Medication safety incidents associated with the remote delivery of primary care: a rapid review

  1. Laura L Gleeson
  2. Barbara Clyne
  3. James W Barlow
  4. Benedict Ryan
  5. Paul Murphy
  6. Emma Wallace
  7. Aoife De Brún
  8. Lisa Mellon
  9. Marcus Hanratty
  10. Mark Ennis
  11. Alice Holton
  12. Muriel Pate
  13. Ciara Kirke
  14. Michelle Flood
  15. Frank Moriarty

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Abstract

Objectives

The COVID-19 pandemic triggered rapid, fundamental changes, notably increased remote delivery of primary care. While the impact of these changes on medication safety is not yet fully understood, research conducted before the pandemic may provide evidence for possible consequences. To examine the published literature on medication safety incidents associated with the remote delivery of primary care, with a focus on telemedicine and electronic prescribing.

Methods

A rapid review was conducted according to the Cochrane Rapid Reviews Methods Group guidance. An electronic search was carried out on Embase and Medline (via PubMed) using key search terms ‘medication error’, ‘electronic prescribing’, ‘telemedicine’ and ‘primary care’. Identified studies were synthesised narratively; reported medication safety incidents were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety.

Key Findings

Fifteen studies were deemed eligible for inclusion. All 15 studies reported medication incidents associated with electronic prescribing; no studies were identified that reported medication safety incidents associated with telemedicine. The most commonly reported medication safety incidents were ‘wrong label/instruction’ and ‘wrong dose/strength/frequency’. The frequency of medication safety incidents ranged from 0.89 to 81.98 incidents per 100 electronic prescriptions analysed.

Summary

This review of medication safety incidents associated with the remote delivery of primary care identified common incident types associated with electronic prescriptions. There was a wide variation in reported frequencies of medication safety incidents associated with electronic prescriptions. Further research is required to determine the impact of the COVID-19 pandemic on medication safety in primary care, particularly the increased use of telemedicine.

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  1. Version published to 10.1093/ijpp/riac087
  2. ScreenIT

    SciScore for 10.1101/2022.05.19.22275325: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Due to the time-sensitive nature of this research topic, a rapid review was conducted in accordance with the interim guidance from the Cochrane Rapid Reviews Group.(17) Compared to a traditional systematic review, abbreviated steps in a rapid review include searching fewer databases, double screening 20% of titles and abstracts, single screening of full texts, and synthesising evidence narratively.
    Cochrane Rapid Reviews Group.
    suggested: None
    The data extraction form was piloted with members of the screening team (LG, MF, FM), data extraction then carried out using Microsoft Excel.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: Due to the emerging nature of the review topic, a rapid review was carried out which, according to the Cochrane Rapid Reviews Methods Group, ‘accelerates the process of conducting a traditional systematic review through streamlining or omitting specific methods to produce evidence for stakeholders in a resource-efficient manner’.(17) A strength of this review was the timely provision of high-quality evidence. This rapid review followed guidance from the Cochrane Rapid Reviews Methods Group and included a search strategy developed with input from a wide group of experts, including a librarian and a systematic reviews expert. Although study selection, data abstraction and risk of bias assessment performed were not performed in duplicate, each step was verified by a second reviewer. However, as with any review, there were also some limitations. Results were limited to English language studies published since the year 2000, and the search was limited to two online databases. The majority of the included studies were conducted in the US, which could limit the generalisability of the review findings. Finally, Ireland has implemented a system for the electronic transfer of prescriptions, as opposed to a comprehensive e-prescribing system, therefore the findings of this study may not accurately reflect the issues currently encountered in the Irish healthcare system. Further Research: This review has highlighted a number of important areas for further resear...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.05.19.22275325v1 on medRxiv