چکیده (انگلیسی):

Background:Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly
focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to,
medication error in primary care.
Methods:We used a novel priority-setting method for identifying and ranking patient safety problems and
solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended
questionnaire to identify three main problems and solutions relating to medication error in primary care. 113
clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and
45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking
was derived. The agreement between the clinicians’ scores was presented using the average expert agreement
(AEA). The study was conducted between September 2013 and November 2014.
Results:The top three problems were incomplete reconciliation of medication during patient‘hand-overs’,
inadequate patient education about their medication use and poor discharge summaries. The highest ranked
solutions included development of a standardized discharge summary template, reduction of unnecessary
prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider
and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on
how to use their medication were considered the top priorities. The highest ranked suggestions received the
strongest agreement among the clinicians, i.e. the highest AEA score.
Conclusions:Clinicians identified a range of suggestions for better medication management, quality assurance
procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible
and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further
exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.