Medication errors in Malta : is there a cause for public health concern?

Abstract

Internationally, medication errors are considered to be a burden in hospitals and in the community, causing significant morbidity and mortality and increased healthcare costs (Phillips & Bredder, 2002; Ferner & Aronson, 2006; Bar-Oz et al., 2008). The aim of this research was to gain understanding of the local situation on medication errors to determine if they are a public health concern. After a comprehensive literature review, a mixed method consisting of four different approaches was used to achieve this aim. (1) The use of a pharmacovigilance database in the identification of medication errors has been established (Alj et al., 2007; Kunac & Tatley 2011), so a retrospective analysis of the 600 reports within the national pharmacovigilance database was undertaken. (2) Questionnaires, on the causes and prevention of prescribing and dispensing errors were distributed. (3) Key players in the field were interviewed and (4) inquiry reports from the medical and pharmacy councils were looked at for medication error related litigation. Results showed that 17.9% of all adverse drug reactions were associated with medication errors and could have potentially been prevented. Medication errors occurred most often at the stages of prescribing (52%), therapeutic monitoring (26%), patients' management of their own care (12%), dispensing (7%) and administration (3%). Increasing age was a risk factor with most medication errors occurring in the 80- 89 year old age group. Distribution of results was similar to other studies but not for administration errors. (Bates et aI., 1993; Leape et a1.l995; Kaushal 2002, Alj et al., 2007; Kunac & Tately, 2011). This may be due to differing methods and operational terminology or due to a less developed culture of reporting of ADRs within the hospital

setting. Most medication errors in this study originated from the community (65%) and the medication classes most likely to be in error were the anti-inflammatory (28%) and anti-bacterial medications (10%). When errors were classified using the psychological theory most errors were likely to be knowledge-based and memory-based errors or rule-based errors. For the questionnaire 48 doctors and 71 pharmacists responded to the questionnaires. For both professions, human factors prevailed as the perceived cause of errors and included overwork (doctors=29/43, pharmacists=37/69), high patient volume (doctors=29/43 , pharmacists 36169) and fatigue from any cause (doctors=28/43 , pharmacists=38/69). System factors included medications with similar and confusing names (21/43) for doctors and illegible handwriting (55/69) for pharmacists. For both professions, reducing interruptions (doctors=20/43, pharmacists=56168) and for doctors lack of availability of resources to consult with were identified as risk-reducing factors. Both professions thought that keeping knowledge of medicines up to date (doctors=41141, pharmacists 54/69), reducing workload (doctors=36/48 , pharmacists=54/69) and having medicine names that are distinctive (doctors=34/48 , pharmacists=53/69) were perceived as important to prevent errors. 2 key players were queried through a series of open ended questions and information pertaining to patient safety and incident reporting locally was obtained which contextualised the study. From the regulatory council inquiry report it was established that litigation related to doctors and pharmacists for medication error was very low (3 court cases from 154 inquiry cases).

The objectives of this study have been met. This study has shown that medication errors do occur and are an emerging challenge to public health. A number of recommendations to address this issue have been made.