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Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study

BACKGROUND: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS: We used a novel priority...

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Autores principales: Tudor Car, Lorainne, Papachristou, Nikolaos, Gallagher, Joseph, Samra, Rajvinder, Wazny, Kerri, El-Khatib, Mona, Bull, Adrian, Majeed, Azeem, Aylin, Paul, Atun, Rifat, Rudan, Igor, Car, Josip, Bell, Helen, Vincent, Charles, Franklin, Bryony Dean
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112691/
https://www.ncbi.nlm.nih.gov/pubmed/27852240
http://dx.doi.org/10.1186/s12875-016-0552-6
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author Tudor Car, Lorainne
Papachristou, Nikolaos
Gallagher, Joseph
Samra, Rajvinder
Wazny, Kerri
El-Khatib, Mona
Bull, Adrian
Majeed, Azeem
Aylin, Paul
Atun, Rifat
Rudan, Igor
Car, Josip
Bell, Helen
Vincent, Charles
Franklin, Bryony Dean
author_facet Tudor Car, Lorainne
Papachristou, Nikolaos
Gallagher, Joseph
Samra, Rajvinder
Wazny, Kerri
El-Khatib, Mona
Bull, Adrian
Majeed, Azeem
Aylin, Paul
Atun, Rifat
Rudan, Igor
Car, Josip
Bell, Helen
Vincent, Charles
Franklin, Bryony Dean
author_sort Tudor Car, Lorainne
collection PubMed
description BACKGROUND: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS: We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. RESULTS: The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. CONCLUSIONS: Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-016-0552-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-51126912016-11-25 Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study Tudor Car, Lorainne Papachristou, Nikolaos Gallagher, Joseph Samra, Rajvinder Wazny, Kerri El-Khatib, Mona Bull, Adrian Majeed, Azeem Aylin, Paul Atun, Rifat Rudan, Igor Car, Josip Bell, Helen Vincent, Charles Franklin, Bryony Dean BMC Fam Pract Research Article BACKGROUND: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS: We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. RESULTS: The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. CONCLUSIONS: Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-016-0552-6) contains supplementary material, which is available to authorized users. BioMed Central 2016-11-16 /pmc/articles/PMC5112691/ /pubmed/27852240 http://dx.doi.org/10.1186/s12875-016-0552-6 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tudor Car, Lorainne
Papachristou, Nikolaos
Gallagher, Joseph
Samra, Rajvinder
Wazny, Kerri
El-Khatib, Mona
Bull, Adrian
Majeed, Azeem
Aylin, Paul
Atun, Rifat
Rudan, Igor
Car, Josip
Bell, Helen
Vincent, Charles
Franklin, Bryony Dean
Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title_full Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title_fullStr Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title_full_unstemmed Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title_short Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study
title_sort identification of priorities for improvement of medication safety in primary care: a prioritize study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112691/
https://www.ncbi.nlm.nih.gov/pubmed/27852240
http://dx.doi.org/10.1186/s12875-016-0552-6
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