High-risk medication errors: Insight from the UK National Reporting and learning system
Background: Ensuring patient safety is of paramount importance in healthcare systems. Rising concerns about medical errors in the UK have necessitated a greater focus on studying the nature of such errors, particularly those involving high-risk medications. Objectives: To conduct a retrospective ana...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | Exploratory Research in Clinical and Social Pharmacy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667276624001288 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850205995623514112 |
|---|---|
| author | Abdulrhman Alrowily Khalid Alfaraidy Saleh Almutairi Abdullah Alamri Wejdan Alrowily Mohammed Abutaleb Mohammad Zaitoun Waddad Sarawi Mashael Aljead |
| author_facet | Abdulrhman Alrowily Khalid Alfaraidy Saleh Almutairi Abdullah Alamri Wejdan Alrowily Mohammed Abutaleb Mohammad Zaitoun Waddad Sarawi Mashael Aljead |
| author_sort | Abdulrhman Alrowily |
| collection | DOAJ |
| description | Background: Ensuring patient safety is of paramount importance in healthcare systems. Rising concerns about medical errors in the UK have necessitated a greater focus on studying the nature of such errors, particularly those involving high-risk medications. Objectives: To conduct a retrospective analysis of incidents related to patient safety in the UK based on data from the National Rporting and Learning System (NRLS). Methods: This study was conducted based on a review of the National Reporting and Learning System (NRLS) patient safety reports published between January 1, 2015, and December 31, 2015. NHS Improvement provides details regarding incidents following approval using a data-sharing agreement. In total, 1500 incidents were analszed and equally divided among the three categories of high-risk drugs: opioids, insulin, and anticoagulants. Excel® features and deductive reasoning (thematic analysis) were used for data analysis. Results: The results showed that the insulin category had both the highest risk and most errors compared with anticoagulants and opioids. These errors primarily result from issues related to administering, prescribing, and dispensing the drugs. Inadequate drug checks, communication difficulties among staff and patients, and high staff workloads are often linked to these errors. Conclusion: This study confirms that the NRLS database is a valuable source of data, and the suggestions put forth, based on these results, could contribute to the formulation of measures that diminish the occurrence of errors related to high-risk drugs in healthcare settings. Information technology should enhance medication safety by tracking the process of medication use. |
| format | Article |
| id | doaj-art-e04e32c2a1e342b494d1a370540f2068 |
| institution | OA Journals |
| issn | 2667-2766 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Exploratory Research in Clinical and Social Pharmacy |
| spelling | doaj-art-e04e32c2a1e342b494d1a370540f20682025-08-20T02:10:57ZengElsevierExploratory Research in Clinical and Social Pharmacy2667-27662025-03-011710053110.1016/j.rcsop.2024.100531High-risk medication errors: Insight from the UK National Reporting and learning systemAbdulrhman Alrowily0Khalid Alfaraidy1Saleh Almutairi2Abdullah Alamri3Wejdan Alrowily4Mohammed Abutaleb5Mohammad Zaitoun6Waddad Sarawi7Mashael Aljead8King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; Corresponding author.King Fahad Military Medical Complex, Dhahran 31932, Saudi ArabiaKing Fahad Military Medical Complex, Dhahran 31932, Saudi ArabiaKing Fahad Military Medical Complex, Dhahran 31932, Saudi ArabiaKing Fahad Military Medical Complex, Dhahran 31932, Saudi ArabiaKing Fahd Central Hospital, Jazan 82666, Saudi ArabiaArmed Forces Hospitals Southern Region, Khamis Mushait 62413, Saudi ArabiaKing Saud University, Riyadh 145111, Saudi ArabiaPrince Sultan Military Medical City, Riyadh 11159, Saudi ArabiaBackground: Ensuring patient safety is of paramount importance in healthcare systems. Rising concerns about medical errors in the UK have necessitated a greater focus on studying the nature of such errors, particularly those involving high-risk medications. Objectives: To conduct a retrospective analysis of incidents related to patient safety in the UK based on data from the National Rporting and Learning System (NRLS). Methods: This study was conducted based on a review of the National Reporting and Learning System (NRLS) patient safety reports published between January 1, 2015, and December 31, 2015. NHS Improvement provides details regarding incidents following approval using a data-sharing agreement. In total, 1500 incidents were analszed and equally divided among the three categories of high-risk drugs: opioids, insulin, and anticoagulants. Excel® features and deductive reasoning (thematic analysis) were used for data analysis. Results: The results showed that the insulin category had both the highest risk and most errors compared with anticoagulants and opioids. These errors primarily result from issues related to administering, prescribing, and dispensing the drugs. Inadequate drug checks, communication difficulties among staff and patients, and high staff workloads are often linked to these errors. Conclusion: This study confirms that the NRLS database is a valuable source of data, and the suggestions put forth, based on these results, could contribute to the formulation of measures that diminish the occurrence of errors related to high-risk drugs in healthcare settings. Information technology should enhance medication safety by tracking the process of medication use.http://www.sciencedirect.com/science/article/pii/S2667276624001288Clinical pharmacologyDrug safetyOpioidsInsulinAnticoagulantsMedication errors |
| spellingShingle | Abdulrhman Alrowily Khalid Alfaraidy Saleh Almutairi Abdullah Alamri Wejdan Alrowily Mohammed Abutaleb Mohammad Zaitoun Waddad Sarawi Mashael Aljead High-risk medication errors: Insight from the UK National Reporting and learning system Exploratory Research in Clinical and Social Pharmacy Clinical pharmacology Drug safety Opioids Insulin Anticoagulants Medication errors |
| title | High-risk medication errors: Insight from the UK National Reporting and learning system |
| title_full | High-risk medication errors: Insight from the UK National Reporting and learning system |
| title_fullStr | High-risk medication errors: Insight from the UK National Reporting and learning system |
| title_full_unstemmed | High-risk medication errors: Insight from the UK National Reporting and learning system |
| title_short | High-risk medication errors: Insight from the UK National Reporting and learning system |
| title_sort | high risk medication errors insight from the uk national reporting and learning system |
| topic | Clinical pharmacology Drug safety Opioids Insulin Anticoagulants Medication errors |
| url | http://www.sciencedirect.com/science/article/pii/S2667276624001288 |
| work_keys_str_mv | AT abdulrhmanalrowily highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT khalidalfaraidy highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT salehalmutairi highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT abdullahalamri highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT wejdanalrowily highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT mohammedabutaleb highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT mohammadzaitoun highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT waddadsarawi highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem AT mashaelaljead highriskmedicationerrorsinsightfromtheuknationalreportingandlearningsystem |