Medication errors in inquiries to the Poison Information Center Erfurt — a systematic analysis

Abstract

Introduction

Poison Information Centers (PICs) fulfil the legal mandate to provide advice and answer inquiries from healthcare professionals and medical nonprofessionals on measures to be taken in the event of an intoxication. Medication errors might be a frequent cause of intoxication. However, hardly any data on medication errors are available from PICs.

Aim

We aimed to investigate the incoming inquiries of a PIC with regard to medication errors.

Methods

In the PIC database, we identified and analyzed medication errors in a retrospective analysis of inquiries from 2013 to 2020. We distinguished between medication errors committed by (i) laypersons or by healthcare professionals in (iia) medical care facilities or (iib) home care facilities. We evaluated the estimated potential risk of toxicity to assess the potential harm to the patient.

Results

From 152,149 inquiries in total, 43.5% (n = 66,229) dealt with drug exposures. We identified medication error in 19.1% (n = 12,619) of those inquiries. Of those medication errors, 80.1% (n = 10,113) were committed by (i) laypersons and 19.9% (n = 2506) were committed by healthcare professionals, with nearly equal proportions occurring in medical care and in home care [(iia) 49.6% and (iib) 50.4%, respectively]. A total of 18,718 drugs were involved, with most medication errors found for ibuprofen, acetaminophen, and levothyroxine. The medication errors led to a minor estimated risk of toxicity in 46.6% (5,877/12,619); moderate and severe risk occurred in 7.0% (886/12,619) and 2.6% (329/12,619), respectively. Medication errors caused by laypersons or healthcare professionals in home care were associated with a lower risk compared to those caused by healthcare professionals in medical care (p < 0.001).

Conclusion

This study identified medication errors that were committed mainly by laypersons in almost 80% of the medication inquiries to a PIC. Medication errors caused by healthcare professionals in medical care led to a higher risk of harm to the patients.

Keywords:

• Medication errors
• poison information center
• medical care
• home care
• medical nonprofessionals

Acknowledgments

The authors thank all inquirers for their trust in our institution. We thank Katharine Worthington for her proof reading for language.

Ethics approval

As we performed a retrospective study, ethics approval was waived by the local ethics committee.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mandy Gollmann and Martina P. Neininger. The first draft of the manuscript was written by Mandy Gollmann and Thilo Bertsche, all authors revised the manuscript. All authors read and approved the final manuscript.

Disclosure statement

All authors declare they have no conflicts of interest.

Data availability statement

The dataset analyzed during the current study is available from the corresponding author upon reasonable request.