Medication Errors and Healthcare Uncertainty: Implications for Pharmaceutical Care in Two Tertiary Hospitals
Abstract
Abstract
Medication errors and uncertainty are of great concern to health professionals due to their prevalence and impact on therapeutic outcomes. The objectives of the study are to explore pharmacists’ perspectives of the relationships between medication errors and healthcare uncertainty; and their effects on pharmaceutical care and therapeutic outcomes in two tertiary hospitals in Lagos, Nigeria.
A 17-item inventory was administered to pharmacists to elicit their perspectives of prescribing, dispensing, and medication administrative errors in the respective professional groups in the two hospitals. The context of ‘uncertainty’ was given to participants to avoid ambiguity of response. Section A was on demographics, Section B comprises three questions each, on prescribing, dispensing and administration errors respectively; section C is on pharmacists’ interventions, patient safety and outcomes. The instrument was validated. Descriptive statistics, correlation and regression analyses, as well as path analyses were used to analyze the results.
A total of 56 pharmacists comprising 20 (36%) and 36 (64%) from hospitals A and B respectively completed the questionnaires. Mean response ratings of variables on medication errors and pharmaceutical care under uncertainty are high ( ≥ 3/5 points). Pearson correlations are significantly positive for the three aspects of medication errors and uncertainty. Multiple regression analyses reveal prescribing and administration errors having more direct effect on healthcare uncertainty (p<0.05); and both types of errors have more direct effect on pharmaceutical care. Standardized coefficient reveals that of all the medication errors, administration errors have the greatest direct effect on pharmaceutical care. Path analysis indicates that total effect of pharmaceutical care on uncertainty is greater than their direct effect.
The impact of medication errors and uncertainty on pharmaceutical care and patient outcomes are significant. These relationships should be closely monitored through interprofessional co-operation aimed at achieving optimal care and errors minimization in the presence of uncertaintyKeywords
Full Text:
PDFReferences
REFERENCES
National Coordinating Council for Medication Error Reporting and Prevention. 2016. Available at: www.nccmerp.org/about-Medication-errors Accessed January 2016.
Cheung KC, Bouvy ML, De Smet PA. Medication errors: the importance of safe dispensing. British J. Clin. Pharmacology 2009; 67 (6): 676-680. PMid: 19594537. Available at: http://dx.doi.org/10.1111/j.1365-2125.2009.0348.x
Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. British J. Clin. Pharm. 2009; 67 (6): 642-628. PMid: 19594530. Available at: http://dx.doi.org/10.1111/j.1365-2125.2009.03425.x Accessed January 2016.
Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann. Surg. 2010; 25 (6): 995-1000. PMid: 19934755. Available at: http://dx.doi.org/10.1097/SLA.ObO13e3181bfdab3 Accessed January 2016.
Ross S, Ryan C, Duncan BM, et al. Perceived causes of prescribing errors by junior doctors in the hospital in-patients: a study from the PROJECT programme. BMJ Quality and Safety. 2013; 22(2): 97-102. PMid: 23112288.http://dx.doi.org/10.1136/bmjqs-2012-001175
Aronson JK. Medication errors: what they are, how they happen, and how to avoid them. QJM: An. International of Medicine. 2009; 102(8):513-521. Available at: www.qjmed.oxfordjournals.org/content/102/8/513 [Accessed 14 January, 2016].
Sheen Williams. Reporting medication errors and near miss. In: Countenary M, Griffiths M., (eds). Medication Safety and Essential Guide. Cambridge University Press, 2009: 155-172.
Ajemigbitse AA, Omole MK, Osi-Ogbu OF, et al. A qualitative study of causes of prescribing errors among junior doctors in a Nigerian in-patient setting. Annals of African Medicine. 2013; 12 (4): 223-231. PMid: 24309411. http://dx.doi.org/10.4103/1596-3519.122691
Ojerinde AC, Adejumo PO. Factors associated with medication errors among health workers in University College Hospital, Nigeria. Journal of Nursing and Health Science. 2014; 3 (3): 22-23. Available at: http://dx.doi.org/10.9790/1959-03342233
O’Riordan M, Dahinden A, Akturk Z et al. Dealing with uncertainty in general practice: an essential skill for the general practitioner. Quality in Primary Care. 2011;19: 175-181.
Oishi A, Murtagh FEM. The challenges of uncertainty and inter-professional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, cares and healthcare professionals. SAGE Journals 2014 [Internet]. Available at: HTTP://pmg.sagePub.com/content/early/20/14/09/...
Schneider A, Wubken M, Linde K, et al. Communicating and dealing with uncertainty in general practice: the association with neuroticism. PLOS ONE. 2014; 9(7): e102780. Available at: http://dx.doi.org/10.1371/journal.pone.0102780 Accessed Aug 2015.
Anderson SE. Implementing a new drug record system: A qualitative study of difficulties perceived by physicians and nurses. Quality and Safety in Health Care. 2002; 11:19-24.
Balas M, Scott L, Rogers A. The prevalence and nature of errors and near errors reported by hospital staff nurses. Applied Nursing Research. 2004; 17(4): 224-230.
Petrova E. Nurses’ perceptions of medication errors in Malta. Nurs. Stand. 2010; 24: 8. [PubMed]
Yung HP, Yu S, Chu C, et al. Nurses’ attitudes and perceived barriers to the reporting of medication administration errors. J. Nurs. Manag. 2016; 24: 580-588. [PubMed]
Dwivedi M, Sharma A, Arora S. A review of medication errors. Journal of Pharmaceutical Technology, Research and Management. 2015; 3(2):89-96. Doi:10.15415/jptrm.2015.32007
Mahmood A, Chaudhury H, Valente M. Nurses’ perceptions of how physical environment affects medication errors in acute settings. Journal of Applied Nursing Research. 2011; 24:229-237.
Debehin A, Babalola OO, Ehrun WO. Pharmacists and Nurses’ perception of medication errors in a Nigerian University Teaching Hospital. International Journal of Health Research. 2008; 1(2):51-61.
Han PKJ, Klein WMP, Arora NK. Varieties of Uncertainty in health care. A conceptual Taxonomy. Medical Decision Making. 2011; 31(6):828-838. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146626/
Sommers LS, Launer J. Clinical uncertainty in primary care: The Challenge of collaborative engagement. New York: Springer Science + Business Media. 2013; 12-15.
Anyika EN, Okeke JI. Prescribing errors and uncertainty: Coping strategies of physicians and pharmacists in a tertiary university hospital. Journal of Hospital Admin. 2016; 5(3):81-89. Available at: http://www.sciedupress.com/jha
Anyika EN, Omosebi OY. Dispensing errors and uncertainty: Perceptions of pharmacists in a tertiary health facility in Lagos, Nigeria. Journal of Hospital Admin. 2016; 5(1):100-106. Available at: http://dx.doi.org/10.5430/jha.V5n1p100
Maria A, Krähenbühl-Melcher SM. Hospital drug safety – Role of the pharmacists. Available at: http://edoc.onibas.ch/diss/DissB-7153 [Accessed 21 September, 2016].
Anyika EN, Alade TB. Evaluation of pharmacists’ participation in post-admission ward rounds in a tertiary hospital in South-West Nigeria. Nigerian Quarterly Journal of Hospital Medicine. 2009; 19(3):151-154.
Nevalainen M, Kuikka L, Pitkälä K. Medical errors and uncertainty in the primary healthcare: A comparative study of coping strategies among young and experienced GPs. Scand. J. Prim Health Care [Internet]. 2014; 32(2): 84-89. PMid: 24914458. Available at: http://dx.doi.org/10.3109/02813432.2014.929820
Smetzer J, Baker C, Byrne FD, et al. Shaping systems for better behavioral choices: Lessons learned from a fatal medication error. Joint Commission Journal on Quality and Patient Safety. 2010; 1-14.
Hellstrom J, Rudholm N. Uncertainty in generic versus brand name prescription decisions. Empir Econ. 2010; 38(3): 503-521. Available at: http://dx.doi.org/10.1007/s00181-009-2277-7 Accessed Aug 2015.
Anacleto TA, Perini E, Rosa MB. Drug dispensing errors in the hospital pharmacy clinics (Sao Paulo). 2007; 62(3):243-250.
Teinila T, Gronroos V, Airaksinen M. A system approach to dispensing errors: A national study of perceptions of the Finnish community pharmacists. Pharmacy World and Sciences. 2008; 30:823-833.
Gallagher TH, Waterman AD, Ebers AG, et al. Patients’ and Physicians’ attitudes regarding the disclosure of medical errors. Journal American Medical Association. 2003; 289:1001-1007. PMid: 12597752. Available at: http://dx.doi.org/10.1001/jama.289.8.1001
Tamuz M, Thomas EJ. Classifying and interpreting threats to patient safety in hospitals: insights from aviation. Journal of Organizational Behavior. 2006; 27: 919-940. Available at: http://onlinelibrary.wiley.co
Verrue CL, Mehuys E, Somers A, et al. Medication administration in nursing homes: Pharmacists’ contribution to error prevention. Journal of American Medical Directors Association. 2010; 11(4): 275-283. Available at: https://www.researhgate.net/publication/
Kang HJ, Park H, Oh JM, Lee EK. Perception of reporting medication errors including near-misses among Korean hospital pharmacists. Medicine (Baltimore). 2017; 96(39): e7795. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626254/
Leguelinel-Blache G, Castelli C, Roux-Marson C, et al. Impact of collaborative pharmaceutical care on in-patients’ medication safety: Study protocol for stepped wedge cluster randomized trial (MEDREV study). Trials. 2018; 19:19. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759250
DOI: http://dx.doi.org/10.18103/imr.v4i8.743
Refbacks
- There are currently no refbacks.