Background
The United States National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer".1(p.700) Medication errors are a global health concern, not only because they affect patients' lives but also because they cost the healthcare system billions of dollars annually.2,3
Medication-related problems account for 2-3% of all hospital admissions in Australia.4 In the United States, it was estimated that medication-related deaths range between 40,000 and 98,000 a year.5,6 In the Middle East, a systematic review of 45 studies from 10 countries reported error rates ranging from 7% to 91% for prescribing errors and from 9% to 80% for administration errors.7 In Europe, up to 12% of patients admitted to hospital suffer from medication-related adverse events.5
Awareness of medication errors globally has given rise to the formation of many collaborations and institutions focusing on improving safety and reporting of errors. Institutions such as the Australian Commission on Safety and Quality in Health Care, the Institute for Safe Medication Practices in the United States, the Canadian Patient Safety Institute and the International Medication Safety Network all include medication safety as a focus.
The process of medication management includes the prescribing, dispensing, administering, monitoring, manufacturing, compounding and storing of medicines. Most interventions described in medication safety programs are associated with one or more of these steps.8-10
Medication safety plays an essential role in all healthcare organizations; focusing on improvement in this area is paramount to wider quality and safety programs. Many interventions to address medication errors have been described in the literature, including use of computer-assisted management, computer-based alerts, computerized physician prescribing systems, barcoding and robotics, as well as clinician training and education, system changes and guideline implementation.5,11-13 These interventions have had varied results in terms of improving patient safety and reducing adverse events in both the hospital and primary care setting. For example, a computerized physician prescribing system contributed to increased medication errors by doctors as they failed to provide a coherent list of what medications patients were taking and which pharmacy was supplying the medications. This is in addition to requests for medication renewal done on paper charts.12 On the other hand, Lainer et al.14 showed that computerized prescriber order entry systems with clinical decision support and involvement of pharmacists were effective at improving medication safety.
Medication safety programs include multiple interventions (more than one) that the organization has put into place to reduce adverse events or medication harm and errors. For example, a program may include implementation of guidelines as well as training sessions for clinicians working in a particular setting. A study by Stuijt et al. described the implementation of a multifaceted medication safety program in an aged care facility in The Netherlands. The program described multiple interventions including an educational training session, a medication administration protocol for patients, a card list for patients, screening of charts and finally advice on medication charts.15
While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated,12-14,16,17 no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature (i.e. the Cochrane Library and JBI Database of Systematic Reviews and Implementation Reports [JBISRIR]) demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliations and computerized physician order entry.
Primary care settings are different as they represent different challenges, especially with continuity of care and maintaining accurate records of patients' information. There is evidence to suggest that failure to maintain accurate and comprehensive clinical information may represent a risk in primary care.13,16-18 Furthermore, there is a paucity of high-quality evidence related to the topic of risk to patients and medication safety in primary care.18
The current scoping review will present the current evidence concerning medication safety programs and their outcome measures in the primary care setting in assessing patient safety.
The current scoping review seeks to map the current medication safety programs used in primary care. First, it will summarize the current literature regarding the characteristics of medication safety programs. Second, it will identify the outcomes used to measure the effectiveness of these programs on patient safety. This scoping review will be useful for clinicians seeking to implement similar programs in primary care organizations. Furthermore, it will identify gaps in the literature regarding the structure of medication safety programs in primary care and their outcome measures.
Inclusion criteria
Types of participants
The current review will consider participants of any age and any condition using care obtained from any primary care services.
Concept
The concept of interest for the proposed scoping review is the characteristics of the medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety.
Context
The context of the review is the primary care setting, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as in-patients.
Types of studies
We will consider quantitative study designs in this scoping review including experimental, descriptive and observational studies reporting any quantitative data that could be included in the review. Qualitative studies will not be considered in this review as the data extracted will not be eligible for inclusion as it will not address the objectives of the scoping review. Due to time constraints, only published data in English will be considered for the review.
Search strategy
A three-step search strategy will be utilized in this review. An initial limited search of Ovid MEDLINE, the JBI Database of Systematic Reviews and Implementation Reports and the Cochrane Library will be undertaken, followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will be undertaken across all included databases. The following databases will be searched: Ovid MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus. Third, the reference lists of all identified reports and articles will be searched for additional studies. We will include literature in English in our review. Studies published from 2000 onwards will only be included as the concept of medication safety programs is only recent and was not developed before this date.19 The following keywords will be used: medication safety, medication program, medication guidelines, medication consensus program, medication safety initiatives/campaigns, adverse events, patient safety, primary care, ambulatory care, aged care and nursing facility. These will be in addition to a comprehensive list of variations of these keywords. Please refer to the search strategy developed in MEDLINE used in Appendix I.
Data extraction
Relevant data will be extracted from the included studies to address the review question. We will use the methodology outlined by Peters et al.20,21
The data extracted will include the following: type of medication safety program, author(s), year of publication, origin/country of origin (where the study was published or conducted), aims/purpose, study population, methodology/methods, comparator, context, details of and key findings and outcomes measured that relate to the scoping review question. A list of the data extraction sheet is shown in Appendix II.
Mapping the results
The extracted data will be represented in a logical and descriptive summary that aligns with the objective of the review. We will include a chart showing the types of medication safety programs and the outcomes measured and key findings in a tabular form as shown in Appendix I. This may be further refined once we have the results of the searches.
Appendix I: Search strategy
Database: Ovid MEDLINE(R) 1946 to present with daily update search strategy
1 medication$.mp.
2 Medication$ safety.mp.
3 Medication$ program$.mp.
4 Medication$ consensus$.mp.
5 medication$ initiative$.mp.
6 medication$ guideline$.mp.
7 medication$ campaign$.mp.
8 1 or 2 or 3 or 4 or 5 or 6 or 7
9 Primary care.mp.
10 primary health care.mp.
11 general practice.mp.
12 ambulatory care.mp.
13 outpatient$ clinic$.mp.
14 9 or 10 or 11 or 12 or 13
15 medication$ error$.mp.
16 patient$ safety.mp.
17 patient$ risk$.mp.
18 adverse event$.mp.
19 15 or 16 or 17 or 18
20 8 and 14 and 19
21 limit 20 to (English language and yr="2000-Current")
Appendix II: Data extraction sheet
References