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      Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review

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          Abstract

          Background

          Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear.

          Objective

          The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals.

          Methods

          We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented.

          Results

          Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5–20.1%), while adverse drug events causing admission were reported in 2.8% (0.7–6.4%) of patients but it was reported that a median of 43.5% (20.0–47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0–0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8–72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5–50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload.

          Conclusion

          Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors.

          Electronic supplementary material

          The online version of this article (10.1007/s40801-017-0125-6) contains supplementary material, which is available to authorized users.

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          Most cited references89

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          To Err Is Human : Building a Safer Health System

          (2000)
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            The Quality in Australian Health Care Study.

            A review of the medical records of over 14,000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an "adverse event", which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
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              Relationship between medication errors and adverse drug events.

              To evaluate the frequency of medication errors using a multidisciplinary approach, to classify these errors by type, and to determine how often medication errors are associated with adverse drug events (ADEs) and potential ADEs. Medication errors were detected using self-report by pharmacists, nurse review of all patient charts, and review of all medication sheets. Incidents that were thought to represent ADEs or potential ADEs were identified through spontaneous reporting from nursing or pharmacy personnel, solicited reporting from nurses, and daily chart review by the study nurse. Incidents were subsequently classified by two independent reviewers as ADEs or potential ADEs. Three medical units at an urban tertiary care hospital. A cohort of 379 consecutive admissions during a 51-day period (1,704 patient-days). None. Over the study period, 10,070 medication orders were written, and 530 medications errors were identified (5.3 errors/100 orders), for a mean of 0.3 medication errors per patient-day, or 1.4 per admission. Of the medication errors, 53% involved at least one missing dose of a medication; 15% involved other dose errors, 8% frequency errors, and 5% route errors. During the same period, 25 ADEs and 35 potential ADEs were found. Of the 25 ADEs, five (20%) were associated with medication errors; all were judged preventable. Thus, five of 530 medication errors (0.9%) resulted in ADEs. Physician computer order entry could have prevented 84% of non-missing dose medication errors, 86% of potential ADEs, and 60% of preventable ADEs. Medication errors are common, although relatively few result in ADEs. However, those that do are preventable, many through physician computer order entry.
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                Author and article information

                Contributors
                +61470322286 , aber5592@uni.sydney.edu.au
                Journal
                Drugs Real World Outcomes
                Drugs Real World Outcomes
                Drugs - Real World Outcomes
                Springer International Publishing (Cham )
                2199-1154
                2198-9788
                14 November 2017
                14 November 2017
                March 2018
                : 5
                : 1
                : 1-24
                Affiliations
                [1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Faculty of Pharmacy, , University of Sydney, ; S114, Pharmacy Building A15, Sydney, NSW 2006 Australia
                [2 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, School of Pharmacy, , University of Gondar, ; Gondar, Ethiopia
                [3 ]ISNI 0000 0004 1773 5396, GRID grid.56302.32, College of Pharmacy, , King Saud University, ; Riyadh, Saudi Arabia
                [4 ]ISNI 0000 0004 1773 5396, GRID grid.56302.32, Medication Safety Research Chair, , King Saud University, ; Riyadh, Saudi Arabia
                [5 ]ISNI 0000 0004 0392 3935, GRID grid.414685.a, Centre for Education and Research on Ageing, Concord Hospital, ; Sydney, NSW Australia
                [6 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, Faculty of Medicine, St Vincent’s Hospital Clinical School, , University of New South Wales, ; Sydney, NSW Australia
                Article
                125
                10.1007/s40801-017-0125-6
                5825388
                29138993
                9689e9f8-41b5-4cb8-9948-b095051d026c
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Systematic Review
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                © The Author(s) 2018

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