Preventable medication harm across health care settings: a systematic review and meta-analysis

Hospital-wide interventions for reducing or preventing in-hospital prescribing errors: a scoping review

INTRODUCTION

Prescribing errors (PEs) in hospital care lead to patient harm, prolonged hospital stays, readmissions, and mortality. Despite interventions that successfully target 'high risk' populations in trials, PE rates remain largely unchanged in real-world settings. Existing studies often focus narrowly on specific populations, overlooking the wider complexities of hospital-wide prescribing. This scoping review evaluates interventions for adult inpatients to identify knowledge gaps in how to reduce in-hospital PEs.

METHODS

A systematic search of PubMed, EMBASE.com, and the Cochrane Library (inception to 13 December 2024) was conducted following PRISMA-ScR guidelines. Studies prospectively evaluating interventions reducing in-hospital PEs were eligible for inclusion; those focusing on specific drugs, wards or populations or lacking original data were excluded.

RESULTS

Fourteen studies met the inclusion criteria. Technological interventions, such as computerized order entry systems, accounted for 35.7% of the studies. Half addressed prescriber-related factors, such as inadequate drug knowledge and prescribing skills, while organizational factors were underexplored.

CONCLUSION

Current interventions fail to address the underlying complexities, leaving critical gaps to decrease in-hospital PEs. To achieve sustainable PE reductions and improve patient safety, a multidisciplinary approach, standardized reporting, organizational reform, and a Safety-II perspective are essential.

Tackling medication errors: how a systems approach improves patient safety

OBJECTIVES

Medication errors are a leading source of preventable harm in healthcare, affecting approximately 1 in 30 patients, with a substantial proportion resulting in severe outcomes. In response, the European Association of Hospital Pharmacists convened a Special Interest Group (SIG) to propose comprehensive and sustainable strategies for reducing these errors across Europe, employing a systems approach.

METHODS

89 anonymised medication error reports, and empirical data from the SIG members' daily practice, were analysed to identify root causes, classified into system-level and individual errors. Expert subgroups then linked root causes to targeted preventive measures. A literature review was conducted, searching PubMed and Embase databases, to assess existing standards and identify gaps in medication safety practices, which informed the analysis.

RESULTS

Analysis revealed that governance deficiencies and inconsistent implementation of existing legal standards contribute significantly to medication errors. System-level issues, including inadequate oversight, understaffing and insufficient technical infrastructures, along with individual errors from cognitive lapses, were prevalent. The literature review supported these findings and highlighted the variability in medication safety practices across systems, underscoring the importance of strategic improvements in healthcare policies.

CONCLUSIONS

Findings highlight the critical need for robust governance, comprehensive policy frameworks and enhanced safety cultures to prevent medication errors. Automation and improved human-machine interfaces are recommended to mitigate active failures and enhance system reliability. This systems-thinking approach, supported by strengthening legislation and better resource allocation, is essential for reducing medication errors and improving patient safety.

Status and related factors of medication safety behaviour of nurses in the operating room: A cross-sectional survey in China

AIM

This study aimed to investigate the current status and influencing factors of medication safety behaviour of operating room nurses.

BACKGROUND

Medication safety is an important safety issue recognised by health organisations all over the world, and the operating room has one of the highest rates of preventable medication-related injuries. However, few studies have investigated the current status and influencing factors of medication safety behaviour of operating room nurses.

DESIGN

A cross-sectional study.

METHODS

From February to March, this study was conducted at three tertiary hospitals in southern China. Operating room nurses completed a series of questionnaires, including nurses' medication environment perception scale and operating room nurse's medication safety behaviour questionnaire. Data analysis included descriptive statistics, ANOVA, correlation analysis, and multiple regression. The STROBE checklist guided the reporting of this study.

RESULTS

A total of 171 questionnaires were analysed. The total score on medication safety behaviour of operating room nurses was 78.20±8.94. The medication environment the operating room nurses perceived was positively correlated with medication safety behaviour (P < 0.01). Additionally, factors related to the medication safety behaviour of operating room nurses included working years(B = 4.899, P = 0.000), the highest level of education(B = 5.440, P = 0.000), professional title(B = -2.644, P = 0.002), the last time of nursing medication safety training(B = -0.914, P = 0.013), and the system and supervision (B = 0.141, P = 0.015).

CONCLUSION

The medication safety behaviour of operating room nurses is low. The relationship between individual factors, medication environment, and medication behaviour of operating room nurses should be deeply considered, and targeted intervention strategies should be carried out to influence factors to improve their medication safety behaviour.

Impacts of Communication Type and Quality on Patient Safety Incidents : A Systematic Review

BACKGROUND

Poor communication in health care increases the risk for patient safety incidents. However, there is no up-to-date synthesis of these data.

PURPOSE

To synthesize studies investigating how poor communication between health care practitioners and patients (and between different groups of practitioners) affects patient safety.

DATA SOURCES

Ovid MEDLINE, CINAHL, APA PsycInfo, CENTRAL, Scopus, and the ProQuest Dissertations & Theses Citation Index from 1 January 2013 to 7 February 2024.

STUDY SELECTION

Studies published in any language that quantified the effects of poor communication on patient safety.

DATA EXTRACTION

Two independent reviewers extracted data, assessed risk of bias, and appraised strength of evidence. Study heterogeneity precluded meta-analysis, so results were reported with narrative description, reporting medians and interquartile ranges (IQRs).

DATA SYNTHESIS

Forty-six eligible studies (67 826 patients) were included. Risk of bias was low for 20, moderate for 16, and high for 10 studies. Four studies investigated whether poor communication was the only identified cause of a patient safety incident; here, poor communication caused 13.2% (IQR, 6.1% to 24.4%) of safety incidents. Forty-two studies investigated whether poor communication contributed to patient safety incidents alongside other causes; here, poor communication contributed to 24.0% (IQR, 12.0% to 46.8%) of safety incidents. Study heterogeneity was high in terms of setting, continent, health care staff, and safety incident type. The strength of the evidence was low or very low.

LIMITATION

There was important study heterogeneity, generally low study quality, and poor reporting of essential data.

CONCLUSION

Poor communication is a major cause of patient safety incidents. Research is needed to develop effective interventions and to learn more about how poor communication leads to patient safety incidents.

PRIMARY FUNDING SOURCE

Stoneygate Trust. (PROSPERO: CRD42024507578).

Medication reconciliation and seamless care led by clinical pharmacists in Slovenia: a national reimbursed program ensuring safe and effective transition of care

BACKGROUND

Medication errors frequently happen during patients' transitions between different healthcare settings. Medication reconciliation, provided by various healthcare specialists, could help reduce these errors. However, clinical pharmacists do not lead this service nationally in most countries.

AIM

This paper describes the development, implementation, and national evaluation of medication reconciliation in Slovenia as part of seamless care.

SETTING

All hospitals and community pharmacies in Slovenia.

DEVELOPMENT

The initial step involved the successful development of legislation in Slovenia. This process, termed 'seamless care,' was defined as a pharmaceutical service and five different steps of this process were developed: medication reconciliation upon admission (including the best possible medication history), during discharge, personal medication cards, and medication dispensing. A standard operational procedure was established in 2023 to guide these practices.

IMPLEMENTATION

A critical milestone in the implementation process was establishing a successful reimbursement scheme in 2023. Hospitals and community pharmacies implemented this service following successful reimbursement. Pharmacy managers and heads of hospital pharmacy departments were responsible for overseeing its implementation in hospitals and community pharmacies. The Health Insurance Institute of Slovenia is measuring the implementation.

EVALUATION

Trials were conducted in various Slovenian hospitals to evaluate this service's effectiveness, appropriateness, and adoption before its full implementation (reduced medication-related problems were observed). The Health Insurance Institute of Slovenia is currently evaluating the sustainability of the service and providing feedback to the providers.

CONCLUSION

Slovenia is the first country in this part of Europe to fully reimburse and implement medication reconciliation as a pharmaceutical service. This practice holds promise for exporting to other countries.

Identification, classification, and documentation of drug related problems in community pharmacy practice in Europe: a scoping review

BACKGROUND

Drug-related problems (DRPs) are significant issues in healthcare contributing to adverse health outcomes and increased healthcare costs. While community pharmacists play a pivotal role in identifying, classifying, and documenting DRPs, there is a need to map approaches undertaken.

AIM

The aim of this scoping review was to examine the approaches to identifying, classifying, and documenting DRPs in community pharmacies in Europe, and their associated barriers and facilitators.

METHOD

The scoping review was conducted according to the Joanna Briggs Institute guidelines and reported according to the PRISMA-ScR guidelines. The search was conducted across 11 databases from inception until March 2023. Studies of all designs reporting DRPs in European community pharmacies were included. Titles, abstracts, and full texts were screened independently by two researchers, followed by data extraction and synthesis.

RESULTS

The search yielded 67 relevant studies. Forty-eight studies described approaches to DRP identification as predominantly relying on professional knowledge and computer software. The classification methods, described in 41 studies, varied with reports of predefined systems and computer-generated classifications. Documentation approaches were described in 53 studies and were primarily computer-based. Facilitators included electronic support systems, pharmacist experience, while barriers encompassed the complexity of classification as well as variations in training, IT solutions, operational structures, and implementation.

CONCLUSION

There is a lack of a standardized approach to identifying, classifying, and documenting DRPs in European community pharmacies. A framework for pharmacist education and a time-saving approach to documenting DRPs consistently could serve to overcome the barriers to their identification and documentation. Furthermore, the implementation of a standardised approach to classifying DRPs could facilitate comparison of the management of DRPs across Europe.

Barriers and facilitators to implementing polypharmacy management frameworks: a theory based qualitative exploration of key stakeholders

BACKGROUND

Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less at the organisational level.

AIM

To explore key stakeholder identified barriers and facilitators to implementation of an organisational level polypharmacy management framework.

METHOD

Qualitative data were collected within the Ministry of Health in Oman. Key stakeholders were purposively sampled encompassing senior representatives of pharmacy, medicine, and nursing directors; healthcare policymakers; patient safety leaders; and academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review and underpinned by the Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until data saturation, were audio-recorded, transcribed and analysed using the Framework Approach.

RESULTS

Thirteen key stakeholders were interviewed, with representation of each target group. Facilitators largely mapped to the CFIR domain of inner setting (i.e., aspects of stakeholder awareness, the electronic health system and national leadership), intervention characteristic (evidence gaps), characteristics of individuals (stakeholders and champions) and process (change strategy). Barriers also largely mapped to the inner setting (policy absence, communication and health professional practice) and outer setting (resource needs).

CONCLUSION

This study has illuminated the facilitators and barriers to the implementation of an organisational level polypharmacy management framework. Further work is required to translate these themes into an actionable plan to implement the framework. Particular attention is required for aspects of the CFIR domain of inner setting (i.e., the internal context within which implementation occurs) as most barriers mapped to this domain.

Look-alike, sound-alike medication perioperative incidents in a regional Australian hospital: assessment using a novel medication safety culture assessment tool

BACKGROUND

Medication safety remains a global concern, with governments and organizations striving to mitigate preventable patient harm across healthcare systems. Look-alike, sound-alike medication incidents and the safety culture are widely acknowledged as a contributor to medication errors, particularly within the high-risk perioperative environment. The Medication Safety Culture Indicator Matrix (MedSCIM) is a novel tool developed by the Canadian Institute for Safe Medication Practices to assess the maturity of the medication safety culture. This study aims to delineate look-alike sound-alike (LASA) medication incidents reported in the pharmacy and perioperative settings of an Australian hospital and assess the maturity of the medication safety culture.

METHODS

The study setting is within a large regional hospital in Australia, servicing both adult and paediatric populations. Medication incidents from 1 April 2018 to 1 April 2023 were retrospectively gathered from the Clinical Incident Management System, Riskman®. Data and statistical analyses were carried out using Microsoft Excel®. The necessary approvals were secured from the Heath Service Human Research and Ethics Committee.

RESULTS

During the 5-year period, a total of 246 (4.1%) of the 6002 medication incidents within the health service were identified as meeting the inclusion criteria. Of the 246 medication incidents, 63.0% were identified from the Pharmacy Department, while 22.0% and 15.0% were from the Post Anaesthetic Care Unit and Anaesthetics Department, respectively. The most frequently reported incident classification in both the Anaesthetics Department and Post Anaesthetic Care Unit was 'incorrect dose', followed by 'incorrect medication'. Throughout the 5-year period, 46 (18.7%) of the 246 medication incidents were attributed to look-alike, sound-alike sources of error, predominantly identified in the Pharmacy Department (73.9%), followed by the Anaesthetics Department (17.4%) and the Post Anaesthetic Care Unit (8.7%). High-risk medications were most frequently reported to the Anaesthetics Department. Packaging (packaging alone, naming and packaging, and syringe swaps) was determined to be a contributing factor in 30 (65.2%) of the 46 LASA medication incidents. MedSCIM assessment revealed a reactive medication safety culture. Additionally, the medication incident report documentation was found to be mostly complete or semi-complete.

CONCLUSION

Our analysis delineated medication incidents occurring across the entire medication management cycle and identified incidents related to LASA medications as a contributor to medication incidents across these clinical settings. This novel medication safety culture tool assessment highlighted opportunities for improvement with clinical incident documentation.

Public Attitudes Toward Violence Against Doctors: Sentiment Analysis of Chinese Users

BACKGROUND

Violence against doctors attracts the public's attention both online and in the real world. Understanding how public sentiment evolves during such crises is essential for developing strategies to manage emotions and rebuild trust.

OBJECTIVE

This study aims to quantify the difference in public sentiment based on the public opinion life cycle theory and describe how public sentiment evolved during a high-profile crisis involving violence against doctors in China.

METHODS

This study used the term frequency-inverse document frequency (TF-IDF) algorithm to extract key terms and create keyword clouds from textual comments. The latent Dirichlet allocation (LDA) topic model was used to analyze the thematic trends and shifts within public sentiment. The integrated Chinese Sentiment Lexicon was used to analyze sentiment trajectories in the collected data.

RESULTS

A total of 12,775 valid comments were collected on Sina Weibo about public opinion related to a doctor-patient conflict. Thematic and sentiment analyses showed that the public's sentiments were highly negative during the outbreak period (disgust: 10,201/30,433, 33.52%; anger: 6792/30,433, 22.32%) then smoothly changed to positive and negative during the spread period (sorrow: 2952/8569, 34.45%; joy: 2782/8569, 32.47%) and tended to be rational and peaceful during the decline period (joy: 4757/14,543, 32.71%; sorrow: 4070/14,543, 27.99%). However, no matter how emotions changed, each period's leading tone contained many negative sentiments.

CONCLUSIONS

This study simultaneously examined the dynamics of theme change and sentiment evolution in crises involving violence against doctors. It discovered that public sentiment evolved alongside thematic changes, with the dominant negative tone from the initial stage persisting throughout. This finding, distinguished from prior research, underscores the lasting influence of early public sentiment. The results offer valuable insights for medical institutions and authorities, suggesting the need for tailored risk communication strategies responsive to the evolving themes and sentiments at different stages of a crisis.

The problem with the existing reporting standards for adverse event and medical error research

The Enhancing the Quality and Transparency of Health Research (EQUATOR) Network indexes over 600 reporting guidelines designed to improve the reproducibility of manuscripts across medical fields and study designs. Although several such reporting guidelines touch on adverse events that may occur in the context of a study, there is a large body of research whose primary focus is on adverse events, near-misses and medical errors that do not currently have a dedicated reporting guideline to help set reporting standards and facilitate comparisons across studies. As part of the process prescribed by EQUATOR for developing such a reporting guideline, we performed a needs assessment, evaluating whether existing standards address key features of a proposed reporting guideline in development, entitled Standard Elements in Studies of Adverse Events and Medical Error (SESAME). We evaluated 12 EQUATOR reporting guidelines for the presence of eight key features of SESAME. Five of the 12 failed to include any of these key features. None of the remaining seven incorporated more than four of the eight SESAME key components, confirming the need for a dedicated reporting guideline for studies of adverse events and medical errors.

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.

Community pharmacists' decision-making patterns in clinical prescription checking: A simulation-based study

Background

Community pharmacists (CPs) make a significant number of decisions on the clinical appropriateness of prescriptions daily to ensure safe and effective use of medications, in a process known as "clinical checking". The process is complex and is affected by multiple factors in practice. This study aimed to investigate the cognitive processes involved in clinical prescription checking by CPs.

Method

This qualitative study employed a purposive sampling technique to recruit a diverse sample from the population of CPs in England. Engaging in Zoom interviews, participants clinically checked three simulated prescriptions, providing concurrent verbal accounts of their thoughts. The participants' commentaries during the task were audio-recorded, transcribed verbatim, and underwent deductive thematic analysis based on Klein's recognition-primed decision-making (RPD) model.

Results

Twelve CPs from diverse backgrounds and varied working conditions were recruited and completed the online checking task. Making decisions on the clinical appropriateness of prescriptions appeared to be a multi-staged procedure whereby several levels of concerns exist, and pharmacists vary in their ability to recognise and resolve those concerns. CPs behaved in a manner similar to that described by the RPD model; they mostly engaged in pattern-recognition during clinical checking, but adopted a more analytical approach when they recognised an atypical situation. Participants showed more consistency when processing cues and expectancies; however, their subsequent actions exhibited substantial variability, coupled with a degree of hesitancy.

Conclusion

Clinical checking of prescriptions is a multifaceted process in which pharmacists employ a blend of pattern recognition and analytical thinking when making decisions. The process differs notably among pharmacists, underscoring the need to understand the factors driving these variations and any hesitancy in decision- making, as well as their potential impact on patient safety.

[Translated article] Evaluation of the safety of medication-use systems in hospital emergency services

INTRODUCTION

The objective of this study was to assess the implementation of safe medication practices in hospital emergency services, in order to understand the points of greatest risk as well as the safety challenges faced by these departments, and to plan collaboratively improvement initiatives.

METHOD

Multicentric and descriptive study based on completion of the "Medication safety self-assessment of emergency services" from May 16, 2023 to November 16, 2023, at voluntarily participating emergency services. The survey contained 93 items grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation, were determined.

RESULTS

A total of 72 emergency services completed the questionnaire. The mean score obtained for the overall questionnaire was 428.3 points (51.1% of the maximum score). Results showed a large variation among the scores of the participating services (range: 164.0-620.5). Four key elements had values below 50%, corresponding to competence and training of professionals in safety practices (38.4%); incorporation of pharmacists in emergency departments (42.1%), availability and accessibility of information about patients (43.1%), and patient education (48.1%). The highest values corresponded to labeling, packaging, and naming of medications (69.2%) and communication of prescriptions and other medication information (64%). No differences were found between emergency departments in the key elements according to the dependency or size of the hospital, or the type of department, except for the item referring to the incorporation of pharmacists in the emergency service, where differences were observed between hospitals with less than 200 beds (28.9%) and those with more than 500 (52.2%).

CONCLUSION

The application of the specific self-assessment questionnaire has made it possible to identify safety practices that are insufficiently implemented into emergency departments in our country and to identify critical points for improvement for which planning collaborative initiatives to reduce medication errors in these units should become a priority.

Evaluation of the safety of medication-use systems in hospital emergency services

INTRODUCTION

The aim of this study was to assess the implementation of safe medication practices in hospital emergency services, in order to understand the points of greatest risk as well as the safety challenges faced by these departments, and to plan collaboratively improvement initiatives.

METHOD

Multicentric and descriptive study based on completion of the "Medication safety self-assessment of emergency services" from 5/16/2023 to 11/16/2023, at voluntarily participating emergency services. The survey contained 93 items grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation, were assessed.

RESULTS

A total of 72 emergency services completed the questionnaire. The mean score obtained for the overall questionnaire was 428.3 points (51.1% of the maximum score). Results showed a large variation among the scores of the participating services (range: 164-620.5). Four key elements had values below 50%, corresponding to competence and training of professionals in safety practices (38.4%); incorporation of pharmacists in emergency departments (42.1%), availability and accessibility of information about patients (43.1%), and patient education (48.1%). The highest values corresponded to labeling, packaging, and naming of medications (69.2%) and communication of prescriptions and other medication information (64%). No differences were found between emergency services in the key elements according to the dependency or size of the hospital, or the type of service, except for the item referring to the incorporation of pharmacists in the emergency service, where differences were observed between hospitals with less than 200 beds (28.9%) and those with more than 500 (52.2%).

CONCLUSION

The application of the specific self-assessment questionnaire has made it possible to identify safety practices that are insufficiently implemented into emergency services in our country and to identify critical points for improvement for which planning collaborative initiatives to reduce medication errors in these departments should become a priority.

Effectiveness of interactive dashboards to optimise prescribing in primary care: a protocol for a systematic review

Introduction

Advances in therapeutics and healthcare have led to a growing population of individuals living with multimorbidity and polypharmacy making prescribing more challenging. Most prescribing occurs in primary care and General Practitioners (GPs) have expressed interest in comparative feedback on their prescribing performance. Clinical decision support systems (CDSS) and audit and feedback interventions have shown some impact, but changes are often short-lived. Interactive dashboards, a novel approach integrating CDSS and audit and feedback elements, offer longitudinal updated data outside clinical encounters. This systematic review aims to explore the effectiveness of interactive dashboards on prescribing-related outcomes in primary care and examine the characteristics of these dashboards.

Methods

This protocol was prospectively registered on PROSPERO (CRD42023481475) and reported in line with PRISMA-P guidelines. Searches of PubMed, EMBASE, Medline, PsychINFO, CINAHL, Scopus, the Cochrane Library, and grey literature, including trial registries were performed to identify interventional studies (randomised and non-randomised) that assess the effectiveness of interactive dashboards on prescribing related outcomes. The search will be supplemented by searching references of retrieved articles with the use of an automated citation chaser. Identified records will be screened independently by two reviewers and data from eligible studies extracted using a purposely developed data extraction tool. We will narratively summarise the intervention types and those associated with improvements in prescribing outcomes. A quantitative synthesis will be carried out if a sufficient number of homogenous studies are identified. Methodological quality will be assessed by two reviewers using the Cochrane Effective Practice and Organisation of Care risk assessment tool.

Discussion

This systematic review will explore the effect of interactive dashboards on prescribing related outcome measures in primary care and describe the characteristics of interactive dashboards. This research may inform future intervention development and shape policymaking particularly in the context of ongoing and planned developments in e-prescribing infrastructure.

Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations

BACKGROUND

Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions.

OBJECTIVE

This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions.

METHODS

A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines.

RESULTS

We included 13 studies that assessed the cost-effectiveness (n=9, 69.2%), cost-benefit (n=3, 23.1%), and cost-utility (n=1, 7.7%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8%) examined automated medication-dispensing systems, and 2 (15.4%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12% (range 8.2%-66.5%) and medication errors by 54.38% (range 24%-83%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9%) and moderate (n=3, 23.1%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs.

CONCLUSIONS

DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability.

'They Take the Mum Off You When You Come In': An Ethnographic Study of Parent Experiences of Medicines Safety Systems in English Hospitals

INTRODUCTION

Medication safety in healthcare settings is a persistent problem, and children may be at greater risk of harm than adults. Most existing research examining medication safety for hospitalised children is from the perspective of healthcare professionals and organisations. This study aimed to ethnographically explore parent and staff perspectives on the role of parents in medication safety in the paediatric hospital setting.

METHODS

230 h of ethnographic observation and 19 semi-structured interviews with clinical staff and parents were conducted over paediatric wards in three acute hospitals in Northern England between October 2020 and May 2022. Data was organised and coded using NVivo and analysed thematically.

RESULTS

Three main themes were identified: (1) Capacity and Capability: Parents were often assumed to be incompetent by organisational policies and managers but at the same time were co-opted to undertake medication processes to meet operational needs. Parental experience was often ignored or judged negatively. When things went wrong parents were sometimes blamed. (2) Communication: parents were seldom meaningfully involved in decisions about their children's medication or provided with appropriate information unless requested. Parental medication histories were treated with suspicion and validated against inaccurate records. (3) Agency and Autonomy: parents often wanted to participate in their child's care but were expected to be passive observers.

CONCLUSIONS

Medication safety for children is a social phenomenon involving healthcare professionals and parents. However, parents are often relegated to a passive role by healthcare staff. We posit that this represents an example of epistemic injustice in the way parents are assumed to be incompetent outsiders with no understanding of the medical care of their children, despite them offering resilience for medicines safety. We recommend further exploration of how parents contribute to resilience and safety for children in hospital and the barriers to this, and how health services can safely support increased engagement and involvement of parents in the care of their children while in hospital.

PATIENT OR PUBLIC CONTRIBUTION

Parents contributed to the analysis and interpretation of the data collection and have contributed to the preparation of the manuscript.

Measuring the patient safety climate in community pharmacies: an updated national survey

BACKGROUND

The patient safety climate in community pharmacies was measured nationally in Sweden in 2008. Since that time the Swedish pharmacy market has undergone a re-regulation which probably has affected the patient safety climate in pharmacies.

OBJECTIVES

The aim was to evaluate the patient safety climate among pharmacists working in Swedish community pharmacies and compare it with historical data.

DESIGN

The patient safety climate among pharmacists was analysed in two cross-sectional surveys. Historical data from 2008 and data collected in 2022 were compared. The Safety Attitudes Questionnaire (SAQ), containing items on safety culture arranged in six dimensions, was used in both surveys. It uses a 5-point Likert scale to create a quantitative description of the respondents' perception of patient safety climate.

SETTING

Community pharmacies in Sweden.

PARTICIPANTS

These surveys were census studies because all pharmacists working in community pharmacies in Sweden were invited to participate and no sampling occurred.

RESULTS

The number of respondents was 2738 in 2008 and 1931 in 2022. The patient safety climate in Swedish community pharmacies appears to have worsened between 2008 and 2022 according to the pharmacists. All values of the dimensions included in the SAQ have decreased, except for the dimension of Stress Recognition, where an increase indicated a larger awareness among the pharmacists of how stress impacts their work. The overall negative trend in SAQ values seen between 2008 and 2022 was consistent, irrespective of the respondent's level of education, their role in the pharmacy or the number of years since their education was completed.

CONCLUSIONS

The patient safety climate in community pharmacies in Sweden seems to have deteriorated. With an increasingly strained healthcare system, community pharmacists must be reliable defenders of patient safety, and it is essential to ensure that the climate in their workplace supports the important work being carried out.

Methodological Approaches for Analyzing Medication Error Reports in Patient Safety Reporting Systems: A Scoping Review

BACKGROUND

Medication errors (MEs) pose risks to patient safety, resulting in substantial economic costs. To enhance patient safety and learning from incidents, health care and pharmacovigilance organizations systematically collect ME data through reporting systems. Despite the growing literature on MEs in reporting systems, an overview of methods used to analyze them is lacking. The authors aimed to identify, explore, and map available literature on methods used to analyze MEs in reporting systems.

METHODS

The review was based on Joanna Briggs Institute's methodology. The authors systematically searched electronic databases Embase, Medline, CINAHL, Cochrane Central, and other sources (Google Scholar, health care safety and pharmacovigilance centers' websites). Literature published from January 2017 to December 2023 was screened and extracted by two independent researchers.

RESULTS

Among the 59 extracted publications, analyses most often focused on MEs occurring in hospitals (57.6%), included both adult and pediatric patients (79.7%), and used national patent safety monitoring systems as a source (69.5%). We identified quantitative (39.0%), qualitative (11.9%), mixed methods (37.3%), and advanced computerized methods (11.9%). Descriptive quantitative analyses for categorized data were common; however, disproportionality analysis constituted a newer approach to address issues with reporting bias. Free-text data were commonly managed by content analysis, while mixed methods analyzed both categorized and free-text data. In addition, text mining, natural language processing, and artificial intelligence were used in more recent studies.

CONCLUSION

This scoping review uncovered a notable span and diversity in methodologies. Future research should assess the use, applicability, and effectiveness of newer methods such as disproportionality analysis and advanced computerized techniques.

Prevalence of potentially inappropriate prescriptions identified using screening tools in paediatric patients: a systematic review

OBJECTIVES

Inappropriate prescriptions are known to cause medication-related problems, but little is known about the prevalence of this issue in paediatric patients. This systematic review provides an overview of the prevalence of potentially inappropriate prescriptions identified through tools developed for the paediatric population and delineates the strengths and limitations of the identification tools.

METHODS

Literature from PubMed, CINAHL, Cochrane database and Google Scholar was searched with a combination of medical subject headings (MeSH) and free-text terms related to inappropriate prescriptions, paediatrics and potentially inappropriate prescription tools. Studies reported in English and published from inception of the databases until May 2023 were selected based on fulfilment of eligibility criteria. All eligible articles were assessed for methodological quality and examined using thematic analysis.

RESULTS

Twelve studies met the inclusion criteria. The majority of the studies were of high quality. Four themes emerged-namely, evaluation tools and calculation methods of inappropriate prescriptions, prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and predictors of PIM and PPO in children. Among the nine tools identified, the original and modified version of the POPI tool was most commonly used. The prevalence of PIM and PPO ranged from 0.04% to 69% and from 1.5% to 55.9%, respectively. Age was the most common predictor reported, whereby PIMs and PPOs were more likely in children aged 2-6 and 6-12 years, respectively.

CONCLUSIONS

Potentially inappropriate prescriptions in paediatric patients is highly prevalent, despite the wide variation in the reported prevalence range and limited implementation of the available tools in practice. Future efforts need to be focused on the development and implementation of age-, disease- or country-specific tools to effectively evaluate and further determine the economic impact of PIMs in children.

Investigating the capabilities of advanced large language models in generating patient instructions and patient educational material

OBJECTIVES

Large language models (LLMs) with advanced language generation capabilities have the potential to enhance patient interactions. This study evaluates the effectiveness of ChatGPT 4.0 and Gemini 1.0 Pro in providing patient instructions and creating patient educational material (PEM).

METHODS

A cross-sectional study employed ChatGPT 4.0 and Gemini 1.0 Pro across six medical scenarios using simple and detailed prompts. The Patient Education Materials Assessment Tool for Print materials (PEMAT-P) evaluated the understandability, actionability, and readability of the outputs.

RESULTS

LLMs provided consistent responses, especially regarding drug information, therapeutic goals, administration, common side effects, and interactions. However, they lacked guidance on expiration dates and proper medication disposal. Detailed prompts yielded comprehensible outputs for the average adult. ChatGPT 4.0 had mean understandability and actionability scores of 80% and 60%, respectively, compared with 67% and 60% for Gemini 1.0 Pro. ChatGPT 4.0 produced longer outputs, achieving 85% readability with detailed prompts, while Gemini 1.0 Pro maintained consistent readability. Simple prompts resulted in ChatGPT 4.0 outputs at a 10th-grade reading level, while Gemini 1.0 Pro outputs were at a 7th-grade level. Both LLMs produced outputs at a 6th-grade level with detailed prompts.

CONCLUSION

LLMs show promise in generating patient instructions and PEM. However, healthcare professional oversight and patient education on LLM use are essential for effective implementation.

Toxic-metabolic encephalopathy induced by metronidazole and disulfiram: classics never die

A 53-year-old male with recovering alcohol dependency, diagnosed with bipolar disorder and recurrent episodes of diverticulitis, came to the emergency department with disorientation and confusion after 3 days of treatment with metronidazole 250 mg/12 hours and ciprofloxacin 500 mg/12 hours for acute diverticulitis. In the hospital emergency department, he presented moments of agitation, fluctuations of attitude, increased basal tremor, with rhythmic movement of the left arm and leg, as well as generalised rigidity with an episode of tonic-clonic seizure of 1.5-2 min duration. After performing different diagnostic tests, significant brain findings were ruled out. The pharmacy department recommended the discontinuation of one of the two drugs. As a result, the on-call doctor adjusted the patient's treatment: disulfiram and previous antibiotic therapy (metronidazole and ciprofloxacin) were discontinued, and amoxicillin/clavulanic acid 2 g/8 hour was prescribed instead. The patient progressed well and fully recovered.

Multifaceted approach to reduce duplicate therapy errors in the emergency department

Medication errors continue to pose a significant risk to patient safety, accounting for half of the avoidable harm in healthcare systems around the world. In emergency departments (EDs), factors such as high patient loads and emergent nature of care increase the likelihood of such errors. An audit conducted at the ED of Changi General Hospital Singapore from January 2019 to July 2022 revealed that the duplicate therapy error comprised 31% of all reported medication errors. Therapeutic duplication occurs when the same or pharmacologically equivalent agents are prescribed concurrently to a patient. These errors not only jeopardise patient safety but also place additional strain on healthcare resources and lead to stress among the staff involved.This quality improvement (QI) project aims to reduce duplicate therapy error by 50% 3 months post-intervention at the ED. Beginning in August 2022 and continuing through December 2023, the project followed a structured approach comprising four phases: problem identification, identifying root causes, developing of targeted interventions and ensuring sustainability. Phase 1 involved an audit from January 2019 to July 2022 to determine the extent and types of medication errors in the ED. In phase 2, a root cause analysis (RCA) of the medication error identified key issues such as system knowledge deficits, inadequate IT processes, environment, policies and procedures and gaps in care coordination. Based on these findings, targeted interventions were developed and implemented in phase 3. Phase 4 focused on sustaining improvements through ongoing audits.The QI project successfully met its goal of reducing duplicate therapy error rates by 50% post-intervention. Additionally, it completely eliminated duplicate therapy errors in certain medication categories.In conclusion, through targeted interventions, active engagement of relevant stakeholders and ongoing efforts to sustain and enhance improvement, a safer healthcare environment can be achieved for patients.

Nurses' adverse event reporting attitudes and related factors: a cross-sectional study in maternal and child specialized hospitals in China

Objective

To investigate the current situation of nurses' attitude toward adverse event reporting and identify its related factors in maternal and child specialized hospitals.

Methods

A questionnaire survey was conducted among 943 nurses in 18 second-level and above maternal and child specialized hospitals in Sichuan province in China. The questionnaire included general information and the Chinese version of Reporting of Clinical Adverse Effects Scale (C-RoCAES).

Results

The total score of adverse events reported by nurses was 63.98 ± 8.77. The scores of the dimensions from high to low were reporting standard (3.13 ± 0.46), reporting impact (2.80 ± 0.54), reporting purpose (1.98 ± 0.66), and reporting environment (1.98 ± 0.42). Educational background (β = -1.87, p < 0.001), professional title (β = -3.51, p < 0.001), and adverse event experience (β = -7.05, p < 0.001) were the positively associated with higher levels of nurses' attitude toward adverse event reporting in maternal and child specialized hospitals (p < 0.05).

Conclusion

The attitude of nurses in maternal and child specialized hospitals to report adverse events is at the middle level. Hospital managers should improve the reporting standards for adverse events, improve the hospital safety culture, strengthen the relevant training for nurses with low education and low professional titles, so as to improve nurses' awareness of adverse event reporting and reporting rate.

Risk factors for wrong-patient medication orders in the emergency department

Objectives

This paper investigates the risk factors for wrong-patient medication orders in an emergency department (ED) by studying intercepted ordering errors identified by the "retract-and-reorder" (RaR) metric (orders that were retracted and reordered for a different patient by the same provider within 10 min).

Materials and Methods

Medication ordering data of an academic ED were analyzed to identify RaR events. The association of RaR events with similarity of patient names and birthdates, matching sex, age difference, the month, weekday, and hour of the RaR event, the elapsed hours since ED shift start, and the proximity of exam rooms in the electronic medical record (EMR) dashboard's layout was evaluated.

Results

Over 5 years (2017-2021), 1031 RaR events were identified among a total of 561 099 medication orders leading to a proportional incidence of 184 per 100 000 ED orders (95% CI: 172; 195). RaR orders were less likely to be performed by nurses compared to physicians (OR 0.54 [0.47; 0.61], P < .001). Furthermore, RaR pairs were more likely to have the same sex (OR 1.26 [95% CI 1.10; 1.43], P = .001) and the proximity of the exam rooms was closer (-0.62 [95% CI -0.77; -0.47], P = .001) compared to control pairs. Patients' names, birthdates, age, and the other factors showed no significant association (P > .005).

Discussion and Conclusion

This study found no significant influence from factors such as similarity of patient names, age, or birthdates. However, the proximity of exam rooms in the user interface of the EMR as well as patients' same sex emerged as risk factors.

Medication Reconciliation of Patients by Pharmacist at the Time of Admission and Discharge from Adult Nephrology Wards

PURPOSE

The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases.

METHODS

A prospective study was performed in adult nephrology wards of a teaching referral hospital in Iran from September 2020 to March 2021. All patients hospitalized in the nephrology ward for at least 1 day who received the minimum of one medication during their ward stay within the study period were considered eligible. Medication reconciliation was performed by taking a best-possible medication history from eligible patients during the first 24 h of ward admission. Medications were evaluated for possible intentional as well as unintentional discrepancies.

RESULTS

Here, 178 patients at admission and 134 patients at discharge were included. The mean numbers of unintentional drug discrepancies for each patient at admission and discharge were 6.13 ± 4.13 and 1.63 ± 1.94, respectively. The mean ± SD numbers of prescribed medications for patients before ward admission detected by the nurse/physician and pharmacist were 6.06 ± 3.53 and 9.22 ± 4.71, respectively (p = 0.0001). The number of unintentional discrepancies at admission and discharge had a significant correlation with the number of drugs used and underlying diseases. The number of unintentional discrepancies at admission was also correlated with patients' age. The number of comorbidities was significantly associated with the number of unintentional medication discrepancies at both admission and discharge. At the time of ward discharge, all patients were given medication consultations.

CONCLUSIONS

The rate of reconciliation errors was high in the adult nephrology ward. The active contribution of pharmacists in the process of medication reconciliation can be significantly effective in identifying these errors.

Development and reliability and validity testing of a medication literacy scale for medical college students

BACKGROUND

Irrational drug use has become a global problem threatening human health. As future health professionals, medical college students' medication literacy (ML) is critical. Their mastery of medication-related knowledge will directly affect public medication safety in the future.

METHODS

The initial scale was developed through a literature review and was modified through expert consultation and student interviews to form the initial scale with 14 items. In 2020, a questionnaire survey was conducted among students in a medical college for item analysis, reliability test, validity test and other analyses.

RESULTS

The total Cronbach's α coefficient was 0.826 and split-half reliability was 0.852. The Cronbach's α coefficients for functional medication literacy, communicative medication literacy, and critical medication literacy were 0.901, 0.858, and 0.851, respectively. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett's spherical test p < 0.001, indicating that the data are very suitable for factor analysis. Three principal axis factors were extracted by principal component analysis, and the total variance interpretation rate was 69.031% (> 40%). The confirmatory factor analysis identified a three-factor model and showed goodness of fit indices for the scale: The χ²/df = 2.623, The Goodness of Fit Index (GFI) = 0.905, The Comparative Fit Index (CFI) = 0.950, Normed Fit Index (NFI) = 0.922, Tucker-Lewis index (TLI) = 0.938, and The Root Mean Square Error of Approximation (RMSEA) = 0.078.

CONCLUSION

A new scale for evaluating the medication literacy of Chinese medical college students was preliminarily developed, demonstrating good reliability and validity. Itcan be used as a preliminary measurement tool for assessing medical students' medication literacy. However, due to the limitations of this study, the practical application of the scale needs to be further examined in a larger sample and should be refined in future studies.

Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study

BACKGROUND

Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms.

METHODS

In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity.

RESULTS

We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable).

CONCLUSIONS

Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.

Raising the barcode: improving medication safety behaviours through a behavioural science-informed feedback intervention. A quality improvement project and difference-in-difference analysis

Barcode medication administration (BCMA) technology can improve patient safety by using scanning technology to ensure the right drug and dose are given to the right patient. Implementation can be challenging, requiring adoption of different workflows by nursing staff. In one London National Health Service trust scanning rates were lower than desired at around 0-20% of doses per ward. Our objective was to encourage patient safety behaviours in the form of medication scanning through implementation of a feedback intervention. This was informed by behavioural science, codesigned with nurses and informed by known barriers to use. Five wards were selected to trial the intervention over an 18-week period beginning August 2021. The remaining 14 hospital wards acted as controls. Intervention wards had varying uptake of BCMA at baseline and represented a range of specialties. A bespoke feedback intervention comprising three behavioural science constructs (gamification, the messenger effect and framing) was delivered to each intervention ward each week. A linear difference-in-difference analysis was used to evaluate the impact of our intervention on scan rates, both for the overall 18-week period and at two weekly intervals within this timeframe. We identified a 23.1 percentage point increase in medication scan rates (from an average baseline of 15.0% to 38.1%) on the intervention wards compared with control (p<0.001) following implementation of the intervention. Feedback had most impact in the first 6 weeks, with an initial percentage point increase of 26.3 (p<0.001), which subsequently plateaued. Neither clinical specialty nor number of beds on each ward were significant factors in our models. Our study demonstrated that a feedback intervention, codesigned with end users and incorporating behavioural science constructs, can lead to a significant increase in the adoption of BCMA scanning.

Characterizing medication safety incidents in surgical patients: a retrospective cross-sectional analysis of incident reports

Background

Medication-related safety incidents (MSIs) are among the most frequent contributors to preventable harm in hospital patients. There is a paucity of research that explores the factors that contribute to MSIs across the departments of high-risk specialties such as surgery.

Objectives

To characterize MSIs involving surgical patients across two secondary care sites at a University Health Board.

Design

Retrospective cross-sectional convergent analysis of anonymous MSI reports extracted from the risk management system between 1st January 2017 and 31st October 2020 was undertaken.

Methods

Incident reports contained categorical data pertaining to the type and nature of the incident as well as free-text reporter accounts. Categorical data were analyzed quantitatively, undergoing descriptive analysis using IBM SPSS Statistics © software (Version 26.0.01; 2019). Content analysis of free-text responses was undertaken using the Organizational Accident Causation model as the underpinning theoretical framework.

Results

Of a total of 670 incidents, most MSIs did not result in harm (n = 495, 73.9%). Most MSIs occurred during administration (n = 439, 65.5%). Half of the incidents (n = 335, 50%) were related to one of three medication types: opioids, antimicrobials, and antithrombotic agents. Communication failures were the most frequent error-producing condition (n = 39, 5.8%) and drug omission was the most frequent active failure (n = 156, 23.3%).

Conclusion

To the knowledge of the authors, this is the first study in the United Kingdom that reports the medications most frequently involved in MSI reports for surgical patients. Staff in the surgical setting should be informed of the high frequency of incidents involving opioids, antimicrobials, heparin, and other antithrombotic agents as they appear in half of MSI reports in the surgical setting. Further research should explore administration error reduction strategies as well as tools to improve communication between staff to mitigate the risk of medicines-related harm associated with key medications.

Evaluating EHR-Integrated Digital Technologies for Medication-Related Outcomes and Health Equity in Hospitalised Adults: A Scoping Review

The purpose of this scoping review is to identify and evaluate studies that examine the effectiveness and implementation strategies of Electronic Health Record (EHR)-integrated digital technologies aimed at improving medication-related outcomes and promoting health equity among hospitalised adults. Using the Consolidated Framework for Implementation Research (CFIR), the implementation methods and outcomes of the studies were evaluated, as was the assessment of methodological quality and risk of bias. Searches through Medline, Embase, Web of Science, and CINAHL Plus yielded 23 relevant studies from 1,232 abstracts, spanning 11 countries and from 2008 to 2022, with varied research designs. Integrated digital tools such as alert systems, clinical decision support systems, predictive analytics, risk assessment, and real-time screening and surveillance within EHRs demonstrated potential in reducing medication errors, adverse events, and inappropriate medication use, particularly in older patients. Challenges include alert fatigue, clinician acceptance, workflow integration, cost, data integrity, interoperability, and the potential for algorithmic bias, with a call for long-term and ongoing monitoring of patient safety and health equity outcomes. This review, guided by the CFIR framework, highlights the importance of designing health technology based on evidence and user-centred practices. Quality assessments identified eligibility and representativeness issues that affected the reliability and generalisability of the findings. This review also highlights a critical research gap on whether EHR-integrated digital tools can address or worsen health inequities among hospitalised patients. Recognising the growing role of Artificial Intelligence (AI) and Machine Learning (ML), this review calls for further research on its influence on medication management and health equity through integration of EHR and digital technology.

Drug administration errors among anaesthesia providers in South Africa: a cross-sectional descriptive study

BACKGROUND

Drug administration errors (DAEs) in anaesthesia are common, the aetiology multifactorial and though mostly inconsequential, some lead to substantial harm. The extend of DAEs remain poorly quantified and effective implementation of prevention strategies sparse.

METHOD

A cross-sectional descriptive study was conducted using a peer-reviewed survey questionnaire, circulated to 2217 anaesthetists via a national communication platform. The aim was to determine the self-reported frequency, nature, contributing factors and reporting patterns of DAEs among anaesthesia providers in South Africa.

RESULTS

Our cohort had a response rate was 18.9%, with 420 individuals populating the questionnaire. 92.5% of surveyed participants have made a DAE and 89.2% a near-miss. Incorrect route of administration, potentially resulting in serious harm, accounted for 8.2% (n = 23/N = 279) of these errors. DAEs mostly reported in cases involving adult patients (80.5%, n = 243/N = 302), receiving a general anaesthetic (71.8%, n = 216/N = 301), where the drug-administrator prepared the drugs themselves (78.7%, n = 218/N = 277), during normal daytime hours (69.9%, n = 202/N = 289) with good lightning conditions (93.0%, n = 265/N = 285). 26% (n = 80/N = 305) of DAEs involved ampoule misidentification, whilst syringe identification error reported in 51.6% (n = 150/N = 291) of cases. DAEs are often not reported (40.3%, n = 114/N = 283), with knowledge of correct reporting procedures lacking. 70.5% (n = 198/N = 281) of DAEs were never discussed with the patient.

CONCLUSIONS

DAEs in anaesthesia remain prevalent. Known error traps continue to drive these incidents. Implementation of system based preventative strategies are paramount to guard against human error. Efforts should be made to encourage scrupulous reporting and training of anaesthesia providers, with the aim of rendering them proficient and resilient to handle these events.

Medical Professionals' Responses to a Patient Safety Incident in Healthcare

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

Unveiling the factors influencing public knowledge and behaviours towards medication errors in Jordan: a cross-sectional study

BACKGROUND

Medication errors are preventable incidents resulting from improper use of drugs that may cause harm to patients. They thus endanger patient safety and offer a challenge to the efficiency and efficacy of the healthcare system. Both healthcare professionals and patients may commit medication errors.

METHODS AND OBJECTIVES

A cross-sectional, observational study was designed using a self-developed, self-administered online questionnaire. A sample was collected using convenience sampling followed by snowball sampling. Adult participants from the general population were recruited regardless of age, gender, area of residence, medical history, or educational background in order to explore their practice, experience, knowledge, and fear of medication error, and their understanding of this drug-related problem.

RESULTS

Of the 764 participants who agreed to complete the questionnaire, 511 (66.9%) were females and 295 (38.6%) had a medical background. One-fifth of participants had experienced medication errors, with 37.7% of this segment reporting these medication errors. More than half of all medication errors (84, 57.5%) were minor and thus did not require any intervention. The average anxiety score for all attributes was 21.2 (The highest possible mean was 36, and the lowest possible was 0). The highest level of anxiety was seen regarding the risk of experiencing drug-drug interactions and the lowest levels were around drug costs and shortages. Being female, having no medical background, and having experience with medication errors were the main predictors of high anxiety scores. Most participants (between 67% and 92%) were able to recognise medication errors committed by doctors or pharmacists. However, only 21.2 to 27.5% of participants could recognise medication errors committed by patients. Having a medical background was the strongest predictor of knowledge in this study (P < 0.001).

CONCLUSION

The study revealed that the prevalence of self-reported medication errors was significantly high in Jordan, some of which resulted in serious outcomes such as lasting impairment, though most were minor. Raising awareness about medication errors and implementing preventive measures is thus critical, and further collaboration between healthcare providers and policymakers is essential to educate patients and establish effective safety protocols.

Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar

INTRODUCTION

Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar.

METHODS

A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD).

RESULTS

A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%).

CONCLUSIONS

Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.

Integrating Medical Librarians in Evidence-Based Medical Practice in Africa: A Survey of Current Practices and Challenges

Librarians' involvement in Evidence-Based Medical Practice (EBMP) has been widely reported from the Global North. The cross-sectional study designed a survey to investigate how African medical librarians integrate into EBMP. The respondents comprised medical librarians from 12 African countries. Findings revealed that African medical librarians are mostly involved in EBMP activities related to resource use, management, and evidence dissemination. The leading EBMP tools reportedly used or promoted by the librarians include UpToDate and Cochrane Library, while the leading challenges encountered in offering support for EBMP are related to skill deficiency, poor funding, and poor internet connectivity.

Deprescribing in older adults in a French community: a questionnaire study on patients' beliefs and attitudes

BACKGROUND

General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed to assess beliefs and attitudes towards deprescribing in patients, aged 65 years or older in primary care, and to identify factors associated with deprescribing and their willingness to stop medication.

METHODS

A questionnaire study was performed between 23 May and 29 July 2022 on patients aged 65 years or older attending a GP's surgery in a French area. We used the French version of the revised Patients' Attitudes Towards Deprescribing self-report questionnaire (rPATD), which measures four subscales ("Burden", "Appropriateness", "Concerns about stopping" and, "Involvement"), patients' willingness to stop one of their regular medicines, and patients' satisfaction with their current medicines.

RESULTS

The study enrolled 200 patients. Median age was 76 years old (IQR 71-81), 55% were women, and 42.5% took 5 or more medications per day. Although most patients (92.5%) were satisfied with their current medicines, 35% were reluctant to stop medications they had been taking for a long time, and 89.5% were willing to stop medication if asked to by their GP. Patients aged less than 75 years old reported more concerns about stopping. Women and patients with higher educational attainment showed significantly higher involvement in medication management.

CONCLUSIONS

The majority of older adults were willing to stop one or more of their regular medicines if asked to do so by their GP. GPs should address deprescribing into their current practice.

Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review

PURPOSE

Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes.

METHODS

We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible.

RESULTS

From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes.

CONCLUSION

Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence

OBJECTIVES

Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals.

METHODS

This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews.

RESULTS

The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased.

CONCLUSIONS

This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.

Pharmaceutical interventions for drug-related problems in the neonatal intensive care unit: incidence, types, and acceptability

Background: Drug-related problems (DRPs) are widespread in hospitalized neonates, but studies on the prevalence of DRPs in this population are limited. The presence of clinical pharmacists on multidisciplinary teams helps prevent and reduce DRPs. Aim: This investigation aimed to identify and classify the incidence of DRPs in the neonatal intensive care unit (NICU), to determine the determining factors associated with DRPs and to document clinical pharmacists' interventions, outcomes, acceptance rates and clinical significance. Method: A prospective descriptive hospital study was conducted from August to November 2023 at the NICU of Children's University Hospital, Assiut University, Egypt. DRPs were classified using the Pharmaceutical Care Network of Europe (PCNE) classification V9.1. Results: Three hundred sixteen neonates were included in the study, with a mean gestational age of 34 ± 4 weeks and a mean birth weight of 2.03 ± 0.85 kg. A total of 1723 DRPs occurred among 283 neonates (89.6%), an average of 5.5 ± 5.1 DRPs per patient. The main types were treatment effectiveness (P1) (799, 46.4%), followed by others (P3) (469, 27.2%), and treatment safety (P2) (455, 26.4%). The leading causes were dose selection (C3) (1264, 61.9%) and "other domain" (C9) (543, 26.6%). Of the 2149 interventions introduced by pharmacists, 98.8% were accepted and 93% were accepted, and fully implemented. As a result, 92% of the DRPs were resolved. Both length of hospital stay and number of medications were significantly associated with DRPs. Conclusion: DRPs are common in the NICU; this study demonstrated the crucial role of clinical pharmacists in identifying and resolving DRPs.

How does communication affect patient safety? Protocol for a systematic review and logic model

INTRODUCTION

One in 10 patients are harmed in healthcare, more than three million deaths occur annually worldwide due to patient safety incidents, and the economic burden of patient safety incidents accounts for 15% of hospital expenditure. Poor communication between patients and practitioners is a significant contributor to patient safety incidents. This study aims to evaluate the extent to which patient safety is affected by communication and to provide a logic model that illustrates how communication impacts patient safety.

METHODS AND ANALYSIS

We will conduct a systematic review of randomised and non-randomised studies, reported in any language, that quantify the effects of practitioner and patient communication on patient safety. We will search MEDLINE, CINAHL, APA PsychINfo, CENTRAL, Scopus and ProQuest theses and dissertations from 2013 to 7 February 2024. We will also hand-search references of included studies. Screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Risk of bias will be assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) for non-randomised studies, and the Cochrane Risk of Bias V.2 (RoB2) for randomised controlled trials. If appropriate, results will be pooled with summary estimates and 95% confidence intervals (CIs); otherwise, we will conduct a narrative synthesis. We will organise our findings by healthcare discipline, type of communication and type of patient safety incident. We will produce a logic model to illustrate how communication impacts patient safety.

ETHICS AND DISSEMINATION

This systematic review does not require formal ethics approval. Findings will be disseminated through international conferences, news and peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42024507578.

Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD

RATIONALE & OBJECTIVE

Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate to advanced CKD.

PREDICTORS

Demographic and biological data (including eGFR), medication prescriptions.

OUTCOME

ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs.

ANALYTICAL APPROACH

Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype).

RESULTS

During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhage (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death and 22 associated with a life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. The risk of acute kidney injury was 2.2% higher and risk of bleeding ADRs was 8% higher for each 1mL/min/1.73m2 lower baseline eGFR.

LIMITATIONS

The results cannot be extrapolated to patients who are not being treated by a nephrologist.

CONCLUSIONS

ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor.

PLAIN-LANGUAGE SUMMARY

Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.

Identifying interventions that improve medication safety & rational use of medicines in India

Background & objectives Medication-related harm is known to be the cause for about 1/10th of hospitalizations. Some estimates from India show that about 90 per cent of medicines consumed are inessential or irrational and contribute towards high out-of-pocket expenditure on health. In this context, the Indian Council of Medical Research in 2022 constituted a National Task Force (NTF) to explore possible solutions that could improve safe and rational use of medicines (SRUMs). The objective of this study was to identify research ideas in the field of SRUM through a survey of relevant stakeholders, and further to prioritize the research ideas using a pre-identified set of criteria. Methods The responses from the identified stakeholders were assessed using the Child Health and Nutrition Research Initiative method, which is an established research priority-setting methodology. First, the NTF asked for two to six research ideas from relevant Indian and global stakeholders on solutions to improve SRUM. The ideas were checked for duplicates, re-phrased where necessary and classified into various sub-themes. Subsequently, the research ideas were scored by Indian experts with relevant technical expertise using a pre-defined set of five criteria: innovativeness, effectiveness, translational value, answerability and applicability. Each research idea received from a stakeholder was assigned a score under each of the five criteria. The overall research priority score was calculated as a mean of all five criteria-specific scores and converted into a percentage. Results The final output of the prioritization process was a list of research ideas or questions, ranked by their scores. Total 209 unique ideas were received from 190 respondents, which were scored by 27 experts. The top three research topics on medication safety focused on cost-effective strategies for improving antimicrobial stewardship, safe use of poly-pharmacy in geriatric patients and drug take-back policy interventions. Regarding the rational use of medicine, the top three topics included testing mobile application-based antimicrobial stewardship interventions, development of diagnostics for antimicrobial resistance, and behavioural interventions. Interpretation & conclusions Several priority ideas found in this study also align with those of global priority, e.g., safe disposal practices and enhanced pharmacovigilance, rational use of medicines. Patient engagement, which underlines many of the top scoring ideas found in this study, is also inclined with the top research priorities reported by the WHO priority exercise on research into the safe use of medicines. However, to the best of our knowledge, this is the first such work from a low- and middle- income country on medication safety and rational use of medicines. The findings of this research priority-setting exercise can help to guide research for the development of policy-relevant and novel interventions to improve SRUM in India.

Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research

BACKGROUND

In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist.

METHODS

Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist.

RESULTS

A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall.

CONCLUSIONS

Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively.

TRIAL REGISTRATION

The review protocol is registered with PROSPERO (CRD42023450715).

Dealing with complications in interventional radiology

It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.

International Trends in Adverse Drug Event-Related Mortality from 2001 to 2019: An Analysis of the World Health Organization Mortality Database from 54 Countries

BACKGROUND AND OBJECTIVE

Adverse drug events (ADEs) are becoming a significant public health issue. However, reports on ADE-related mortality are limited to national-level evaluations. Therefore, we aimed to reveal overall trends in ADE-related mortality across the 21st century on an international level.

METHODS

This observational study analysed long-term trends in ADE-related mortality rates from 2001 to 2019 using the World Health Organization Mortality Database. The rates were analysed according to sex, age and region. North America, Latin America and the Caribbean, Western Europe, Eastern Europe and Western Pacific regions were assessed. Fifty-four countries were included with four-character International Statistical Classification of Disease and Related Health Problems, Tenth Revision codes in the database, population data in the World Population Prospects 2019 report, mortality data in more than half of the study period, and high-quality or medium-quality death registration data. A locally weighted regression curve was used to show international trends in age-standardised rates.

RESULTS

The global ADE-related mortality rate per 100,000 population increased from 2.05 (95% confidence interval 0.92-3.18) in 2001 to 6.86 (95% confidence interval 5.76-7.95) in 2019. Mortality rates were higher among men than among women, especially in those aged 20-50 years. The population aged ≥ 75 years had higher ADE-related mortality rates than the younger population. North America had the highest mortality rate among the five regions. The global ADE-related mortality rate increased by approximately 3.3-fold from 2001 to 2019.

CONCLUSIONS

The burden of ADEs has increased internationally with rising mortality rates. Establishing pharmacovigilance systems can facilitate efforts to reduce ADE-related mortality rates globally.

Mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients

Introduction

In recent years, patient safety activities have shifted from being centered on healthcare providers to involving patients themselves. Health literacy of inpatients has a direct impact on patient participation behavior. Patient safety perception was also associated with willingness to participate in patient safety and patient participation behavior. Therefore, this study aimed to investigate the mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients.

Methods

This cross-sectional study was conducted to confirm the relationship between study variables. A total of 262 inpatients were recruited from patients admitted to the ward of a tertiary general hospital between October and November 2023. Participants were invited to complete self-reported questionnaires that measured health literacy, patient safety perception, willingness to participate in patient safety, patient participation behavior, and demographic information. Data were analyzed using a dual mediation model applying the PROCESS macro (Model 6) with 95% bias-corrected bootstrap confidence intervals.

Results

This study analyzed the direct effects of health literacy on patient safety perceptions and patient participation behavior. Health literacy indirectly affected patient participation behavior through patient safety perceptions and willingness to participate in patient safety. Regarding the relationship between health literacy and patient participation behavior, patient safety perceptions and willingness to participate in patient safety showed a significant dual mediating effect.

Conclusions

This study identified the factors that promote patient participation behavior among inpatients. The mediating effect of patient safety perception on the relationship between health literacy and patient participation behavior was found to be strong. Building health literacy among inpatients ensures patient safety by increasing patient safety perceptions.