The frequency and nature of medical error in primary care: understanding the diversity across studies (original) (raw)
Medical errors in primary care: results of an international study of family practice
Canadian family physician Médecin de famille canadien, 2005
To describe errors Canadian family physicians found in their practices and reported to study investigators. To compare errors reported by Canadian family physicians with those reported by physicians in five other countries. Analytical study of reports of errors. The Linnaeus Collaboration was formed to study medical errors in primary care. General practitioners in six countries, including a new Canadian family practice research network (Nortren), anonymously reported errors in their practices between June and December 2001. An evolving taxonomy was used to describe the types of errors reported. Practices in Canada, Australia, England, the Netherlands, New Zealand, and the United States. Family physicians in the six countries. Types of errors reported. Differences in errors reported in different countries. In Canada, 15 family doctors reported 95 errors. In the other five countries, 64 doctors reported 413 errors. Although the absence of a denominator made it impossible to calculate ...
A preliminary taxonomy of medical errors in family practice
Quality and Safety in Health Care, 2002
Objective: To develop a preliminary taxonomy of primary care medical errors. Design: Qualitative analysis to identify categories of error reported during a randomized controlled trial of computer and paper reporting methods. Setting: The National Network for Family Practice and Primary Care Research. Participants: Family physicians. Main outcome measures: Medical error category, context, and consequence. Results: Forty two physicians made 344 reports: 284 (82.6%) arose from healthcare systems dysfunction; 46 (13.4%) were errors due to gaps in knowledge or skills; and 14 (4.1%) were reports of adverse events, not errors. The main subcategories were: administrative failures (102; 30.9% of errors), investigation failures (82; 24.8%), treatment delivery lapses (76; 23.0%), miscommunication (19; 5.8%), payment systems problems (4; 1.2%), error in the execution of a clinical task (19; 5.8%), wrong treatment decision (14; 4.2%), and wrong diagnosis (13; 3.9%). Most reports were of errors that were recognized and occurred in reporters' practices. Affected patients ranged in age from 8 months to 100 years, were of both sexes, and represented all major US ethnic groups. Almost half the reports were of events which had adverse consequences. Ten errors resulted in patients being admitted to hospital and one patient died. Conclusions: This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.
Investigating the prevalence and causes of prescribing errors in general practice
2012
Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.
The prevalence and nature of prescribing and monitoring errors in English general practice
2013
1Prescribing is therefore an essential skill for GPs. For every prescribing decision, the potential for benefit needs to be balanced against the risk of harm. The prescriber must use clinical knowledge to apply bodies of evidence, rules, and guidance to a prescribing decision, while also taking into account the patient’s view. The challenge of prescribing has increased, owing to the increased complexity of medical care, and the treatment of older and more severely ill patients. 2 Errors can occur in this process. In primary care, published error rates per prescription item vary from less than 1%, 3 to over 40%, 4 the latter being a Swedish study where failure to document the indication for a drug was considered an error. Such variation in error rates is likely to be significantly affected by the definition of error and the rigour with which error detection is undertaken. Nevertheless, prescribing errors in primary care are a preventable source of harm, with a systematic review showi...
Analysis of 583 Physician-Reported Errors
2009
Background: Missed or delayed diagnoses are a com- mon but understudied area in patient safety research. To better understand the types, causes, and prevention of such errors, we surveyed clinicians to solicit perceived cases of missed and delayed diagnoses. Methods: A 6-item written survey was administered at 20 grand rounds presentations across the United States and by mail at 2
2011
Aim To compare the prevalence and causes of prescribing errors in newly written medication orders and how quickly they were rectified, in three NHS organisations. Methods Errors in newly written inpatient and discharge medication orders were recorded in Spring/Summer 2009 by ward pharmacists on medical admissions and surgical wards, as well as the number of erroneous doses administered (or omitted) before errors were corrected. Logistic regression analysis was used to explore the effects of ward (nested within organisation) and clinical specialty, and whether the pharmacist had checked the patient's medication history during data collection. Causes were explored using semistructured interviews with key informants. Results Overall, 1025 prescribing errors were identified in 974 of 6605 medication orders (14.7%, 95% confidence interval (CI) 13.8% to 15.6%). A mean of 0.9 doses were administered (or omitted) before each error was corrected (range 0e11), with differences between specialties and organisations. The error rate on medical admissions wards (16.3%) was significantly higher than that on surgical wards (12.2%), but this was accounted for by the higher proportion of prescribing being on admission, where omission of patients' usual medication was often identified. There were significant differences among wards (and organisations). Contributing factors included lack of feedback on errors, poor documentation and communication of prescribing decisions, and lack of information about patients' medication histories from primary care. Conclusions There were variations among wards, organisations and specialties in error rates and how quickly they were rectified. Exploring reasons for differences between organisations may be useful in identifying best practice and potential solutions.
Prescribing errors in general practice: A prospective study
European Journal of General Practice, 2009
Prescribing is one of the commonest tasks in daily general practice. Surprisingly there is little published research on errors that occur in this area. The aim of this study was to estimate the seriousness and level of prescribing errors that occurred in general practice. This prospective survey documented errors in prescriptions from 28 general practitioners as they occurred over a 3-day period in 12 community pharmacies. From a total of 3,948 prescriptions, 491 (12.4%) contained one or more errors. From a total of 8,686 drug items, 546 (6.2%) contained one or more errors. Of the errors the majority were minor (398, 72.9%), a smaller number (135, 24.7%) were major nuisance errors, and there were 13 (2.4%) potentially serious errors. The most common errors related to drug directions and dosage.
2008
Context: Harm associated with primary care medical errors is not well described. Objective: The objective of this project was to investigate the relationship between primary care medical errors and patient harm. Main Outcome Measures: The principal outcome measures for this study were: association between specific attributes of medical errors and levels of patient harm and frequency of harm classified hierarchically into five categories: (1) unknown or no known harm, (2) unstable or too early to tell if harm has occurred, (3) patient discomfort or inconvenience, (4) increased risk to patient or others, and (5) known clinical harm to the patient. Results: Clinical harm to the patient was reported in more than 10 percent of the 608 medical error reports. Prescription-related errors were most frequently associated with clinical harm (OR 5.25; 95 percent CI, 3.0-9.19; P <0.01). Conclusion: Errors in certain processes and systems are associated with patient harm in primary care. These findings might help prioritize the key areas of clinical care that warrant further study and intervention to improve patient safety.