Dataset Information

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

ABSTRACT:

Objective

To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design

Systematic review and meta-analysis.

Data sources

Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods

Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I² statistic, and publication bias was evaluated.

Results

Of the 7313 records identified, 70 studies involving 337?025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions

Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

SUBMITTER: Panagioti M

PROVIDER: S-EPMC6939648 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

Panagioti Maria M Khan Kanza K Keers Richard N RN Abuzour Aseel A Phipps Denham D Kontopantelis Evangelos E Bower Peter P Campbell Stephen S Haneef Razaan R Avery Anthony J AJ Ashcroft Darren M DM

BMJ (Clinical research ed.) 20190717

<h4>Objective</h4>To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.<h4>Design</h4>Systematic review and meta-analysis.<h4>Data sources</h4>Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.<h4>Review methods</h4>Observational studies reporting prevent ...[more]

PMID: 31315828

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Project description:IntroductionChildren admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.ObjectiveThe objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units.Data sourcesSeven electronic databases were searched between January 2000 and March 2019.Study selectionQuantitative studies that examined medication errors/preventable adverse drug events using direct observation, medication chart review, or a mixture of methods in children ??18 years of age admitted to paediatric or neonatal intensive care units were included.Data extractionData on study design, detection method used, rates and types of medication errors/preventable adverse drug events, and medication classes involved were extracted.ResultsThirty-five unique studies were identified for inclusion. In paediatric intensive care units, the median rate of medication errors was 14.6 per 100 medication orders (interquartile range 5.7-48.8%, n?=?3) and between 6.4 and 9.1 per 1000 patient-days (n?=?2). In neonatal intensive care units, medication error rates ranged from 4 to 35.1 per 1000 patient-days (n?=?2) and from 5.5 to 77.9 per 100 medication orders (n?=?2). In both settings, prescribing and medication administration errors were found to be the most common medication errors, with dosing errors the most frequently reported error subtype. Preventable adverse drug event rates were reported in three paediatric intensive care unit studies as 2.3 per 100 patients (n?=?1) and 21-29 per 1000 patient-days (n?=?2). In neonatal intensive care units, preventable adverse drug event rates from three studies were 0.86 per 1000 doses (n?=?1) and 0.47-14.38 per 1000 patient-days (n?=?2). Anti-infective agents were commonly involved with medication errors/preventable adverse drug events in both settings.ConclusionsMedication errors occur frequently in critically ill children admitted to paediatric and neonatal intensive care units and may lead to patient harm. Important targets such as dosing errors and anti-infective medications were identified to guide the development of remedial interventions.

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Dataset Information

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

Objective

Design

Data sources

Review methods

Results

Conclusions

Publications

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

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