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

Walker, Dennis ORCID: https://orcid.org/0000-0003-0322-845X and Moloney, Clint ORCID: https://orcid.org/0000-0003-2520-1506 and SueSee, Brendan ORCID: https://orcid.org/0000-0002-2829-2645 and Sharples, Renee and Blackman, Rosanna and Long, David ORCID: https://orcid.org/0000-0002-6278-7377 and Hou, Xiang-Yu (2022) Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. Prehospital Emergency Care. ISSN 1090-3127


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 theatre 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.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Files associated with this item cannot be displayed due to copyright restrictions.
Faculty/School / Institute/Centre: Current – Faculty of Health, Engineering and Sciences - School of Health and Medical Sciences (1 Jan 2022 -)
Faculty/School / Institute/Centre: Current - Faculty of Business, Education, Law and Arts - School of Education (1 Jul 2019 -)
Date Deposited: 28 Jun 2022 23:02
Last Modified: 06 Nov 2022 05:12
Uncontrolled Keywords: Medication error; medication safety; paramedic; prehospital; EMS; ambulance
Fields of Research (2020): 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320219 Paramedicine
42 HEALTH SCIENCES > 4203 Health services and systems > 420317 Patient safety
Socio-Economic Objectives (2020): 20 HEALTH > 2003 Provision of health and support services > 200399 Provision of health and support services not elsewhere classified
20 HEALTH > 2003 Provision of health and support services > 200311 Urgent and critical care, and emergency medicine
Identification Number or DOI: https://doi.org/10.1080/10903127.2022.2068089
URI: http://eprints.usq.edu.au/id/eprint/49376

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