An exploration of the factors contributing to paramedic medication errors in the pre-hospital environment

An exploration of the factors contributing to paramedic medication errors in the pre-hospital environment

Medication errors represent a significant issue in terms of patient safety. While there is a significant body of evidence regarding medication errors in the hospital environment, there is currently limited research on medication errors in the pre-hospital environment or by paramedics. As rates of medication error in the pre-hospital environment have been estimated at close to 13% in some studies, this represents a significant issue for patient safety requiring further investigation. Furthermore, there is evidence that many errors go unreported or unrecognised, having further implications in terms of the inability to use data from those events for the development of safety initiatives and medication safety guidelines. This research project identifies factors that contribute to or prevent medication errors and establishes the unique context of medication errors and medication safety within the paramedic pre-hospital environment. The first phase of the research involved a mixed method systematic review, which qualitatively identified contributing and protective factors within the existing literature. These were encompassed within seven key themes: organisational factors (including reporting as a sub-theme), equipment and medications, environmental factors, procedure-related factors, communication, patient-related factors (paediatrics and patient acuity) and cognitive factors. The results of the systematic review were used to develop a validated survey tool for quantification of those identified factors within Australasian paramedic practice. Overall, the incidence of medication errors was low, but with many errors not being reported. Organisational culture and management of errors both need to be improved. When taking contribution to known errors into account, fatigue, rushing/time pressure, distractions at the scene, the requirement to calculate dosage, multiple medications being used, and high patient acuity carried the highest relative risks. Further research is required to explore the relationships between the identified factors.

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