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

BMC Family Practice

Research Article

Helen Bell¹  Bryony Dean Franklin²  Charles Vincent³  Rifat Atun⁴  Mona El-Khatib⁵  Paul Aylin⁵  Lorainne Tudor Car⁵  Nikolaos Papachristou⁵  Azeem Majeed⁵  Rajvinder Samra⁶  Josip Car⁷  Adrian Bull⁸  Joseph Gallagher⁹  Kerri Wazny^1,10  Igor Rudan^1,10 

[1] Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK;Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust/UCL School of Pharmacy, London, UK;Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK;Department of Global Health and Population & Department of Health Policy and Management, Harvard, Boston, USA;Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK;Faculty of Health & Social Care, Health & Social Care Programme, The Open University, Milton Keynes, UK;Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore;Imperial College Health Partners, London, UK;UCD Conway Institute, gHealth Research Group, The University College Dublin School of Medicine, Dublin, Ireland;Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK;

关键词: Medication error;    Patient safety;    Priority-setting;    Crowd-sourcing;    Primary care;    Clinicians;   

DOI  :  10.1186/s12875-016-0552-6

 received in 2016-04-01, accepted in 2016-10-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundMedication 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.MethodsWe 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.ResultsThe 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.ConclusionsClinicians 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.

【 授权许可】

CC BY   
© The Author(s). 2016