Enhancing medication error reporting

Abstract

Medication errors within healthcare settings are a cause for concern. Reporting of such errors may contribute to a reduction in medication error occurrence to improve patient safety. The study aims to increase medication error reporting (MER) in a local rehabilitation setting, Karin Grech Rehabilitation Hospital (KGRH), by identifying and addressing barriers which inhibit submission of such reports. A validated questionnaire was distributed to the study population consisting of doctors, pharmacists and nurses, to acquire feedback on awareness on the current MER system in place. Analyses of data from the questionnaire were utilised to determine strategies to improve error reporting. Presentation sessions focusing on MER were organised for each professional group within the study population. QR code flyers were developed and strategically placed on wards. A graphic report format to provide staff with feedback was developed and validated by a team of HCPs. Following implementation of the new strategies, trends in MER from June-September 2023 and October 2023 - January 2024 were compared. Questionnaire results indicated that 88% of the study population (N=86) are aware of the current MER system in place, but 55% (n=47) have never reported a medication error. Most HCPs (87%, n=75) regarded the MER form to be accessible, but 35% (n=30) encounter barriers to report errors. Over 58% (n=50) of the study population did not know how to access the electronic version of the medication error report form. Periodic feedback reports for submitted MERs are considered helpful to increase reporting by 84% (n=72) of HCPs, while 52% (n=45) are not aware of the 4-monthly feedback provided. Following implementation of the new strategies, a statistically significant increase (p<0.001) in the number of reports submitted was noted, from a mean of 10 to 27 reports per month. The new report format was implemented for provision of feedback to staff. This research contributed to improving awareness, report accessibility and feedback provision resulting in a significant increase in MER. The enhancement of MER practice has the potential to contribute towards continuous quality improvement, to foster a safety culture for HCPs, and improve patient safety.