Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review

Abstract

Introduction

There is limited research available on safe medication management practices in emergency medical services (EMS) practice, with most evidence-based medication safety guidelines based on research in nursing, operating theater and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment.

Methods and analysis

The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality; however, this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and “qualitized” quantitative data.

Results

Fifty-six articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified.

Discussion

The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication error occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.

Acknowledgments

This review will form part of a PhD through the University of Southern Queensland by Dennis Walker, for which Clint Moloney, Brendan SueSee, and David Long are supervisors.

Author Contributions

D. Walker was responsible for the design of the review and protocol, supported by C. Moloney and B. SueSee as research supervisors. R. Sharples and R. Blackman assisted with screening and data extraction. All authors have contributed to the assessment of methodological quality. D. Long and B. SueSee assisted with qualitative analysis. All authors have contributed to development and editing of the review.

Disclosure Statement

There is no conflict of interest in this project.

Ethics

There was no ethical approval required for this review.

Protocol Registration

This review has been conducted according to an established systematic review protocol (23). PROSPERO Registration: CRD42020148265