STRATEGIES FOR REDUCING MEDICATION ERRORS DURING HOSPITALIZATION: INTEGRATIVE REVIEW

Costa, Claudia Regina de Barros; Santos, Sara Soares dos; Godoy, Simone de; Alves, Leila Maria Marchi; Silva, Ítalo Rodolfo; Mendes, Isabel Amélia Costa

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Sumário

REVIEW • Cogit. Enferm. 26 • 2021 • https://doi.org/10.5380/ce.v26i0.79446 copy

STRATEGIES FOR REDUCING MEDICATION ERRORS DURING HOSPITALIZATION: INTEGRATIVE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

to synthesize the knowledge related to strategies to reduce medication errors during the hospitalization of adult patients

Method

integrative literature review carried out in October 2020 through the search for publications in electronic databases: Web of Science, Pubmed, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean literature in Health Sciences and Google Scholar

Results

sample composed of 12 studies, whose strategies for the reduction of medication errors were presented according to the categories: involvement of the clinical pharmacist in clinical activities, implementation of information technologies, educational strategies mediated by simulation and games, and workload reduction

Conclusion

associated with technologies, the involvement of the clinical pharmacist in the medical and nursing team will result in improvements in the reduction of adverse medication events and in the quality of care provided to the patient

DESCRIPTORS
Medication error; Patient Safety; Hospital Medication Systems; Safety Management; Nursing Care

Periodical / country of development / year	Research site	Journal specialty / level of evidence
Therapeutics and Clinical Risk Management, China, 2015⁽¹⁷17 Wang H, Jin J, Feng X, Huang X, Zhu L, Zhao X, et al. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Ther Clin Risk Manag. [Internet]. 2015 [acesso em 30 nov 2020]; 5(11): 393-406. Disponível em: https://doi.org/10.2147/TCRM.S79238. https://doi.org/10.2147/TCRM.S79238... ⁾	Teaching hospital	Interdisciplinary (VI)
PloS One, France, 2015⁽¹⁸18 Hernandez F, Majoul E, Montes-Palacios C, Antignac M, Cherrier B, Doursounian L, et al. An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit. PLoS ONE [Internet]. 2015 [acesso em 26 nov 2020]; 10(7). Disponível em: https://doi.org/10.1371/journal.pone.0134101. https://doi.org/10.1371/journal.pone.013... ⁾	Teaching hospital, orthopedic surgical unit	Interdisciplinary (VI)
Pharmacy Practice, USA, 2015⁽¹⁹19 Smith L, Mosley J, Lott S, Cyr Jr. E, Amin R, Everton E, et al. Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting. Pharmacy Pract. [Internet]. 2015 [acesso em 30 nov 2020]; 13(4). Disponível em: http://dx.doi.org/10.18549/PharmPract.2015.04.634. https://doi.org/10.18549/PharmPract.2015... ⁾	For-profit community hospital affiliated with the health system of the Hospital Corporation of America (HCA)	Pharmacy (IV)
Latin American Journal of Nursing (Rlae), Brazil, 2016⁽²⁰20 Volpe CRG, Melo EMM de, Aguiar LB de, Pinho DLM, Stival MM. Risk factors for medication errors in the electronic and manual prescription. Rev. Latino-Am. Enfermagem [Internet]. 2016 [acesso em 29 nov 2020]; 24. Disponível em: http://dx.doi.org/10.1590/1518-8345.0642.2742. https://doi.org/10.1590/1518-8345.0642.2... ⁾	Public hospital	Nursing (VI)
European Journal of Hospital Pharmacy (EJHP), Denmark, 2016⁽²¹21 Risor BW, Lisby M, Sorensen J. An automated medication system reduces errors in the medication administration process: results from a Danish hospital study. Eur J Hosp Pharm. [Internet]. 2016 [acesso em 27 nov 2020]; 23 (4): 189-96. Disponível em: https://doi.org/10.1136/ejhpharm-2015-000749. https://doi.org/10.1136/ejhpharm-2015-00... ⁾	Teaching hospital, hematological	Hospital pharmacy (IV)
Journal of Research in Pharmacy Practice (JRPP), Iran, 2017⁽²²22 Farzi S, Irajpour A, Saghaei M, Ravaghi H. Causes of Medication Errors in Intensive Care Units from the Perspective of Healthcare Professionals. J Res Pharm Pract [Internet]. 2017 [acesso em 26 nov 2020]; 6(3): 158-65. Disponível em: https://doi.org/10.4103/jrpp.JRPP_17_47. https://doi.org/10.4103/jrpp.JRPP_17_47... ⁾	Teaching hospital	Pharmacy (VI)
Epidemiology and Health, Iran, 2017⁽²³23 Fathi A, Hajizadeh M, Moradi K, Zandian H, Dezhkameh M, Kazemzadeh S, et al. Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiol Health [Internet]. 2017 [acesso em 26 nov 2020]; 17(39). Disponível em: https://doi.org/10.4178/epih.e2017022. https://doi.org/10.4178/epih.e2017022... ⁾	Teaching hospital	Epidemiology and Public Health (VI)
PLoS One, France, 2017⁽²⁴24 Nguyen Tri-Long, Leguelinel-Blache G, Kinowski Jean-Marie, Roux-Marson C, Rougier M, Spence J, et al. Improving medication safety: Development and impact of a multivariate model-based strategy to target high-risk patients. PLoS ONE [Internet]. 2017 [acesso em 27 nov 2020]; 12(2). Disponível em: https://doi.org/10.1371/journal.pone.0171995. https://doi.org/10.1371/journal.pone.017... ⁾	Teaching hospital	Interdisciplinary (IV)
BMJ Quality Improvement Reports, Netherlands, 2017⁽²⁵25 Plas AV de, Slikkerveer M, Hoen S, Schrijnemakers R, Driessen J, Vries F de, et al. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm. BMJ Qual Improv Rep. [Internet]. 2017 [acesso em 28 nov 2020]; 6(1). Disponível em: https://doi.org/10.1136/bmjquality.u215011.w5936. https://doi.org/10.1136/bmjquality.u2150... ⁾	Teaching hospital	Health (III)
Hospital Pharmacy, USA, 2018⁽²⁶26 Pouliot JD, Neal EB, Lobo BL, Hargrove F, Gupta RK. The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy. Hospital Pharmacy [Internet]. 2018 [acesso em 27 nov 2020]; 53(3):170-6. Disponível em: https://doi.org/10.1177/0018578717741392. https://doi.org/10.1177/0018578717741392... ⁾	Teaching hospital	Pharmacy (IV)
Therapeutic Advances in Drug Safety, Australia, 2019⁽²⁷27 Tran T, Taylor SE, Hardidge A, Mitri E, Aminian P, George J, et al. Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and post intervention study. The Adv Drug Saf. [Internet]. 2019 [acesso em 28 nov 2020]; 10. Disponível em: https://doi.org/10.1177/2042098619863985. https://doi.org/10.1177/2042098619863985... ⁾	Teaching hospital	Interdisciplinary (III)
Einstein (São Paulo), Brazil, 2019⁽²⁸28 Vilela RPB, Jericó M de C. Implementing technologies to prevent medication errors at a high-complexity hospital: analysis of cost and results. Einstein (São Paulo) [Internet]. 2019 [acesso em 29 nov 2020]; 17(4). Disponível em: https://doi.org/10.31744/einstein_journal/2019gs4621. https://doi.org/10.31744/einstein_journa... ⁾	Teaching hospital	Health (VI)

Article title	Strategies for reducing medication errors
Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era⁽¹⁷17 Wang H, Jin J, Feng X, Huang X, Zhu L, Zhao X, et al. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era. Ther Clin Risk Manag. [Internet]. 2015 [acesso em 30 nov 2020]; 5(11): 393-406. Disponível em: https://doi.org/10.2147/TCRM.S79238. https://doi.org/10.2147/TCRM.S79238... ⁾	Three-and-a-half year intervention program focusing on medication errors, aiming for institutional accreditation by Joint Commission International (JCI)
Causes of Medication Errors in Intensive Care Units from the Perspective of Healthcare Professionals⁽²²22 Farzi S, Irajpour A, Saghaei M, Ravaghi H. Causes of Medication Errors in Intensive Care Units from the Perspective of Healthcare Professionals. J Res Pharm Pract [Internet]. 2017 [acesso em 26 nov 2020]; 6(3): 158-65. Disponível em: https://doi.org/10.4103/jrpp.JRPP_17_47. https://doi.org/10.4103/jrpp.JRPP_17_47... ⁾	Computerized entry of the prescription order; identical format for writing the prescription; permanent education to the health team; effective human resource in care; collaboration of the pharmacist; involvement of family/caregivers in the medication reconciliation process in hospital.
Medication errors among nurses in teaching hospitals in the West of Iran: what we need to know about prevalence, types, and barriers to reporting⁽²³23 Fathi A, Hajizadeh M, Moradi K, Zandian H, Dezhkameh M, Kazemzadeh S, et al. Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiol Health [Internet]. 2017 [acesso em 26 nov 2020]; 17(39). Disponível em: https://doi.org/10.4178/epih.e2017022. https://doi.org/10.4178/epih.e2017022... ⁾	Reduction of the nursing team's workload and implementation of permanent education programs for the health team.
An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit⁽¹⁸18 Hernandez F, Majoul E, Montes-Palacios C, Antignac M, Cherrier B, Doursounian L, et al. An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit. PLoS ONE [Internet]. 2015 [acesso em 26 nov 2020]; 10(7). Disponível em: https://doi.org/10.1371/journal.pone.0134101. https://doi.org/10.1371/journal.pone.013... ⁾	A Computerized Physician Order Entry (CPOE) system associated with verification by the clinical pharmacist.
Improving medication safety: Development and impact of a multivariate model-based strategy to target high-risk patients⁽²⁴24 Nguyen Tri-Long, Leguelinel-Blache G, Kinowski Jean-Marie, Roux-Marson C, Rougier M, Spence J, et al. Improving medication safety: Development and impact of a multivariate model-based strategy to target high-risk patients. PLoS ONE [Internet]. 2017 [acesso em 27 nov 2020]; 12(2). Disponível em: https://doi.org/10.1371/journal.pone.0171995. https://doi.org/10.1371/journal.pone.017... ⁾	A multivariate model to predict potential medication-related adverse events as a strategy to improve the allocation of the clinical pharmacist and subsequent patient safety.
The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy⁽²⁶26 Pouliot JD, Neal EB, Lobo BL, Hargrove F, Gupta RK. The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy. Hospital Pharmacy [Internet]. 2018 [acesso em 27 nov 2020]; 53(3):170-6. Disponível em: https://doi.org/10.1177/0018578717741392. https://doi.org/10.1177/0018578717741392... ⁾	A support tool for clinical decision making incorporated into the Computerized Physician Order Entry (CPOE) system.
An automated medication system reduces errors in the medication administration process: results from a Danish hospital study⁽²¹21 Risor BW, Lisby M, Sorensen J. An automated medication system reduces errors in the medication administration process: results from a Danish hospital study. Eur J Hosp Pharm. [Internet]. 2016 [acesso em 27 nov 2020]; 23 (4): 189-96. Disponível em: https://doi.org/10.1136/ejhpharm-2015-000749. https://doi.org/10.1136/ejhpharm-2015-00... ⁾	An Automated Medication System - AMS integrates electronic medication administration records (eMARs) and barcode-assisted automatic dispensing (BCMA).
Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting⁽¹⁹19 Smith L, Mosley J, Lott S, Cyr Jr. E, Amin R, Everton E, et al. Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting. Pharmacy Pract. [Internet]. 2015 [acesso em 30 nov 2020]; 13(4). Disponível em: http://dx.doi.org/10.18549/PharmPract.2015.04.634. https://doi.org/10.18549/PharmPract.2015... ⁾	Involvement of the clinical pharmacist in the medication reconciliation process during hospitalization
Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and post intervention study⁽²⁷27 Tran T, Taylor SE, Hardidge A, Mitri E, Aminian P, George J, et al. Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and post intervention study. The Adv Drug Saf. [Internet]. 2019 [acesso em 28 nov 2020]; 10. Disponível em: https://doi.org/10.1177/2042098619863985. https://doi.org/10.1177/2042098619863985... ⁾	Involvement of the clinical pharmacist in the medication reconciliation process during hospitalization and electronic prescription using eMMS (electronic medication management system) in hospitalized orthopedic patients.
Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm⁽²⁵25 Plas AV de, Slikkerveer M, Hoen S, Schrijnemakers R, Driessen J, Vries F de, et al. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm. BMJ Qual Improv Rep. [Internet]. 2017 [acesso em 28 nov 2020]; 6(1). Disponível em: https://doi.org/10.1136/bmjquality.u215011.w5936. https://doi.org/10.1136/bmjquality.u2150... ⁾	Hospital Improvement Program, Lean Six Sigma. Customized intervention for the problems: five-step cycle, DMAIC (define, measure, analyze, improve, control), with team training, routine changes in the medication administration process, posters and folders.
Implementing technologies to prevent medication errors at a high-complexity hospital: analysis of cost and results⁽²⁸28 Vilela RPB, Jericó M de C. Implementing technologies to prevent medication errors at a high-complexity hospital: analysis of cost and results. Einstein (São Paulo) [Internet]. 2019 [acesso em 29 nov 2020]; 17(4). Disponível em: https://doi.org/10.31744/einstein_journal/2019gs4621. https://doi.org/10.31744/einstein_journa... ⁾	Integration of various technologies in the medication chain in the prevention of medication errors.
Risk factors for medication errors in the electronic and manual prescription⁽²⁰20 Volpe CRG, Melo EMM de, Aguiar LB de, Pinho DLM, Stival MM. Risk factors for medication errors in the electronic and manual prescription. Rev. Latino-Am. Enfermagem [Internet]. 2016 [acesso em 29 nov 2020]; 24. Disponível em: http://dx.doi.org/10.1590/1518-8345.0642.2742. https://doi.org/10.1590/1518-8345.0642.2... ⁾	Electronic prescription (EP) with support for clinical decision making X manual prescription (MP), identifying risk factors for medication errors.

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[1] Corresponding author
Isabel Amélia Costa Mendes Universidade de São Paulo – Ribeirão Preto, SP, Brasil E-mail: iamendes@usp.br