Profiling harmful medication errors in an acute Irish teaching hospital.

Area of Science:

• Healthcare Safety
• Medication Error Analysis
• Risk Management

Background:

• Hospital medication error reporting systems face challenges with large data volumes and limited resources.
• Prioritization is essential for managing numerous safety issues identified in medication error reports.
• Existing research often focuses on individual error criteria or only errors causing patient harm.

Purpose of the Study:

• To identify and prioritize the most significant medication-related risks within an acute teaching hospital.
• To develop a profile of harmful medication errors reported in a tertiary healthcare setting in Ireland.
• To utilize a novel approach linking multiple criteria for risk assessment.

Main Methods:

• Analysis of a 5-year database of medication errors from an internal voluntary reporting system.
• Separate analysis of medication class, patient outcome, and type of error.
• Cross-tabulation of these criteria to identify high-risk scenarios.

Main Results:

• Identification of medication classes, error types, and adverse patient outcomes most frequently linked to patient harm.
• Cross-tabulation revealed ten priority risk areas responsible for the majority of patient harm.
• A detailed profile of harmful medication errors was established.

Conclusions:

• A cross-tabulation strategy effectively prioritized medication-associated risks in a hospital error database.
• The developed profile of harmful medication errors aligns with international findings.
• This approach provides a valuable tool for healthcare organizations to manage medication safety risks.