Medication errors during a pandemic: what have we learnt?

Descriptive analysis of the national drug adverse events (AEs) database in Lebanon

Background

Adverse Events (AE) including both Adverse Drug Reactions (ADRs) and Medication Errors (MEs) are worldwide health issues tackled by Pharmacovigilance (PV) systems. In Lebanon, ADRs and MEs are monitored by the Lebanese National Pharmacovigilance Program (LNPVP) implemented under the supervision of the Lebanese Ministry of Public Health (MoPH) to ensure the post-marketing surveillance of each authorised medication. The objective of this paper is to evaluate the prevalence of detected AEs within the Lebanese population in a descriptive analysis.

Methods

This is a retrospective analysis-based study that describes collected national AE cases for all marketed medications as well as medications in the pre-marketed phase as part of clinical studies in Lebanon, the LNPVP data system spontaneously received that from Marketing Authorisation Holders (MAHs) between 2018 and 2023.

Results

Since the initiation of the LNPVP programme, a total of 21,631 Individual Case Safety Reports (ICSRs) have been processed; 3,855 of which were excluded and the remaining 17,776 ICSRs are the subject of this paper and correspond to 37,768 AEs associated with medications authorised for use in Lebanon. Among respondents, 55.3% were females, whereas 37.9% were associated with males. In addition, the LNPVP has received a total of 1,961 cases of suspected medication errors, constituting 5.2% of the overall reported AEs.

Conclusion

Our results showed that Lebanon, a country that suffers from a turbulent economic and health context, was able to implement a PV system and operate with efficiency while evaluating a 5-year worth of ICSR reports. The dissemination of this information promotes stakeholder awareness by encouraging a collaborative approach among patients, healthcare providers, and regulatory authorities in Lebanon. However, further research is warranted to investigate factors contributing to MEs in Lebanon.

Recent mortality rates due to complications of medical and surgical care in the US

OBJECTIVES

Medical errors and complications pose a major threat to the safety of healthcare systems worldwide. This article was hence aimed at determining the current burden of complications of medical and surgical care in the US.

METHODS

We searched the latest version of the US Centers for Disease Control and Prevention (CDC) WONDER online database (years 2018-2022) using ICD-10 codes Y40-Y84 (complications of medical and surgical care).

RESULTS

The age-adjusted death rate for complications of medical and surgical care increased from 1.17 × 100,000 in 2018 to 1.49 × 100,000 in 2021, but then declined to 0.85 × 100,000 in 2022. The gender-specific analysis showed a similar trend, with the age-adjusted death rate values always being higher in men than in women. A clear age-dependent relationship was also found in the crude mortality rate for complications of medical and surgical care, as higher death rates were observed in older patients.

CONCLUSIONS

This analysis reveals that the burden of complications of medical and surgical care has increased over time, especially during the COVID-19 pandemic, but has then considerably declined in 2022. However, root cause analysis and actions are still needed for preventing the still noticeable consequences of medical complications.

The pharmacists' interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic

Introduction

Healthcare systems in developing countries faced significant challenges during COVID-19, grappling with limited resources and staffing shortages. Assessment of the impact of pharmaceutical care expertise, particularly in critical care units during the pandemics, in developing countries remains poorly explored. The principal aim of our study was to assess the impact of the Drug and Therapeutics Committee (DTC), comprising clinical pharmacists, on the incidence, types, and severity of medication errors and associated costs in using COVID-19 medications, especially antibiotics.

Methods

An interventional pre-post study was carried out at a public isolation hospital in Egypt over 6 months.

Results

Out of 499 medication orders, 238 (47.7%) had medication errors, averaging 2.38 errors per patient. The most frequent were prescribing errors (44.9%), specifically incorrect drug choice (57.9%), excessive dosage (29.9%), treatment duplication (4.5%), inadequate dosage (4.5%), and overlooked indications (3.6%). Linezolid and Remdesivir were the most common medications associated with prescribing errors. Pharmacists intervened 315 times, primarily discontinuing medications, reducing doses, introducing new medications, and increasing doses. These actions led to statistically significant cost reductions (p < 0.05) and better clinical outcomes; improved oxygen saturation, decreased fever, stabilised respiratory rates, and normalised white blood cell counts. So, clinical pharmacist interventions made a notable clinical and economic difference (66.34% reduction of the expenses) in antibiotics usage specifically and other medications used in COVID-19 management during the pandemic.

Conclusion

Crucially, educational initiatives targeting clinical pharmacists can foster judicious prescribing habits.

Predisposing Factors to Medication Errors by Nurses and Prevention Strategies: A Scoping Review of Recent Literature

Medication errors have serious consequences and high costs for the patient and the system. The treatment process and the care required for critically ill patients are complex, and these patients are more vulnerable to errors and potential consequences. A scoping review using the JBI methodology was conducted across PubMed, CINAHL, and MEDLINE databases and reported by the PRISMA-ScR guidelines to explore strategies that can mitigate medication errors by nurses. The search strategy focused on references published between January 2012 and April 2023. Sixteen studies were included, and the results were organized into thematic areas. Medication errors by nurses are in the areas of preparation, administration, and documentation; organizational, system-related, procedural, personal, and knowledge and training factors are predisposing factors for errors; educational intervention, verification and safety methods, organizational changes, and error reporting are the strategic areas to mitigate medication error. The organization of the data could be different, as it depends on the reviewers' experience. Knowledge of the factors that cause medication errors and interventions to mitigate them make it possible to outline strategies to minimize their occurrence and achieve health gains. The protocol preceding this review has been registered in the Open Science Framework and published.

Interventions to Minimize Medication Error by Nurses in Intensive Care: A Scoping Review Protocol

Medication errors represent a concern for healthcare organizations due to their negative consequences. In the nursing context, these errors represent a threat to the quality of care and patient safety. Many factors have been identified as potential causes for these errors in intensive care units. A scoping review will be developed to identify interventions/strategies to minimize the occurrence of medication errors by nurses, considering the Joanna Briggs Institute (JBI) methodology. A search will be conducted in the EbscoHost (CINAHL Complete and MEDLINE), Embase and PubMed databases. Data analysis, extraction and synthesis will be carried out by two reviewers independently. This review will attempt to map which interventions are more specific to minimizing medication error by nurses in intensive care and to recognize which factors influence this type of error to mitigate practices that may lead to error. This protocol acts as the framework for a scoping review in the strategy to map the interventions and which factors contribute to the medication error by intensive care nurses. This study was prospectively registered with the Open Science Framework on 21 April 2023 with registration number DOI 10.17605/OSF.IO/94KH3.