What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature

Abstract

Objective: To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients' homes.

Design: Systematic review.

Data source: Six international databases were searched for publications between 1 January 2006 and 31 December 2015.

Data extraction and analysis: Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines' management process and the conceptual framework from the International Classification for Patient Safety.

Results: 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug-drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients' care and care being provided by family physicians/general practitioners.

Conclusion: A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.

Keywords: adverse drug events; error-related adverse drug events; incidence; medication errors; prevalence; risk factor.

Figure 1

PRISMA flow diagram (from Moher et al 88). CINAHL, Cumulative Index to Nursing and Allied Health Literature; EMRO, Eastern Mediterranean Regional Office; RCT, randomised controlled trial. *Articles may be duplicated between the excluded groups.

Figure 2

Medication errors prevalence estimates according to settings.