National and Local Medication Error Reporting Systems-A Survey of Practices in 16 Countries

被引:36
作者
Holmstrom, Anna-Riia [1 ]
Airaksinen, Marja [1 ]
Weiss, Marjorie [2 ]
Wuliji, Tana [3 ]
Chan, Xuan Hao [3 ]
Laaksonen, Raisa [2 ]
机构
[1] Univ Helsinki, Fac Pharm, Div Social Pharm, Helsinki 00014, Finland
[2] Univ Bath, Dept Pharm & Pharmacol, Bath BA2 7AY, Avon, England
[3] Int Pharmaceut Federat, The Hague, Netherlands
关键词
patient safety; medication safety; safety culture; incident reporting; medication error; ADVERSE DRUG EVENTS; SAFETY; CARE;
D O I
10.1097/PTS.0b013e3182676cf3
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objectives: To explore the existence and characteristics of national and local medication error reporting (MER) systems and to describe national medication safety experts' perceptions of a good and effective MER system and barriers to reporting. Methods: In a descriptive cross-sectional study, 32 medication safety experts were identified through member organizations of the International Pharmaceutical Federation in 88 countries and other professional organizations in 3 additional countries. These experts were invited to participate in an online survey. Results: Sixteen national medication safety experts from different countries participated in the study (response rate, 50%). A national (n = 5) or local (n = 6) MER system existed in 11 of these countries. In 5 countries, no MER system existed. The most common features of the MER systems were confidentiality of the reported information and providing feedback to those involved in reporting. Most experts perceived that a good and effective MER system was characterized by the opportunity to learn from errors by those involved in reporting, having a nonpunitive approach to reporting, and ease of use. They also perceived that a blame culture, lack of time, training, and coordination of reporting were the main barriers to reporting. Conclusions: Blame culture, a lack of time, training and coordination of reporting continue to be the major barriers to reporting. Learning from errors and having a nonpunitive approach to reporting were thought to be the most critical features of a MER system. Difficulties in identifying national medication safety experts indicates a need for promoting international networking of medication safety experts and bodies for sharing information and learning from others.
引用
收藏
页码:165 / 176
页数:12
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