Medication safety in the community: A review of the literature

Background

Medications can help us stay healthy, cure some diseases, relieve symptoms of disease and improve quality of life. But like any form of treatment, they are not without risks. Although the majority of medication use occurs in the community, much of our knowledge about the prevalence and impact of medication incidents comes from the hospital environment. 

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Aim

This literature review was undertaken by NPS to obtain a greater understanding of medication safety issues in the community setting. The review explored three key areas: 

  1. Outcomes and prevalence of adverse drug events and medication errors in the community.
  2. Factors contributing to or increasing the risk of adverse drug events and medication errors.
  3. Interventions to reduce medication related adverse events that result in mortality, hospital admissions, emergency department attendances and/or morbidity in the community.

Design/method

Researchers conducted searches of key bibliographic databases and journals for relevant articles between January 1995 and February 2008. The search strategy identified 6238 articles of which 278 unique studies were included in the review. 

Summary of results

Outcomes and prevalence of adverse drug events and medication errors

  • Around 6% of hospital admissions in Australia are associated with adverse drug events, with almost one third of admissions for the elderly associated with adverse events.
  • Consistently high error rates occurred during transfer of care between hospital and community settings.
  • Ten percent of general practice patients in Australia report experiencing an adverse drug event, while 25% of high-risk patients reported adverse events associated with medicines.
  • Medication errors in the community remain a problem and their prevalence varies according to the stage of the medication process. 
  • Documentation errors that occurred during transfer of care had consistently high error rates, with 52 to 88% of transfer documents containing an error.

Factors contributing to the increased risk of medication incidents

  • Those at high risk of adverse events associated with medicines are older people, those with serious health conditions, those taking multiple medications, those using high-risk medicines and those being transferred between community and hospital care. 
  • Poor communication was the most common factor reported that contributed to medication errors. Problems with communications occurred between health professionals and patients, between GPs and pharmacists, and among health professionals. These problems were highlighted when patients were transferred between hospital and community settings.

Interventions to improve medication safety

  • Many interventions did not have a significant impact on patient outcomes such as rates of mortality, hospital admissions/readmissions, emergency department attendances, adverse drug event rates and quality of life.
  • Interventions that take a comprehensive approach to managing specific disease states such as heart failure and include medication reviews, home visits and/or telephone follow-up do show positive patient outcomes.
  • Interventions, which restricted their focus to specific high-risk drugs or drug classes showed some improvements in health outcomes.

Implications and recommendations

To guide the development and evaluation of future medication safety interventions, we need to improve the quality of available information about the prevalence and outcomes of medication incidents in the community by:

  • developing and promoting consistent definitions of events related to medication safety to allow appropriate comparisons between prevalence and intervention studies
  • developing and agreeing on valid and reliable methods for measuring the prevalence of medication incidents in the community and the preventability of incidents identified
  • performing regular intensive monitoring studies investigating the prevalence of adverse drug events and medication errors and promoting the ongoing aggregation of currently available prevalence data relating to medication incidents in the Australian community 
  • identify and/or develop valid intermediate measures of medication safety that can be used to assess the impact of interventions to reduce adverse drug events in the community
  • ensure that studies are adequately powered to detect practical improvements in patient safety.

Priority should be given to future medication safety interventions that:

  • incorporate medication safety initiatives into disease management programs that target disease states where medication management is an important process of care and the patient population is prone to high hospital admission rates (e.g. people with heart failure)
  • target people who are using specific drugs that are associated with a high risk of adverse drug events
  • target high-risk settings such as aged care facilities and transfer of care as interventions in these settings may have greater potential for impact 
  • apply evidence about the factors that contribute to adverse drug events to develop strategies that will improve the early detection and prevent the impact of adverse drug events.