Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors

• Published in: European journal of clinical pharmacology Vol. 75; no. 9; pp. 1269 - 1282
• Main Authors: Thomas, Binny, Paudyal, Vibhu, MacLure, Katie, Pallivalapila, Abdulrouf, McLay, James, El Kassem, Wessam, Al Hail, Moza, Stewart, Derek
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2019; Springer Nature B.V
• Subjects: Biomedical and Life Sciences; Biomedicine; Causation; Check lists; Data collection; Hospitals - statistics & numerical data; Humans; Medical errors; Medication Errors - statistics & numerical data; Middle East - epidemiology; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology; Prevalence; Quality control; Middle East; Middle East; Error causation; Systematic review; Medication errors; Prescribing errors
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-019-02689-y

Purpose The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors. Methods CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason’s Accident Causation model. Results Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of ‘medication error’ were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per ‘total number of medication orders’/ ‘number of prescriptions’, the median across all studies was 10% (IQR 2–35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason’s model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9). Conclusion There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors’ prevalence, severity, outcomes and contributory factors is warranted.