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

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 theater 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. 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. 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. 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.

急诊医疗服务(EMS)领域中关于安全用药管理实践的相关研究较为匮乏，多数循证用药安全指南均基于护理、手术室及药房场景的研究制定。防范用药差错需全面识别各类影响因素，涵盖组织层面、流程环节及患者特征等维度。现有关于用药差错发生率的研究结论并不一致，且多项来源均指出差错存在未充分上报的情况，因此难以量化该问题的真实规模。用药差错的定义也存在差异，院前场景下用药差错的特定界定尚未明确。本综述的目标为识别院前环境中急诊医疗服务人员发生用药差错的影响因素。本综述纳入了所有涉及院前场景下急诊医疗服务人员与用药安全或用药差错相关的干预措施或现象的定性与定量研究。研究团队通过检索多个数据库以筛选符合上述纳入标准的文献。所有入选文献均接受了方法学质量评价，但该评价并未作为文献排除的依据。文献筛选、质量评价及数据提取的各个环节均由两名独立评审员完成，若出现无法达成一致的争议，则由第三名评审员进行裁决。本综述采用汇聚整合研究方法，对定性数据及经质化转化的定量数据开展统一的定性综合分析。本综述最终纳入56篇文献，其中病例报告与定性研究为占比最高的文献类型。定性分析结果共归纳出7大类核心主题：组织因素（以上报机制为子主题）、设备/药品、环境因素、流程相关因素、沟通、患者相关因素（以儿科人群为子主题）及认知因素。研究同时识别出了用药差错的风险诱因与保护因素。现有关于用药差错的研究证据异质性较强，且在数量与质量上均存在局限。多种因素共同影响用药差错的发生，明确这些因素对降低差错风险至关重要。鉴于当前已有研究在测量方式、定义及研究场景上均存在差异，用药差错的发生率难以准确量化。未来需开展进一步研究，以量化特定实践场景中已识别的各类影响因素的流行程度。