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  1. Di Simone E, Di Muzio M, Dionisi S, Giannetta N, Di Muzio F, De Gennaro L, et al.
    Eur Rev Med Pharmacol Sci, 2019 Jun;23(12):5522-5529.
    PMID: 31298407 DOI: 10.26355/eurrev_201906_18224
    INTRODUCTION: Western world health care systems have been trying to improve their efficiency and effectiveness in order to respond properly to population aging and non-communicable diseases epidemic. Treatment of the elderly population is becoming complex due to the high number of prescribed drugs because of multimorbidity. Errors in drugs administration in different health care related settings are an actual important issue due to different causes. Aim of this observational study is to measure the online interest in seeking medication errors information related to risk management and shift work.

    MATERIALS AND METHODS: We investigated Google Trends® for popular search relating to medication errors, risk management and shift work. Relative search volumes (RSVs) were evaluated from 2008 to 2018. A comparison between RSV curves related to medication errors, risk management and shift work was carried out. Then, we compared the world to Italian search.

    RESULTS: RSVs were persistently higher for risk management than for medication errors (mean RSVs 069 vs. 48%) and RSVs were stably higher for medication errors than shift work (mean RSVs 48 vs. 22%). In Italy, RSVs were much lower compared to the rest of the world, and RSVs for medication errors during the study period were negligible. Mean RSVs for risk management and shift work were 3 and 25%, respectively. RSVs related to medication errors and clinical risk management were correlated (r=0.520, p<0.0001).

    CONCLUSIONS: Google Trends® search query volumes related to medication errors, risk management and shift work are different. RSVs for risk management are higher, and they are correlated with medication errors. Also, shift work search appears to be lower. These results should be interpreted in order to correctly evaluate how to decrease the number of medication errors in different health care related setting.

    Matched MeSH terms: Medication Errors/prevention & control
  2. Fatokun O
    Curr Drug Saf, 2020;15(3):181-189.
    PMID: 32538733 DOI: 10.2174/1573403X16666200615144946
    BACKGROUND: While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists' beliefs regarding these measures in Malaysia.

    OBJECTIVES: This study examined community pharmacists' beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures.

    METHODS: A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia.

    RESULTS: The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002).

    CONCLUSION: The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

    Matched MeSH terms: Medication Errors/prevention & control
  3. Neoh CF, Hassali MA, Shafie AA, Awaisu A, Tambyappa J
    Curr Drug Saf, 2009 Sep;4(3):199-203.
    PMID: 19534650
    Good medicine labelling practice is vital to ensure safe use of medicines. Non-compliance to labelling standards is a potential source of medication errors. This study was intended to evaluate and compare compliance towards labelling standard for dispensed medications between community pharmacists and general practitioners in Penang, Malaysia. A total of 128 community pharmacies and 26 general practitioners' clinics were visited. Using 'Simulated Client Method' (SCM), data were collected on the medications dispensed upon presentation of hypothetical common cold symptoms. The medications dispensed were evaluated for labelling adequacy. Result revealed that majority of the dispensed medications obtained were not labelled according to regulatory requirements. However, general practitioners complied better than community pharmacists in terms of labelling for: name of patient (p<0.001), details of supplier (p<0.001), dosage of medication (p=0.023), frequency to take medication (p=0.023), patient's reference number (p<0.001), date of supply (p<0.001), special instructions for medication (p=0.008), storage requirements (p=0.002), and indication for medication (p<0.001). Conversely, community pharmacists labelled dispensed medications with the words "Controlled Medicine" more often than did general practitioners (p<0.001). Although laws for labelling dispensed medicines are in place, most community pharmacists and general practitioners did not comply accordingly, thereby putting patients' safety at risks of medication errors.
    Matched MeSH terms: Medication Errors/prevention & control
  4. Haseeb A, Winit-Watjana W, Bakhsh AR, Elrggal ME, Hadi MA, Mously AA, et al.
    BMJ Open, 2016 06 16;6(6):e011401.
    PMID: 27311911 DOI: 10.1136/bmjopen-2016-011401
    OBJECTIVES: To evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals.

    DESIGN: Quasi-experimental study consisting of a single group before-and-after study design.

    SETTING: A public emergency hospital in Mecca, Saudi Arabia.

    PARTICIPANTS: 660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed.

    INTERVENTION: The intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011.

    MAIN OUTCOME: Reduction in the incidence of HRAs use from the preintervention to postintervention study period.

    FINDINGS: The five most common abbreviations recorded prior to the interventions were 'IJ for injection' (28.6%), 'SC for subcutaneous' (17.4%), drug name and dose running together (9.7%), 'OD for once daily' (5.8%) and 'D/C for discharge' (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%).

    CONCLUSIONS: Pharmacist-led educational interventions can significantly reduce the use of HRAs by healthcare providers. Future research should investigate the long-term effectiveness of such educational interventions through a randomised controlled trial.

    Matched MeSH terms: Medication Errors/prevention & control*
  5. Huckvale C, Car J, Akiyama M, Jaafar S, Khoja T, Bin Khalid A, et al.
    Qual Saf Health Care, 2010 Aug;19 Suppl 2:i25-33.
    PMID: 20693213 DOI: 10.1136/qshc.2009.038497
    BACKGROUND: Research on patient care has identified substantial variations in the quality and safety of healthcare and the considerable risks of iatrogenic harm as significant issues. These failings contribute to the high rates of potentially avoidable morbidity and mortality and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare universally. Of particular international interest is the use of eHealth applications. There is, however, a large gap between the theoretical and empirically demonstrated benefits of eHealth applications. While these applications typically have the technical capability to help professionals in the delivery of healthcare, inadequate attention to the socio-technical dimensions of their use can result in new avoidable risks to patients.

    RESULTS AND DISCUSSION: Given the current lack of evidence on quality and safety improvements and on the cost-benefits associated with the introduction of eHealth applications, there should be a focus on implementing more mature technologies; it is also important that eHealth applications should be evaluated against a comprehensive and rigorous set of measures, ideally at all stages of their application life cycle.

    Matched MeSH terms: Medication Errors/prevention & control
  6. Rajah R, Hanif AA, Tan SSA, Lim PP, Karim SA, Othman E, et al.
    Int J Clin Pharm, 2019 Feb;41(1):237-243.
    PMID: 30506127 DOI: 10.1007/s11096-018-0762-1
    Background Detecting errors before medication dispensed or 'near misses' is a crucial step to combat the incidence of dispensing error. Despite this, no published evidence available in Malaysia relating to these issues. Objective To determine the incidence of medication labeling and filling errors, frequency of each type of the errors and frequency of the contributing factors at the final stage before dispensing. Setting Six Penang public funded hospitals outpatient pharmacies. Methods A prospective multicentre study, over 8 week's period. Pharmacists identified and recorded the details of either medication labeling and/or filling error at the final stage of counter-checking before dispensing. Besides, the contributing factors for each error were determined and recorded in data collection form. Descriptive analysis was used to explain the study data. Main outcome measure The incidence of near misses. Results A total of 187 errors (near misses) detected, with 59.4% (n = 111) were medication filling errors and 40.6% (n = 76) were labeling errors. Wrong drug (n = 44, 39.6%) was identified as the highest type of filling errors while incorrect dose (n = 34, 44.7%) was identified as the highest type of labeling errors. Distracted and interrupted work environment was reported to lead the highest labeling and filling errors, followed by lack of knowledge and skills for filling errors and high workload for labeling errors. Conclusion The occurrence of near misses related to medication filling and labelling errors is substantial at outpatient pharmacy in Penang public funded hospitals. Further research is warranted to evaluate the intervention strategies needed to reduce the near misses.
    Matched MeSH terms: Medication Errors/prevention & control*
  7. Lee JL
    Int J Clin Pharm, 2020 Apr;42(2):604-609.
    PMID: 32095976 DOI: 10.1007/s11096-020-00996-4
    Background Prescribing errors in children are common due to individualization of dosage regimen. It potentially has a great impact especially in this vulnerable population. Objective To determine the prevalence and common types of prescribing errors in a Malaysian pediatric outpatient department and to determine the factors contributing to prescribing errors. Setting Pediatric Outpatient Department and Outpatient Pharmacy at a tertiary care hospital in Malaysia. Method This is a prospective, cross sectional observational study where all new prescriptions received by the outpatient pharmacy from patients attending pediatric out-patient clinic were included for analysis. Descriptive statistics and logistic regression were used to analyze the data. Main outcome measure Frequency, types, potential clinical consequences and contributing factors of prescribing errors. Results Two hundred and fifty new prescriptions with 493 items were analyzed. There were 13 per 100 prescriptions with at least one prescribing error and 7.3% of the total items were prescribed incorrectly. The most common types of prescribing error were, an ambiguous prescription (61.1%) followed by an unrecommended dose regimen (13.9%). Logistic regression analysis showed that the risk of a prescribing error significantly increased when the prescription was written by a house officer (OR 4.72, p = 0.029). Errors were judged to be potentially non-significant (33.3%), significant (36.1%), or serious (30.6%). Conclusion The experience of prescribers is an important factor that contributes to prescribing errors in pediatrics. Many of the errors made were potentially serious and may impact on the patients' well-being.
    Matched MeSH terms: Medication Errors/prevention & control*
  8. Chua SS, Lai PSM, Sim SM, Tan CH, Foong CC
    BMC Med Educ, 2019 Apr 05;19(1):101.
    PMID: 30953493 DOI: 10.1186/s12909-019-1525-y
    BACKGROUND: The success of interprofessional collaboration in healthcare services requires a paradigm shift in the training of future health profession practitioners. This study aimed to develop and validate an instrument to measure Student Acceptance of Interprofessional Learning (SAIL) in Malaysia, and to assess this attribute among medical and pharmacy students using a prescribing skills training workshop.

    METHODS: The study consisted of two phases. In Phase 1, a 10-item instrument (SAIL-10) was developed and tested on a cohort of medical and pharmacy students who attended the workshop. In Phase 2, different cohorts of medical and pharmacy students completed SAIL-10 before and after participating in the workshop.

    RESULTS: Factor analysis showed that SAIL-10 has two domains: "facilitators of interprofessional learning" and "acceptance to learning in groups". The overall SAIL-10 and the two domains have adequate internal consistency and stable reliability. The total score and scores for the two domains were significantly higher after students attended the prescribing skills workshop.

    CONCLUSIONS: This study produced a valid and reliable instrument, SAIL-10 which was used to demonstrate that the prescribing skills workshop, where medical and pharmacy students were placed in an authentic context, was a promising activity to promote interprofessional learning among future healthcare professionals.

    Matched MeSH terms: Medication Errors/prevention & control*
  9. Shafie AA, Hassali MA, Azhar S, See OG
    Res Social Adm Pharm, 2012 May-Jun;8(3):258-62.
    PMID: 21824823 DOI: 10.1016/j.sapharm.2011.06.002
    The role of pharmacists has transformed significantly because of changes in pharmacists' training and population health demands. Within this context, community pharmacists are recognized as important health personnel for the provision of extended health services. Similarly, in Malaysia, the need to transform community pharmacy practice has been discussed by all interested parties; however, the transition has been slow due in part to the nonexistence of a dispensing separation policy between pharmacists and medical doctors in private community practices. For decades, medical doctors in private community practices have had the right to prescribe and dispense, thus diluting the role of community pharmacists because of overlapping roles. This article explores dispensing separation in Malaysia and, by taking into account the needs of health professionals and health care consumers, suggests a mechanism for how dispensing separation practice can be implemented.
    Matched MeSH terms: Medication Errors/prevention & control
  10. Thiruchelvam K, Hasan SS, Wong PS, Kairuz T
    J Am Med Dir Assoc, 2017 01;18(1):87.e1-87.e14.
    PMID: 27890352 DOI: 10.1016/j.jamda.2016.10.004
    BACKGROUND: Aging is often associated with various underlying comorbidities that warrant the use of multiple medications. Various interventions, including medication reviews, to optimize pharmacotherapy in older people residing in aged care facilities have been described and evaluated. Previous systematic reviews support the positive impact of various medication-related interventions but are not conclusive because of several factors.

    OBJECTIVES: The current study aimed to assess the impact of medication reviews in aged care facilities, with additional focus on the types of medication reviews, using randomized controlled trials (RCTs) and observational studies.

    METHODS: A systematic searching of English articles that examined the medication reviews conducted in aged care facilities was performed using the following databases: PubMed, CINAHL, IPA, TRiP, and the Cochrane Library, with the last update in December 2015. Extraction of articles and quality assessment of included articles were performed independently by 2 authors. Data on interventions and outcomes were extracted from the included studies. The SIGN checklist for observational studies and the Cochrane Collaboration's tool for assessing risk of bias in RCTs were applied. Outcomes assessed were related to medications, reviews, and adverse events.

    RESULTS: Because of the heterogeneity of the measurements, it was deemed inappropriate to conduct a meta-analysis and thus a narrative approach was employed. Twenty-two studies (10 observational studies and 12 controlled trials) were included from 1141 evaluated references. Of the 12 trials, 8 studies reported findings of pharmacist-led medication reviews and 4 reported findings of multidisciplinary team-based reviews. The medication reviews performed in the included trials were prescription reviews (n = 8) and clinical medication reviews (n = 4). In the case of the observational studies, the majority of the studies (8/12 studies) reported findings of pharmacist-led medication reviews, and only 2 studies reported findings of multidisciplinary team-based reviews. Similarly, 6 studies employed prescription reviews, whereas 4 studies employed clinical medication reviews. The majority of the recommendations put forward by the pharmacist or a multidisciplinary team were accepted by physicians. The number of prescribed medications, inappropriate medications, and adverse outcomes (eg, number of deaths, frequency of hospitalizations) were reduced in the intervention group.

    CONCLUSION: Medication reviews conducted by pharmacists, either working independently or with other health care professionals, appear to improve the quality of medication use in aged care settings. However, robust conclusions cannot be drawn because of significant heterogeneity in measurements and potential risk for biases.

    Matched MeSH terms: Medication Errors/prevention & control*
  11. Raja Lope RJ, Boo NY, Rohana J, Cheah FC
    Singapore Med J, 2009 Jan;50(1):68-72.
    PMID: 19224087
    This study aimed to determine the rates of non-adherence to standard steps of medication administration and medication administration errors committed by registered nurses in a neonatal intensive care unit before and after intervention.
    Matched MeSH terms: Medication Errors/prevention & control*
  12. Salmasi S, Wimmer BC, Khan TM, Zaidi STR, Ming LC
    Res Social Adm Pharm, 2018 Feb;14(2):207-209.
    PMID: 28330781 DOI: 10.1016/j.sapharm.2017.02.015
    Matched MeSH terms: Medication Errors/prevention & control*
  13. Mortell M
    Br J Nurs, 2019 Nov 14;28(20):1292-1298.
    PMID: 31714835 DOI: 10.12968/bjon.2019.28.20.1292
    This article employs a paediatric case study, involving a 3-year-old child who had an anaphylactic reaction that occurred as a result of the multidisciplinary team's failure to identify and acknowledge the patient's documented 'known allergy' status. It examines and reconsiders the ongoing healthcare dilemma of medication errors and recommends that known allergy status should be considered the second medication administration 'right' before the prescribing, transcribing, dispensing and administration of any drug. Identifying and documenting drug allergy status is particularly important when caring for paediatric patients, because they cannot speak for themselves and must rely on their parents, guardians or health professionals as patient advocates. The literature states that medication errors can be prevented by employing a 'rights of medication administration' format, whether that be the familiar '5 rights' or a more detailed list. However, none of these formats specify known allergy status as a distinct 'right'. The medication safety literature is also found wanting in respect of the known allergy status of the patient. When health professionals employ a medication administration rights format prior to prescribing, transcribing, dispensing or administering a medication, the 'known allergy status' of the patient should be a transparent inclusion.
    Matched MeSH terms: Medication Errors/prevention & control*
  14. Jafarzadeh Ghoushchi S, Dorosti S, Ab Rahman MN, Khakifirooz M, Fathi M
    J Healthc Eng, 2021;2021:5533208.
    PMID: 33868619 DOI: 10.1155/2021/5533208
    Medication Errors (MEs) are still significant challenges, especially in nonautomated health systems. Qualitative studies are mostly used to identify the parameters involved in MEs. Failing to provide accurate information in expert-based decisions can provoke unrealistic results and inappropriate corrective actions eventually. However, mostly, some levels of uncertainty accompany the decisions in real practice. This study tries to present a hybrid decision-making approach to assigning different weights to risk factors and considering the uncertainty in the ranking process in the Failure Modes and Effect Analysis (FMEA) technique. Initially, significant MEs are identified by three groups of qualified experts (doctors, nurses, and pharmacists). Afterward, for assigning weights to the risk factors, Z-number couples with the Stepwise Weight Assessment Ratio Analysis (SWARA) method, named Z-SWARA, to add reliability concept in the decision-making process. Finally, the identified MEs are ranked through the developed Weighted Aggregated Sum Product Assessment (WASPAS) method, namely, Z-WASPAS. To demonstrate the applicability of the proposed approach, the ranking results compare with typical methods, such as fuzzy-WASPAS and FMEA. The findings of the present study highlight improper medication administration as the main failure mode, which can result in a fatality or patient injury. Moreover, the utilization of multiple-criteria decision-making methods in combination with Z-number can be a useful tool in the healthcare management field since it can address the problems by considering reliability and uncertainty simultaneously.
    Matched MeSH terms: Medication Errors/prevention & control
  15. Chew KS, Ooi SK, Abdul Rahim NF, Wong SS, Kandasamy V, Teo SS
    BMC Health Serv Res, 2023 Nov 27;23(1):1310.
    PMID: 38012617 DOI: 10.1186/s12913-023-10247-7
    BACKGROUND: Conventional cognitive interventions to reduce medication errors have been found to be less effective as behavioural change does not always follow intention change. Nudge interventions, which subtly steer one's choices, have recently been introduced.

    METHODS: Conducted from February to May 2023, this study aimed to determine the relationships between perceived effectiveness and perceived ease of implementation of six nudge interventions to reduce medication errors, i.e., provider champion, provider's commitment, peer comparison, provider education, patient education and departmental feedback, and the moderating effects of seniority of job positions and clinical experience on nudge acceptability. Partial Least Square Structural Equation Modelling was used for data analysis.

    RESULTS AND DISCUSSION: All six nudge strategies had significant positive relationships between perceived effectiveness and acceptability. In three out of six interventions, perceived ease of implementation was shown to have positive relationships with perceived acceptability. Only seniority of job position had a significant moderating effect on perceived ease of implementation in peer comparison intervention. Interventions that personally involve senior doctors appeared to have higher predictive accuracy than those that do not, indicating that high power-distance culture influence intervention acceptability.

    CONCLUSION: For successful nudge implementations, both intrinsic properties of the interventions and the broader sociocultural context is necessary.

    Matched MeSH terms: Medication Errors/prevention & control
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