Identifying high-risk medication: a systematic literature review.

Area of Science:

• Pharmacovigilance
• Patient Safety
• Drug Safety

Background:

• Medication errors (MEs) are frequent but often do not cause patient harm.
• Understanding which drugs cause serious MEs is crucial for targeted safety interventions.
• Previous efforts show medication reviews reduce MEs but not necessarily patient outcomes.

Purpose of the Study:

• To identify specific drugs and drug classes that are most frequently associated with serious medication errors.
• To provide evidence for prioritizing drug safety efforts.

Main Methods:

• Systematic literature review across multiple databases (PubMed, Embase, Cochrane, etc.).
• Inclusion of Danish databases for patient complaints and reported errors.
• Analysis of articles and case reports detailing MEs causing serious adverse reactions (ARs), requiring causality and preventability data.

Main Results:

• Seven drug classes (methotrexate, warfarin, NSAIDs, digoxin, opioids, aspirin, beta-blockers) accounted for 47% of serious MEs.
• A total of 30 drugs/classes caused 82% of serious MEs.
• The top ten drugs in fatal events comprised 73% of identified drugs.

Conclusions:

• Targeting interventions on these seven high-risk drug classes can substantially reduce severe patient harm.
• Focusing on these drugs may decrease hospitalizations, disability, and mortality by nearly 50%.