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Thompson, Keith (2022) Professionals’ Perceptions of Harm Arising from Medication Safety Incidents. [Dissertation (University of Nottingham only)]

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Abstract

Objectives. To determine (1) the differences in healthcare professionals’ perception of actual and potential harm arising from medication safety incidents; (2) the impact of prescribing eligibility and advanced clinical practice on perception of harm; (3) the impact of training in assessing risk relating to medication safety incidents or errors on perception of harm; and (4) the impact of years’ experience on perception of harm.

Participants. Eighty-nine healthcare professionals who responded to a self-administered perception of harm scenario questionnaire (12 allied health professionals; 11 doctors; 18 nurses and midwives; 25 pharmacists; and 23 pharmacy technicians).

Methods. Participants were invited to complete a self-administered questionnaire comprising five medication error scenarios relating to different stages of the medicines use process. They were asked to assess the actual harm which resulted from the error, using the five-point National Response and Learning System (NRLS) scale; and the potential harm which could have resulted had the error not been identified. Participants were also asked to respond to a number of questions on their scope of practice and experience and provide comments on the factors which they took into account when assessing levels of actual and potential harm.

Results. Doctors assigned the highest total harm score across all scenarios for both actual and potential harm, whilst pharmacists and pharmacy technicians assigned the lowest total harm score for actual and potential harm respectively (ns). Variability within professional groups was higher for actual harm than potential harm and highest in allied health professionals and pharmacy technicians for total actual harm scores. There was no statistically significant difference in overall harm scores (actual and potential) between prescribers and non-prescribers; and those trained to assess risk relating to medication safety incidents compared with those who were not. However, there was an indication variability may be reduced in the prescribing and ‘trained’ groups. There was no statistical difference in overall harm scores across 5 experience ranges. In one scenario (demonstrating an administration error), there was a statistically significant difference in assessment of potential harm (H = 10.844; p=0.028), driven by statistically significant differences in assessment between pharmacy technicians and all other groups except for allied health professionals.

Key factors considered in assessment of actual harm included likely long-term effect on the patient; impact on patients’ length of stay in hospital; requirement for additional care or intervention; immediate impact including symptoms or distress; requirement for additional monitoring; and duration and reversibility of harm.

Conclusions. There is variability within and between different healthcare professional groups’ perception of actual and potential harm arising from medication errors when assessing using the NRLS scale with no guidance. The greatest variability was found to arise from pharmacy technicians. Whilst there is variability across different levels of practice, experience and training status, these differences were not found to be significant, although there is a signal that variability may be less within groups who have had additional training. The assessment of actual harm arising from a medication error appears to be more subjective (variable) than assessment of potential harm suggesting that it is easier to assess potential harm, potentially through what has is described herein as a ‘worst-case-scenario lens.’ Factors associated with perceptions of harm in respondents are explored and may more closely align with other scoring systems than the NRLS scale used in England. Further work is required to develop and validate an improved tool to address the challenge of subjectivity in harm assessment arising from medication errors in England; and to assess the impact on subjectivity of training those who are involved in reporting and investigation of medication errors are trained in the use of such a tool. Healthcare providers should be mindful of the issue of subjectivity in assessing levels of harm arising from medication safety incidents and put steps in place to reduce this; for example, by peer review of incidents which meet a harm threshold. Interventions such as these will be important to be able to better measure the impact of interventions to reduce the number and impact of patient safety incidents.

Item Type:	Dissertation (University of Nottingham only)
Depositing User:	Thompson, Keith
Date Deposited:	20 Jun 2023 15:26
Last Modified:	20 Jun 2023 15:26
URI:	https://eprints.nottingham.ac.uk/id/eprint/69132

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