Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

Abdulrhman Al Rowily; Zahraa Jalal; Malcolm J. Price; Mohammed H. Abutaleb; Hind Almodiaemgh; Maha Al Ammari; Vibhu Paudyal

doi:10.1007/s00228-021-03212-y

Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

Abdulrhman Al Rowily, Zahraa Jalal, Malcolm J. Price, Mohammed H. Abutaleb, Hind Almodiaemgh, Maha Al Ammari, Vibhu Paudyal^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

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Abstract

PURPOSE: This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs).

METHODS: A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason's accident causation model.

RESULTS: From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15-25%; I² = 96%; 95% PrI 4-43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73-82%; I² = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing.

CONCLUSIONS: Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings.

PROTOCOL: A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996.

Original language	English
Pages (from-to)	623–645
Number of pages	23
Journal	European Journal of Clinical Pharmacology
Volume	78
Early online date	22 Dec 2021
DOIs	https://doi.org/10.1007/s00228-021-03212-y
Publication status	Published - Apr 2022

Bibliographical note

Keywords

Non-vitamin K antagonist oral anticoagulants
Direct acting oral anticoagulants (DOACs)
Medication errors
Systematic review
Meta-analysis

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Al Rowily, A., Jalal, Z., Price, M. J., Abutaleb, M. H., Almodiaemgh, H., Al Ammari, M., & Paudyal, V. (2022). Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis. European Journal of Clinical Pharmacology, 78, 623–645. https://doi.org/10.1007/s00228-021-03212-y

@article{8a06e12a98c14d80bac7462d74a86250,

title = "Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis",

abstract = "PURPOSE: This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs).METHODS: A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason's accident causation model.RESULTS: From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15-25%; I2 = 96%; 95% PrI 4-43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73-82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing.CONCLUSIONS: Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings.PROTOCOL: A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996.",

keywords = "Non-vitamin K antagonist oral anticoagulants, Direct acting oral anticoagulants (DOACs), Medication errors, Systematic review, Meta-analysis",

author = "{Al Rowily}, Abdulrhman and Zahraa Jalal and Price, {Malcolm J.} and Abutaleb, {Mohammed H.} and Hind Almodiaemgh and {Al Ammari}, Maha and Vibhu Paudyal",

note = "{\textcopyright} 2021. The Author(s).",

year = "2022",

month = apr,

doi = "10.1007/s00228-021-03212-y",

language = "English",

volume = "78",

pages = "623–645",

journal = "European Journal of Clinical Pharmacology",

issn = "0031-6970",

publisher = "Springer",

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Al Rowily, A, Jalal, Z , Price, MJ, Abutaleb, MH, Almodiaemgh, H, Al Ammari, M & Paudyal, V 2022, 'Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis', European Journal of Clinical Pharmacology, vol. 78, pp. 623–645. https://doi.org/10.1007/s00228-021-03212-y

Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis. / Al Rowily, Abdulrhman; Jalal, Zahraa ; Price, Malcolm J. et al.
In: European Journal of Clinical Pharmacology, Vol. 78, 04.2022, p. 623–645.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients

T2 - a systematic review and meta-analysis

AU - Al Rowily, Abdulrhman

AU - Jalal, Zahraa

AU - Price, Malcolm J.

AU - Abutaleb, Mohammed H.

AU - Almodiaemgh, Hind

AU - Al Ammari, Maha

AU - Paudyal, Vibhu

PY - 2022/4

Y1 - 2022/4

N2 - PURPOSE: This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs).METHODS: A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason's accident causation model.RESULTS: From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15-25%; I2 = 96%; 95% PrI 4-43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73-82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing.CONCLUSIONS: Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings.PROTOCOL: A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996.

AB - PURPOSE: This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs).METHODS: A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason's accident causation model.RESULTS: From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15-25%; I2 = 96%; 95% PrI 4-43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73-82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing.CONCLUSIONS: Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings.PROTOCOL: A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996.

KW - Non-vitamin K antagonist oral anticoagulants

KW - Direct acting oral anticoagulants (DOACs)

KW - Medication errors

KW - Systematic review

KW - Meta-analysis

U2 - 10.1007/s00228-021-03212-y

DO - 10.1007/s00228-021-03212-y

M3 - Review article

C2 - 34935068

SN - 0031-6970

VL - 78

SP - 623

EP - 645

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

ER -

Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

Abstract

Bibliographical note

Keywords

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