Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review
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Published on: June 11, 2012
Richard N Keers1, Steven D Williams, Jonathan Cooke
1Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, University of Manchester, Manchester, M13 9PT, UK, richard.keers@manchester.ac.uk.
Background:
There is a need to identify effective interventions to minimize the threat posed by medication administration errors (MAEs).
Objective:
Our objective was to review and critically appraise interventions designed to reduce MAEs in the hospital setting.
Data Sources:
Ten electronic databases were searched between 1985 and November 2013.
Methods:
Randomized controlled trials (RCTs) and controlled trials (CTs) reporting rates of MAEs or related adverse drug events between an intervention group and a comparator group were included. Data from each study were independently extracted and assessed for potential risk of bias by two authors. Risk ratios (RRs, with 95 % confidence intervals [CIs]) were used to examine the effect of an intervention.
Results:
Six RCTs and seven CTs were included. Types of interventions clustered around four main themes: medication use technology (n = 4); nurse education and training (n = 3); changing practice in anesthesia (n = 2); and ward system changes (n = 4). Reductions in MAE rates were reported by five studies; these included automated drug dispensing (RR 0.72, 95 % CI 0.53-1.00), computerized physician order entry (RR 0.51, 95 % 0.40-0.66), barcode-assisted medication administration with electronic administration records (RR 0.71, 95 % CI 0.53-0.95), nursing education/training using simulation (RR 0.17, 95 % CI 0.08-0.38), and clinical pharmacist-led training (RR 0.76, 95 % CI 0.67-0.87). Increased or equivocal outcome rates were found for the remaining studies. Weaknesses in the internal or external validity were apparent for most included studies.
Limitations:
Theses and conference proceedings were excluded and data produced outside commercial publishing were not searched.
Conclusions:
There is emerging evidence of the impact of specific interventions to reduce MAEs in hospitals, which warrant further investigation using rigorous and standardized study designs. Theory-driven efforts to understand the underlying causes of MAEs may lead to more effective interventions in the future.
Insights
Effective interventions like automated dispensing and nurse training can significantly reduce medication administration errors (MAEs) in hospitals. Further rigorous research is needed to confirm these findings and develop standardized study designs for future MAE reduction strategies.
Area of Science:
- Healthcare Quality and Safety
- Clinical Pharmacy
- Health Services Research
Background:
- Medication administration errors (MAEs) pose a significant threat in healthcare settings.
- There is a critical need for evidence-based interventions to mitigate MAEs.
- Reducing MAEs is essential for improving patient safety and healthcare outcomes.
Purpose of the Study:
- To systematically review and critically appraise interventions aimed at reducing MAEs in hospital environments.
- To synthesize evidence on the effectiveness of various interventions in minimizing medication errors.
- To identify key themes and promising strategies for MAE reduction.
Main Methods:
- A comprehensive search of ten electronic databases was conducted from 1985 to November 2013.
- Included studies were randomized controlled trials (RCTs) and controlled trials (CTs) comparing MAE rates.
- Data extraction and risk of bias assessment were performed independently by two authors, with meta-analysis using risk ratios (RRs).
Main Results:
- Thirteen studies (6 RCTs, 7 CTs) were included, focusing on technology, education, anesthesia practice, and ward systems.
- Interventions demonstrating significant MAE reduction included automated drug dispensing, CPOE, barcode administration, simulation-based nursing training, and pharmacist-led training.
- Five studies reported reductions in MAE rates, while others showed equivocal or increased rates; most studies had validity limitations.
Conclusions:
- Emerging evidence supports the effectiveness of specific interventions in reducing hospital MAEs.
- Further investigation using rigorous, standardized study designs is warranted.
- Theory-driven research into the root causes of MAEs is crucial for developing more impactful future interventions.
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