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A validated, reliable method of scoring the severity of medication errors
1Centre for Pharmacy Practice, School of Pharmacy, London University, England.
Abstract:
A method of scoring the severity of medication errors that does not require knowledge of patient outcomes was developed and tested. Thirty health care professionals from four U.K. hospitals scored 50 medication errors in terms of potential patient outcomes on a scale of 0 to 10, where 0 represented a case with no potential effect and 10 a case that would result in death. Sixteen error cases reported in the literature with actual patient outcomes were included among the cases to assess the validity of the scores. Ten of the errors were scored twice. The severity of the error cases, the occasion on which they were scored, the judge, each judge's profession, and the interactions between these were considered as potential sources of variability in scoring. The data were analyzed by applying generalizability theory to two models: one based on the 10 cases that were scored twice and ignoring the effect of differences in profession and one based on all 50 cases and ignoring the effect of the occasion of scoring. Generalizability coefficients for different numbers of judges and scoring occasions were calculated. A generalizability coefficient of 0.8 or more was considered to represent acceptable reliability. Most of the variance was attributable to differences in the cases. The analysis showed that, to achieve a generalizability coefficient of more than 0.8, at least four judges would have to score each case, each on one occasion, with the mean score used as a severity indicator. A reliable, valid method of scoring the severity of medication errors that did not require knowledge of patient outcomes was developed; at least four judges were required in order to achieve reliable scores, and reliability was not affected by the professions of the judges or the number of occasions on which the errors were scored.
Insights
A new method reliably scores medication error severity without patient outcome data. Using at least four healthcare professionals per error ensures reliable severity assessment, crucial for patient safety.
Area of Science:
- Healthcare quality and safety
- Medication error analysis
- Psychometrics
Background:
- Medication errors pose significant risks to patient safety.
- Accurate severity scoring is essential for risk management and prevention.
- Existing methods may rely on patient outcomes, which are not always available.
Purpose of the Study:
- To develop and validate a method for scoring medication error severity independent of patient outcomes.
- To determine the reliability and generalizability of the proposed scoring method.
- To identify the optimal number of assessors required for reliable severity scores.
Main Methods:
- Developed a severity scoring scale (0-10) based on potential patient harm.
- 30 healthcare professionals from four UK hospitals scored 50 medication errors.
- Applied generalizability theory to analyze score variability from cases, judges, and scoring occasions.
- Included literature cases with known outcomes to assess score validity.
Main Results:
- Most score variance was due to differences between medication error cases.
- A generalizability coefficient of 0.8 or higher, indicating acceptable reliability, required at least four judges per case.
- Score reliability was not significantly affected by judge profession or the number of scoring occasions.
- The developed method proved reliable and valid for assessing medication error severity.
Conclusions:
- A reliable and valid method for scoring medication error severity without patient outcome data has been established.
- Utilizing a minimum of four judges per medication error is necessary to achieve reliable severity scores.
- The method's reliability is independent of the judges' professional backgrounds and the frequency of scoring occasions.