More than 237 million medication errors are made all along the care process every year in England alone, estimated to cost the NHS at least £98 million and contributing to the loss of more than 1700 lives annually, say UK researchers.
Rachel Ann Elliott, PhD, professor in health economics, Manchester Centre for Health Economics, University of Manchester, and colleagues used a range of sources to examine the adverse drug event (ADE) rate in primary and secondary care, and in care homes.
Primary Care and Care Homes
The research was published by BMJ Quality & Safety on June 11th.
It showed that more than half of the medication errors were made at the point of administration. While rates per patient were lowest in primary care, the size of the sector means that almost 40% of errors occurred there.
In contrast, error rates in care homes were proportionately the highest, despite accounting for the smallest number of patients.
The team writes that the "ubiquitous" use of medicines in healthcare "leads unsurprisingly to high numbers of medication errors, although most are not clinically important".
They estimate that just over 70% of errors are minor in nature, with 25% having the potential to cause moderate harm and only 2% potentially resulting in serious harm.
Human Error
The researchers add that "understanding the prevalence and burden of medication errors can help inform decisions about where to prioritise funding of patient safety initiatives to reduce the burden".
To those ends, their work has already been used by the UK Department of Health and Social Care (DHSC) to inform the commissioning of "a new system to monitor and prevent medication errors and the development of indicators for safer prescribing, by linking prescribing data in primary care to hospital admissions".
Dr Pallavi Bradshaw, from the Medical Protection Society, was quoted by ITV News as saying: "It is important to note that many errors are down to human error, often resulting from exhaustion or burnout, rather than a lack of knowledge or incompetence."
She believes that the disruption to normal services caused by the COVID-19 pandemic may also cause a "spike in errors".
"These unfortunate and unintended mistakes occur at various points in the process and involve different healthcare professionals," Dr Bradshaw added. "A shift to a culture of openness and learning is needed if we are to see an improvement in system-wide mistakes like these."
Costs of Harm
More than a decade ago, the National Patient Safety Agency estimated that preventable harm linked to medication could cost more than £750 million every year in England alone.
With the introduction of new medications and patients’ increasingly complex medical needs making ADEs an increasingly important issue, the World Health Organisation launched in 2017 its third Global Patient Safety Challenge, with the aim of halving ADEs worldwide by 2022.
In response, the researchers were commissioned by the DHSC to examine the prevalence and burden of medication error in the NHS.
Focusing on England, they used published studies, among other sources, to determine the number of medication errors in primary care, care homes, and secondary care at each stage of the medication use process:
- Prescribing
- Transition from hospital to primary care or care homes
- Dispensing
- Administration
- Monitoring
They also estimated the number of opportunities for error at each stage and in each setting, using data such as the total number of prescriptions in primary and secondary care and the average number of items used per patient in hospital or in care homes.
The burden attributable to medication errors was then determined in terms of its severity, patient harm and costs, including admissions to hospital, length of hospital stay and post-discharge resource use.
The team estimated that, overall, there are 237,287,788 medication errors each year in England.
Of these, 21.3% occur at the prescribing phase, 1.4% at the transition phase, 15.9% at the dispensing phase, 54.4% during administration and 7.0% during monitoring.
In terms of their setting, 38.4% occurred in primary care, 41.7% in care homes, and 19.9% in secondary care.
The researchers explain that, although error rates per patients are the lowest in primary care, "the burden of errors is the second highest due to the size of the sector".
"Care homes cover fewer patients than the other sectors, but have the highest error rates per patient, leading to a disproportionately high overall number of errors," they add.
Levels of Harm
The team go on to report that 72.1% of medication errors have the potential to cause minor harm only, while 25.8% could cause moderate harm, and 2.0% severe harm, equating to 66 million errors that could cause notable harm.
The estimated annual cost to the NHS of the ADEs was £98.5 million, accounting for 181,265 bed days and causing 712 deaths and contributing to 7108 deaths overall.
The highest burden scenario examined by the researchers suggested an overall cost to the NHS of more than £1.6 billion on the broader range of NHS services, consuming 3,817,817 bed days and contributing to 22,303 deaths.
Discussing the findings, the team notes that previous research has indicated that the drugs most commonly implicated in ADEs include non-steroidal
anti-inflammatory drugs (NSAIDs), antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids.
While NSAIDs, anticoagulants and antiplatelets cause more than one third of avoidable ADEs, almost 80% of deaths were due to gastrointestinal bleeds caused by NSAIDs, aspirin or warfarin.
With older people more likely to suffer ADEs, the team says that "this presents a clear message for policymakers as to where targeted interventions could have the greatest impact".
The research is funded by the National Institute for Health Research Policy Research Programme and conducted through the Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions.
No conflicts of interest declared.
BMJ Qual Saf 2020. doi: 10.1136/bmjqs-2019-010206
