pharmacist input. The studies described provide insight into suboptimal management in the critical care environment and have implications for the development of specific improvement strategies and future training.

In the medical setting, medication errors are not merely about an error done by an individual since the personnel is one of the elements of the patient care system. For the purpose of analyzing the cause of medication errors by tracing to compound layers—from the organizational layer to the pharmaceutical personnel layer, the 7th version of the US Department of Defends Human Factors Analysis and Classification System (DoD HFACS 7.0) is applied. The aim of the present study is to adopt the DoD HFACS 7.0 questionnaire into the medical setting so that it can be used to observe the cause of medication error. However, in order to gain an effective application of DoD HFACS 7.0 for pharmaceutical workers in Indonesia, it needs to be adopted to devise Med HFACS. The result shows that out of 109 sub-categories in DoD HFACS 7.0, as many as 90 subcategories can be included in Med HFACS. Meanwhile, 19 sub-categories are not included because they are less relevant to the pharmaceutical field as well as they potentially cause bias if attached in the duties of professional pharmacy personnel.

Report from the WHO that one of the highest causes of medication errors is Look Alike – Sound Alike (LASA) drugs, leading to errors in receiving information about the drugs, which of course will affect patient safety. Efforts to reduce medication errors have been widely implemented, such as conducting medication training, managing medications, and storing and labeling medications. However, all of that leads to human error, so the utilization of technology is needed to address this issue. The technology expected to help reduce medication errors is the utilization of artificial intelligence (AI). AI is designed for automation processes and systems that can learn independently, allowing the causes of medication errors such as LASA to be learned by the system and predicted automatically. Deep learning is a part of AI that works by providing solutions accurately and automatically. The Recurrent Neural Networks (RNN) algorithm is one of the deep learning methods that has been proven accurate in predictions based on previous research studies. In this study, LASA predictions were made using RNN with the aim of serving as an aid to reduce medication errors, thereby ensuring patient safety. The accuracy achieved is 99% for training and 81% for testing.

BackgroundMedication errors (ME) are a major global issue, adversely impacting patient safety and health outcomes. The World Health Organization n March 2017 published ‘Medication without Harm, 3rd Global Patient Safety...

Although the field of dermatology has a relatively low incidence of medical errors, dermatologic surgery is a major area where medical errors occur. The purpose of this article is to catalog the many cutaneous site identification techniques used by practitioners and determine which techniques are most evidence based. A comprehensive literature review of cutaneous surgical site identification techniques and medical errors in dermatology. Wrong-site surgery often occurs because of an inability to identify the surgical site because of factors such as inadequate documentation from referring physicians, well-healed scars obscuring the biopsy site, and a patient's inability to visualize the surgical site. Practitioners use techniques such as photography, dermabrasion, written descriptions using anatomic landmarks, and site identification protocols for surgical site identification. Site identification remains a challenge for dermatologists and is a leading cause of medical errors in this field. Patients are often unreliable in their ability to identify biopsy sites; therefore, practitioners must take a proactive role to ensure that medical errors do not occur. This article provides a thorough description and evaluation of current site identification techniques used in dermatology with the aim to improve quality of care and reduce medical errors.

Introduction. Little is known about medication errors which occur with the antidotes ethanol and fomepizole, used for treatment of methanol and ethylene glycol poisoning. Study objectives were to describe and compare the frequency, type, outcome and underlying causes of medication errors associated with ethanol and fomepizole. Methods. Patients aged ≥13 years were included if they were hospitalized in 1996–2005 for methanol or ethylene glycol poisoning and treated with ethanol or fomepizole. Charts from 10 hospitals were separately reviewed by two abstracters who recorded case details. A consensus panel of clinicians used the abstracted data to identify medication errors and classify error outcome. Fisher's exact test determined significant differences in the proportion of ethanol and fomepizole-treated cases with medication error and univariate logistic regression identified risk factors associated with harmful dosage errors. Results. There were 145 ethanol- and 44 fomepizole-treated cases. There was ≥1 medication error in 113/145 (78%) ethanol- and 20/44 (45%) fomepizole-treated cases (p = 0.0001) with more ethanol-related errors involving excessive dose, inadequate monitoring and inappropriate antidote duration. Harmful errors occurred in 19% of ethanol- and 7% of fomepizole-treated cases (p = 0.06) and were largely due to excessive antidote dose or delayed antidote initiation. Occurrence of harmful dosage error was reduced in cases with Poison Control Centre consultation, odds ratio (95% confidence interval) 0.39 (0.17, 0.91), hemodialysis 0.37 (0.16, 0.88), or fomepizole versus ethanol 0.24 (0.06, 1.04). Conclusion. Fomepizole was less prone to medication error than ethanol. Error-related harm was most commonly due to excessive antidote dose or delayed antidote initiation.

Somatized or stigma? Causal attributions and emotional responses in shaping social distance towards people with mental illness, China

Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed, twice as many medications, as patients outside of the intensive care unit (ICU) and nearly all of them suffer, a potentially life-threatening error at some point during their hospitalization. Today, in the health care profession, all types of medication errors including missed dose, wrong dosage forms, wrong time interval, wrong route, etc., are a big deal, for quality patient care. Problems related to medications, are common in the healthcare profession, and are responsible for significant morbidity, mortality, and cost. Several recent studies have demonstrated that patients frequently have difficulty in reading and understanding medication labels. According to the Institute of Medicine report, “Preventing Medication Errors”, cited poor labeling as a top most cause of medication errors in the USA. Evidence suggests that specific content and format of prescription drug labels, facilitate a better communication to minimize apprehension by patients regarding medication errors.

Medication errors are commonly due to various reasons. Understanding and minimizing the mistakes will benefit society by reducing the cost and untoward effects of the medications; hence the presented study is carried out. The primary goal of this study was to detect and evaluate the incidence, types, factors, and severity of medication errors in the medicine and orthopedic wards of a tertiary care hospital in India. This study was carried out in the Department of Medicine and Orthopedic wards of the Teaching Hospital and Research Centre. The required data were collected in the Case Record Form and reviewed daily from admission to discharge in the posted department. Different medication errors were identified and documented, and the severity of medication errors was determined using NCC MERP guidelines. A total of 200 inpatient cases from the orthopedic and medicine wards were collected, 100 cases from each ward. In an orthopedic ward, 40% of patients were 20-39 years of age, and in a medical ward, 48% were 60-79 years of age. A total of 136 and 103 medication errors were observed in the orthopedic and medical wards. Among them, 65% and 62% were prescription errors, 25% and 18% were administration errors, 6% and 12% were transcription errors, and 4% and 8% were dispensing errors. The cause of medication errors was 64.7%, 62.1% were due to physicians, 31.6% and 30.1% were due to nurses, and 3.7% and 7.8% were due to pharmacists in orthopedic and medicine wards. The majority of medication errors, 68.4%, and 62.1%, belonged to category-B severity in the orthopedic and medicine ward, respectively. The clinical pharmacist can play a significant role in preventing medication errors by early detection. However, since our medication treatment system needs a well-organized detection and reporting mechanism, Hence, as the first step, we must implement a system where mistakes/Errors are routinely detected and reported.