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Medication errors reported by US family physicians and their office staff
  1. G M Kuo1,
  2. R L Phillips2,
  3. D Graham3,
  4. J M Hickner4
  1. 1
    Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
  2. 2
    Robert Graham Center, Washington DC, USA
  3. 3
    American Academy of Family Physicians National Research Network, Leawood, Kansas, USA
  4. 4
    Department of Family Medicine, Division of the Biological Sciences and the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
  1. G M Kuo, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, MC-0714, La Jolla, CA 92093-0714, USA; gmkuo{at}ucsd.edu

Abstract

Background: Most medication error studies come from inpatient settings. There is limited information about medication errors in primary care settings.

Objective: To describe medication errors reported by family physicians and their office staff and to estimate their preventability using currently available electronic prescribing and monitoring tools.

Design, setting, participants and study instrument: In two error reporting studies conducted by the American Academy of Family Physicians (AAFP) National Research Network (NRN), 1265 medical errors were voluntarily reported by >440 primary care clinicians and staff from 52 physician offices. The 194 error reports related to medications were abstracted and analysed using a medication error coding tool—Medication Error Types, Reasons, and Informatics Preventability (METRIP).

Main outcome measures: Type, severity and preventability of medication errors and associated adverse drug events (ADEs).

Results: 126 (70%) of the medication errors were prescribing errors, 17 (10%) were medication administration errors, 17 (10%) documentation errors, 13 (7%) dispensing errors and 5 (3%) were monitoring errors. ADEs resulted from 16% of reported medication errors. The severity of harm from reported errors were: prevented and did not reach patients, (72, 41%), reached patients but did not require monitoring (63, 35%), reached patients and required monitoring (15, 8%), reached patients and required intervention (23, 13%) and reached patients and resulted in hospitalisation (5, 3%). No deaths were reported. Of the errors that were prevented from reaching patients, 29 (40%) were prevented by pharmacists, 14 (19%) by physicians, 12 (17%) by patients and 5 (7%) by nurses. 102 (57%) of the reported errors might have been prevented with enhanced electronic prescribing and monitoring tools.

Conclusions: Most medication errors reported from US family physician offices were related to prescribing errors and more than half of the errors reached patients. The errors were prevented by pharmacists, patients and physicians. More than half of the errors could be prevented by electronic tools.

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Footnotes

  • Funding: We gratefully acknowledge the funding and support from the Agency for Healthcare Research and Quality (AHRQ) to the American Academy of Family Physicians National Research Network (AAFP NRN) and the Robert Graham Center (P20HS11584) and to GMK, (K08HS014552); from the American Academy of Family Physicians to the AAFP NRN and the Robert Graham Center.

  • Competing interests: The authors declare that they have no potential, perceived, or real competing and/or conflicts of interest.

  • Ethics approval: The error reporting studies were approved by institutional review boards at Georgetown University, the University of Missouri-Kansas City, the AAFP, and by individual site institutional review boards as required. Analysis for this study was also approved by the Baylor College of Medicine institutional review board.

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