Understanding system-focused barriers to the identification and reporting of medication errors and adverse drug events in emergency medical services

Abstract

Introduction: Emergency medical services (EMS) represent an important and increasingly used entry point into the healthcare system. These services are often provided in the backdrop of challenging environments, with few diagnostic resources available, and for patients of varying acuity. As a result, the potential for medication errors (MEs) and adverse drug events (ADEs) is significant. However, the identification and reporting of these occurrences is poorly understood. Methods: A healthcare failure mode and effects analysis was conducted at the Hamad Medical Corporation Ambulance Service, Qatar, to identify and mitigate potential system-focused barriers to the identification and reporting of ADEs and MEs in the EMS setting. Between May 2018 and July 2018, a process map and potential failure points were developed and identified. Probabilities, severity, and hazard scores were calculated for each failure point, and action items were developed to address these. Results: In total, 110 potential failure points were identified among 22 sub-processes, divided between six major processes. In terms of severity, most were classified as either ‘moderate’ [n = 90 (80%)] or ‘major’ [n = 14 (13%)]. In terms of probability, failure points classified as ‘frequent’ [n = 39 (35%)] and ‘occasional’ [n = 38 (35%)] made up the majority. Through consensus, 76 failure points (69%) were deemed necessary for action. Five strategic-level, system-focused action items were identified to mitigate against the failure points meeting the criteria for action. Conclusions: The unique circumstances that occur within the EMS setting dictate that bespoke solutions be developed to allow for ease of implementation and ongoing success of use. Strategies that also take advantage of mobile technology are crucial for a service that has mobility as one of its core functions.