Rating the severity of medication administration errors: a systematic review

Abstract

Background: Medication errors are a global problem – endangering human lives and crippling health systems. Its incidence had been demonstrated in many research studies and concomitant factors surrounding the problem have been widely explored. Evidently, a problem regarding the research in this field seems to recur. The jargon and terminology used to describe and differentiate medication errors are haphazard and unstandardized, especially regarding the severity rating of medication errors. Aim and objectives: The main research aim of this study was to identify elements that could be included in a comprehensive medication error severity rating scale. This was to be achieved by exploring and describing the concepts “severity” and “medication error”; to explore and describe the categorization of medication errors in recent literature; and by providing a summary of constituents of a comprehensive medication administration error rating scale. Design: A systematic review design was chosen for this study. Search strategy: Electronic databases available to the North-West University were utilised. These included the following: EBSCO-host, Scopus, Web of Science, SA-epublications and Pubmed central. Studies were selected based on their relevance to the study subject and whether it contained the sought-after information. The PICO-statement was also utilised to assist in the inclusion and exclusion of studies. Research studies were appraised by a tool developed by Alan and Baker (as sourced by Alshehri et al., 2017:873), to determine quality of selected studies. Data extraction: Quantitative and qualitative data was extracted from the quality appraised studies regarding definitions of “severity” and “medication error”, categorizing of medication errors, and constituents of medication administration severity rating scales. These were represented in various tables and schemes. Data synthesis: A thematic synthesis approach was followed. Coding of qualitative data led to the culmination of themes. These were used to quantify data that could be presented in histograms and pie-charts. Synthesized results were presented in a narrative fashion. This process was followed for the main objectives of the study in determining the definition of “medication error” and “severity”, the classification of medication administration errors, and summarizing the constituents of medication error severity rating scales. Results: 17 research reports were used for the data extraction. Themes regarding the definition of “medication error” indicated that certain elements recur in different definitions, which could be used to establish a guideline for defining medication administration errors. The lack of an objective definition of “severity” in research reports was established. Themes on the classification of medication errors indicate that “the five rights” of medication administration is a frequently utilized classification system, as well as that of the NCC MERP. The medication treatment process node should also be considered with classification of errors. Regarding the severity rating tools of medication errors, constituents of a comprehensive medication administration severity rating scale were summarized and closely resembled the categories as presented in the NCC MERP scale with some minor differences discovered. Conclusion: From the study results, “medication error” can be defined as any treatment process error in the use of a medication caused by a health care provider/user’s deviation from expected actions, irrelevant of harm incurred or not. The following definition for “severity” is presented: The degree of either harm incurred or intervention-acuity required by a medication administration error; with harm ranging from hazard to death, and encompassing errors such as not reaching the patient, negligible errors, errors where action precludes harm, mild, moderate, severe and life-threatening harm. Regarding classification, it is recommended that medication errors should be firstly classified according to the medication treatment process node (medication prescription, transcription, dispensing, administration, documentation and monitoring) and secondly according to type of error (wrong patient, wrong medication (with added deviations related to the drug), wrong route, wrong time, and omission). Relating to the use of a standardised severity rating scale, the use of the NCC MERP scale is recommended, with the consideration of some minor adjustments.