[Management of medication errors in general medical practice: Study in a pluriprofessionnal health care center]
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Laure Pourrain1, Michel Serin2, Anne Dautriche3
1Maison de santé amandinoise, 58310 Saint-Amand en Puisaye, France.
Background:
Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care.
Objectives:
The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures.
Methods:
The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares.
Results:
During the 3 months study 4712 medical consultations were performed and we collected 64 medication errors. Most of affected patients were at the extreme ages of life (9,4 % before 9 years and 64 % after 70 years). Medication errors occurred at home in 39,1 % of cases, at pluriprofessionnal health care house (25,0 %) or at drugstore (17,2 %). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2 % of cases. Drug induced adverse effects occurred in 5 patients, 3 of them needing hospitalization (1 patient recovered, 1 displayed sequelae and 1 died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5 %) and poor treatment adherence (18,75 %). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent.
Conclusion:
Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care.
Insights
Medication errors in primary care are frequent and often severe. This study shows that implementing a management process in a multidisciplinary setting can improve patient safety and reduce adverse events.
Area of Science:
- Healthcare Management
- Patient Safety
- Clinical Pharmacy
Background:
- Medication errors are a leading cause of adverse events in French healthcare.
- Current management processes are underutilized in primary ambulatory care settings.
Purpose of the Study:
- To assess medication error management in general ambulatory practice.
- To characterize medication errors and analyze root causes for corrective measures.
Main Methods:
- Study conducted in a multidisciplinary healthcare house.
- Utilized validated stages and tools adapted for ambulatory care.
Main Results:
- 64 medication errors identified in 4712 consultations over 3 months.
- Errors frequently affected elderly and very young patients, occurring at home, clinic, or pharmacy.
- 17.2% of errors had severe clinical consequences, including hospitalization and death.
- Prescribing errors and incorrect drug use were common, with care process and human factors as root causes.
Conclusions:
- Medication error management is feasible in ambulatory care with a trained coordinator and adapted tools.
- Error management highlights specific organizational vulnerabilities in general practice, including care transitions and patient involvement.
- Findings underscore the need for improved coordination and communication in ambulatory care to prevent medication errors.
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