Background Even with global efforts to prevent medication errors, they still occur and cause patient harm. Little systematic research has been done in Norway to address this issue. Objectives To describe the frequency, stage and types of medication errors in Norwegian hospitals, with emphasis on the most severe and fatal medication errors. Methods Medication errors reported in 2016 and 2017 (n=3557) were obtained from the Norwegian Incident Reporting System, based on reports from 64 hospitals in 2016 and 55 in 2017. Reports contained categorical data (eg, patient age, incident date) and free text data describing the incident. The errors were classified by error type, stage in the medication process, therapeutic area and degree of harm, using a modified version of the WHO Conceptual Framework for the International Classification for Patient Safety. Results Overall, 3372 reports were included in the study. Most medication errors occurred during administration (68%) and prescribing (24%). The leading types of errors were dosing errors (38%), omissions (23%) and wrong drug (15%). The therapeutic areas most commonly involved were analgesics, antibacterials and antithrombotics. Over half of all errors were harmful (62%), of which 5.2% caused severe harm, and 0.8% were fatal. Conclusions Medication errors most commonly occurred during medication administration. Dosing errors were the most common error type. The substantial number of severe and fatal errors causing preventable patient harm and death emphasises an urgent need for error-prevention strategies. Additional studies and interventions should further investigate the error-prone medication administration stage in hospitals and explore the dynamics of severe incidents.

IntroductionBarcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations.ObjectiveTo gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes.MethodsWe conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data.ResultsWe observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design.ConclusionOur findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation.

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To establish the scope of harm related to medications, and thus design harm-reduction measures, healthcare organizations are required to measure medication safety events. This chapter will investigate methodologies for detecting adverse drug events and medication errors, analyze what type of events they detect, and discuss their advantages and limitations. We conducted a scoping review, and identified studies that compared at least two detection methods directly. The review resulted in 13 studies, of which ten were conducted in hospitals, and three were from the outpatient setting. Methods used to detect medication safety events were: incident reporting, record review, computerized surveillance, direct observation, and interviews. The detection rate of adverse drug events and medication errors varied substantially depending on the method. Incident reporting detected small numbers of events, but detected events that were not identified by other methods. Record review detected more adverse drug events than incident reporting, but missed whole classes of events, such as medication administration errors and omissions. Direct observation detected most medication errors. Computerized surveillance has promising detection abilities and can be less resource and time-intensive compared with record review, after the initial implementation. Small numbers of events were detected using any one method alone, that is, none of the methods can serve as a gold standard, and each method described has its place in monitoring medication safety. The literature supports a combination of methods to be used to detect adverse drug events and medication errors. The 10 studies in this scoping review that are from hospitals, are also described and discussed in the PhD thesis of the first author(Mulac, 2022). The scoping review, however, resulted in a low number of studies (n = 3) from the outpatient setting, which highlights the research and knowledge gaps of detecting methods for adverse drug events in municipal health and care services.