A mixed method study of medication errors reporting and related issues among healthcare practitioners in primary care clinics

Abstract

Background: Errors in healthcare practice are primarily the results of weaknesses in the work systems. The magnitude of the errors and their causes need to be identified and understood to allow for the formulation of appropriate safety solutions. This is attainable through reporting of errors to any local or national reporting system with the intention of learning and sharing information from past mistakes. Therefore, this research aims to investigate the knowledge of reporting medication errors (ME), perception of barriers to and facilitators for reporting, attitude towards reporting self and peers committed ME and the current reporting practice among different groups of healthcare practitioners (HCPs) in primary care clinics. Method: This research employed a mixed method approach to answer the research questions: 1) a systematic review of a global evidence on the issue of interest; 2) a retrospective review of MEs reports submitted to the Medication Error Reporting System (MERS); 3) a questionnaire survey among 376 HCPs using a developed and validated instrument. Results: 1) Systematic review yielded 13 studies fulfilled the inclusion criteria. The knowledge on ME reporting was examined but it lacked in-depth exploration. Barriers and facilitators were categorised into six factors: error, individual, reporting system, organisation, work environment and external factors. HCPs were less likely to report ME; either to an internal or external system. The severity of error outcome to a patient is an important determinant to reporting. 2) The retrospective review of ME database showed only 16% of the reports originated from primary care. Near misses were classified in 86.3% of the MEs. The vast majority of MEs (98.1%) had no harmful effects on the patients. Prescribing contributed to more than three-quarters of the overall MEs (76.1%). Pharmacists detected and reported the majority of MEs (92.1%). Cases of erroneous dosage or strength of medicine (30.75%) were the leading type of error, while cardiovascular (25.4%) was the most common category of drug found. 3) Questionnaire survey revealed that 41% of the respondents were classified as having a good knowledge of ME and ME reporting. Heavy workload (mean=3.90), time constrained (mean=3.85) and unclear of reporting process (mean=3.82) were the top three barriers to ME reporting. The statement of reporting can improve current practices (mean=4.15), patient was harmed (mean=4.04) and HCPs are trained to use the reporting system (mean=4.02) were found to be among the high-ranking motivators to reporting. The likelihood of reporting self-committed ME and peer-committed ME associated with harm to patient was higher than reporting near misses. The professional characteristics of HCPs were found to be significantly influential in the knowledge, perceived barriers and facilitators and attitude towards reporting MEs. Conclusion: In a nutshell, ME reporting practice in primary care is substantially poor. Strategies for improving ME reporting should focus on providing continuous training on the reporting aspects, strengthening the learning component from the reported MEs, and providing a more efficient reporting feedback system.