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.

Identifying high-risk medications and error types in Danish patient safety database using disproportionality analysis

BACKGROUND

Medication error (ME) surveillance in Danish healthcare relies on the mandatory national incident reporting system, the Danish Patient Safety Database (DPSD). Individual case reviews and descriptive statistics with frequency counts are the most often used approaches when analyzing MEs in incident reporting systems, including the DPSD. However, incident reporting systems often generate a large number of reports and may suffer from underreporting; consequently, additional approaches are needed to overcome these challenges. Disproportionality analysis (DPA) is a statistical tool used for signal detection of adverse drug reactions in pharmacovigilance reports, but the evidence for using DPA on ME analysis in safety reporting systems is limited.

OBJECTIVES

We aimed to test the feasibility of DPA by analysing harmful MEs reported to DPSD 2014-2018.

METHODS

We utilized proportional reporting ratios (PRR) to identify signals of diproportionality.

RESULTS

We identified well-known high-risk medicines, including anticoagulants, opioids, insulins, antiepileptic, and antipsychotic drugs, and their association with several ME types and stages in a medication process.

CONCLUSION

DPA might be suggested as an additional tool for screening MEs and identifying priority areas for further investigation in safety reporting systems.

"Everybody Makes Mistakes": Children's Views on Medical Errors and Disclosure

PURPOSE

The aim of this study was to explore the views of chronically-ill pediatric patients on medical errors and disclosure processes.

DESIGN AND METHODS

Semi-structured, qualitative interviews were conducted with twenty pediatric patients. Participants comprised ten children (8-12 years) and ten adolescents (13-18 years). Multiple methods using qualitative approaches were applied to explore and elicit views on medical errors, disclosure and recommendations for patient safety. For the children, art and play-based methods along with visual aids and vignettes were used to facilitate discussion. Older participants predominantly engaged in discussing the issue of medical errors through an examination of vignettes representing levels of harm.

RESULTS

Participants revealed a range of perspectives including a strong desire to be told of errors. While they wanted those responsible for the error to be held accountable, they acknowledged that everyone makes mistakes. Children's rights and participation in patient safety as well as the existence of secret errors emerged spontaneously through the data analysis.

CONCLUSIONS

Chronically-ill children want to know about errors, from the person responsible for the error, and consider apologies and genuine remorse to be critical for coping. Children acknowledge that disclosure requires a case-by-case analysis.

PRACTICE IMPLICATIONS

The results have implications for how we view disclosure processes with children and how to engage them in patient safety.