Ciapponi, A., Fernandez Nievas, S. E., Seijo, M., Rodríguez, M. B., Vietto, V., García-Perdomo, H. A., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Garcia-Elorrio, E. (2021). Reducing medication errors for adults in hospital settings. The Cochrane Database of Systematic Reviews, 11(11), 1-215.
Medical professionals have already made many attempts to address medication errors and have evaluated the impact of the proposed solutions. A systematic review and meta-analysis by Ciapponi et al. (2021) constitutes the first level of evidence and includes interrupted time series (ITS) and RCTs. Studies included in the review investigated the intervention’s effect on reducing medication error rates. Several factors support the reliability of this study and the evidence presented.
In particular, the Cochrane Library is known for its careful approach to reviews. In line with the organization’s guidelines, the authors used a comprehensive search strategy and strict inclusion criteria to select publications for the study. For data collection and analysis, Ciapponi et al. (2021) applied Cochrane and the Effective Practice and Organization of Care, which aims to support the reliability of reviews. Notably, for each of the 65 included articles, additional checks of their results and a test for bias were conducted.
The authors of the review considered the intervention results from the included publications and assessed the level of evidence presented. The most convincing of the found proofs is the middle-level evidence, which shows that reconciliation, computerized physician order entry (CPOE), and clinical decision support systems (CDSS) can potentially reduce medication errors. Despite the careful approach to the review and analysis, this study is not without weaknesses.
Ciapponi et al. (2021) note heterogeneity across settings, populations, and interventions in the selected sources. Moreover, they did not find evidence of high effectiveness for the interventions; all the evidence was rated at the average or low level. Nevertheless, the thoroughness and extensiveness of the approach make the article a helpful source for exploring interventions.
Desborough, J. A., Clark, A., Houghton, J., Sach, T., Shaw, V., Kirthisingha, V., Holland, R. C., & Wright, D. J. (2020). Clinical and cost effectiveness of a multi-professional medication reviews in care homes (CAREMED). TheInternational Journal of Pharmacy Practice, 28(6), 626–634.
One aspect specialists consider when addressing errors and improving the drug management process is the intervention’s effectiveness for patients’ health. Desborough et al. (2020) conducted a cluster-randomized controlled trial, which constitutes level I evidence. It aimed to test an intervention of a multi-professional medication review (MPMR) applied in nursing homes. The researchers suggested that such an intervention can improve the appropriateness of prescribed drugs, reduce the number of incidents, and lead to better health outcomes.
Of the 900 target participants, 826 were 65 or older. An independent statistician performed randomization, and institutions were sorted by size and resident mix, then divided into control and intervention groups using minimization by variance (Desborough et al., 2020). Homes in the intervention group received MPMR training and continued practice using the new approach, while residences in the control group continued routine practice. The authors performed statistical analyses using random-effects models and conducted a sensitivity analysis.
A comprehensive methodology is a study’s strength, indicating a high level of reliability. Moreover, the intervention results demonstrated that MPMR reduced the likelihood of prescribing inappropriate medications. As a result, such a measure can address the problem of polypharmacy and facilitate drug regimens. However, the intervention did not have a convincing impact on patient health outcomes while increasing resource needs.
The study has limitations; for example, because of the intervention’s peculiarities, the specialists involved in MPMR could not remain ignorant of the experiment, which could introduce bias. Moreover, it was conducted across two counties in England, which may limit the generalizability of the results. Nevertheless, MPMR is a highly innovative approach; therefore, its study also promotes the search for effective interventions to address medication errors.
Mahlknecht, A., Krisch, L., Nestler, N., Bauer, U., Letz, N., Zenz, D., Schuler, J., Fährmann, L., Hempel, G., Flamm, M., & Osterbrink, J. (2019). Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: Results from the interventional study InTherAKT. BMC Geriatrics, 19(1), 257.
The process of providing a patient’s medication also depends significantly on the quality of communication and collaboration between the specialists involved. Mahlknecht et al. (2019) conducted a quasi-experimental study of an interprofessional medication review intervention delivered via online platforms. This type of study corresponds to the level of evidence II.
Using power calculations, the authors determined that a sample of more than 58 participants was needed, and they eventually enrolled 130 participants from 19 nursing homes. The study collected and analyzed data using several methods, including medical record reviews, patient contact, and descriptive and statistical analyses. Using a comprehensive approach, standardized measures, and the involvement of specialists from various profiles enhances the study’s reliability.
The authors also studied the health effects on residents in addition to the effectiveness of prescribing and delivering drugs. The results showed that the intervention improved medication appropriateness and enhanced team communication efficiency. However, the number of drugs used increased, and the effect on patients’ health was insignificant. It is worth noting that the study included a sample of homes from only one region, a significant limitation that may affect the generalizability of the results.
The staff were involved in the study and therefore knew about the intervention. Moreover, participation was supported by more motivated employees, which can lead to selection bias. Thus, the study results are optimistic for cooperation between professionals in the medication delivery process. However, a more rigorous design and methodology are needed to ensure the intervention’s effectiveness.
Elbeddini, A., Almasalkhi, S., Prabaharan, T., Tran, C., Gazarin, M., & Elshahawi, A. (2021). Avoiding a Med-Wreck: A structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources. Journal of Pharmaceutical Policy and Practice, 14(1), 1-10.
Standardizing processes and using auxiliary protocols are promising areas for studying solutions to reduce medication errors. Elbeddini et al. (2021) conducted a quasi-experimental study on developing an auditing tool. The choice of such an approach means their results should be evidence of the II level. The methods used by the authors included multi-site gap analysis, multiple sets of observations, questionnaires, and a literature review (Elbeddini et al., 2021). Consequently, the study’s reliability and credibility are based on researchers collecting and analyzing data from multiple sources to present a better solution.
Based on the study results, the authors identified a lack of standardization, communication, and training as essential factors contributing to adverse medication incidents. They are confident that the standardized auditing tool used throughout the medication delivery process can reduce drug errors and significantly improve service quality. Despite the optimistic predictions, the study still includes some weaknesses. In particular, only three sittings were studied, and the proposed standardized protocol still needs to be verified and approved (Elbeddini et al., 2021). However, the ideas presented in the publication can be adapted and used as a tool to reduce errors in the nursing home.
Irons, M. W., Auta, A., Portlock, J. C., & Manfrin, A. (2022). Medication errors and processes to reduce them in care homes in the United Kingdom: A scoping review. Home Health Care Services Quarterly, 41(2), 91-123.
The literature has long included discussions of medication errors, and therefore, many studies aim to review relevant sources. Irons et al. (2022) conducted a scoping review of the literature to address errors in nursing homes in England. Although a structured approach was used, the review included literature sources of various methodologies, not just experimental studies, and therefore, the level of evidence is V.
The authors applied several criteria for the inclusion and exclusion of publications, namely the topic of medication error research, the connection to nursing homes in the UK, and the time of publication between 2006-2021 (Irons et al., 2022). Comprehensive parallel searches were chosen as a search strategy to explore databases, conduct general Internet searches, and view bibliographies. After applying the criteria and excluding the duplicates, the researchers evaluated the evidence and synthesized the results. The chosen approach enables a systematic and comprehensive study of the topic, thereby enhancing the study’s trustworthiness.
Considering the study’s findings, it is worth noting that the authors identified strong evidence for the effectiveness of monitored dosage systems in reducing administration errors. However, the application of these systems implies challenges with different types of medicines (Irons et al., 2022). The authors also note that the effectiveness of information sharing among employees involved in the medication-delivery process is essential and that communication sheets are helpful. The limitations of this source include the small number of publications in the review and their diverse methodology. Moreover, since the study focused on nursing homes in one country, the solutions presented may be tailored to its healthcare system and may be unsuitable for other territories.
Stolic, S., Ng, L., & Sheridan, G. (2023). Electronic medication administration records and nursing administration of medications: An integrative review. Collegian, 30(1), 163-189.
The medication administration process, like other procedures, often requires maintaining appropriate records to support accountability. However, the format of the records may vary, which may also affect the probability of errors. According to Stolic and Sheridan (2023), their integrative review is among the first to explore, summarize, and evaluate publications on the effects of electronic medication administration records (e-MARs) on errors.
The review included 18 empirical studies published from 2007 to 2020 and adopted a six-step approach proposed by Whittemore and Knafl. As an integrative review, it corresponds to level V. The choice of this methodology enabled a systematic analysis of many sources, thereby supporting reliability.
Notably, the authors found mixed results: some studies reported decreased errors, while others reported increased errors. Nevertheless, the literature generally supports the benefit of e-MAR. The analysis by Stolic and Sheridan (2023) helps consider solutions to the problem of mistakes, but has drawbacks. In particular, the review included a small number of publications, most of which were associated with other healthcare settings, such as intensive care. Moreover, the authors note the weakness of evidence in studies that reported improvements.
Naidu, M., & Alicia, Y. (2019). Impact of bar-code medication administration and electronic medication administration record system in clinical practice for an effective medication administration process. Health, 11(5), 511-526.
Other authors have attempted to review the use of technologies such as e-MAR and barcodes. Naidu and Alicia (2019) conducted a thorough literature review, corresponding to the V level of evidence. They assessed the rationality of the technologies, their pros and cons, and their implementation and management within the organization.
Moreover, the authors implemented their drug management proposal in one organization. While this study has a weak methodology that does not describe its data collection and analysis process, it provides detailed information. This approach may be helpful for a comprehensive evaluation of potential studies. At the same time, the publication supports the benefits of the technologies studied but warns of difficulties in the preliminary stages of implementation.