Interventions on Medication Administration Errors in Nigerian and Indonesian Hospitals: A Narrative Review

Introduction

Globally, patient harms occur in healthcare institutions.^1,2,3 Such harms are a threat to patient safety. They are being experienced in both developed and developing countries. Therefore, the World Health Organisation came up with strategies to address these harms.^4,5 Guidelines were developed to be adopted or adapted by nations to address the menace of patient harm in their healthcare system.

Threats to patient safety are more prevalent in developing countries than in developed countries.⁶ Access to quality healthcare services and the availability of infrastructure are not optimal in these countries.⁷ These, among other factors, exposed them to the experience of more prevalent patient harm.

Medication error is one of the leading causes of patient harm.^8,9,10 Medication errors can occur in any of the stages of the medication use process (MUP).⁹ The MUP stages include prescribing, transcribing, dispensing, administration, and monitoring. All stages have witnessed medication errors resulting in patient harm.

Medication administration errors are a major problem in healthcare institutions.¹¹ Some interventions have been made to solve the problem of medication administration error, but the problem persists.^12-16 A multi-approach intervention may be needed to curb the menace of medication administration errors to prevent, reduce, or eliminate them. Prevention of these harms should be the most preferred.

Developing countries abound in Africa and Asia.^17-19 Nigeria and Indonesia are typical examples of these countries. Both are lower-middle-income countries (LMIC) and densely populated. Indonesia is the fourth most populous country in the world and the third highest in Asia.²⁰ Nigeria has the sixth-highest population in the world and the highest population in Africa.²¹ Both countries provide a blend of geographical location, population, and income status of developing countries.

Previous reviews on interventions for medication administration errors have a global focus with attention more on developed countries.^22-29 There is no review on interventions on medication administration errors conducted specifically in Asian and African countries. It means that no review has been conducted in Nigeria and Indonesia. The researchers are based in the two countries. Therefore, the review is needed for the appropriate implementation of interventions by the researchers in the future.

There is a need to conduct a review of interventions on and recommended interventions to medication administration errors in Asia and Africa for evidence-based decision-making. Indonesia and Nigeria, having a high ranking among countries that have high populations in the world, serve as good references and starting points for the selection of the two developing countries for commencing efforts towards eradicating medication administration errors in the Asian and African regions. Comparing the interventions in these countries will also give a brief depiction of the intervention practices on or intervention recommendations to medication administration errors for probable implementation of context-applicable interventions across the two countries.

The study aims to review interventions on and recommended interventions to medication administration errors in Indonesia and Nigeria using a narrative review methodology. The interventions on medication administration errors will be determined, recommended interventions examined, and a comparison will be made.

Methods

Study Selection

All studies were exported to EndNote. EndNote was employed for screening, reviewing, and selecting eligible studies for review. Screening of eligible studies by title and abstract and full texts for inclusion was conducted independently by two reviewers. The screening process is summarized using the PRISMA flow diagram in Figure 1 below.

Figure 1

Results

Discussion

Patient safety is an emerging field in developing countries and has not garnered the necessary attention that it is worth.⁴³ In the same vein, medication administration errors have garnered minimal attention in healthcare institutions. A reflection of this claim is revealed in the fact that there have been no studies that have conducted interventions on and given solutions to medication administration errors in hospitals in Nigeria. Indonesia, on the other hand, had two interventional studies on medication administration errors. This is low when compared to the high prevalence rate of medication administration errors in healthcare institutions in developing countries .^44,45,46,47 Both countries are lagging in the area of interventional studies on medication administration errors.

Medication Safety Practice training is important to address medication administration errors.³² It will ensure awareness is created about the harm caused to patients due to medication administration errors and their prevalence in healthcare institutions. Healthcare professionals will be trained on ways to reduce these errors. This will, in turn, make healthcare services in hospitals safer for patients.^48,49

A pharmacist, being a drug expert, is key to addressing medication administration errors.^50,51 It was reflected in the study where pharmacists were part of the medication administration team in a haemodialysis room and improvement in medication administration safety was recorded.³³ Therefore, it is expedient that pharmacists are assigned tangible roles in inpatient wards and are involved in ward rounds to avert potential medication administration error dangers.

Patients’ and healthcare professionals’ reports of the incidence of medication administration errors are a good way of sourcing data on medication administration errors for informed decision-making. As both are stakeholders in medication administration, necessary information can be gathered from them. The hospital management and leaders, therefore, must learn from these medication errors and prevent their further occurrence in the future. A Critical Incident Reporting system and committee can be created to look into these errors to learn from them.⁵² Institutional structures, such as Drug and Therapeutics Committees (DTCs), that offer regular forums for collaborative review and learning across disciplines are also recommended.⁵³ These committees’ roles in preventing prescribing and dispensing errors can be part of a holistic approach to reducing medication administration errors.

The revealing of fifteen (15) recommended interventions from the studies in the review attests to the fact that multiple approaches are needed to tackle medication administration errors. Intervention should come from all stakeholders involved in medication administration.^54,55 All stakeholders have a role to play. For instance, pharmaceutical industries need to improve the design of ampoules, drug labelling, and packaging of manufactured drugs; it will decrease the likelihood of errors that come from look-alike, sound-alike medications.⁵⁶ Healthcare professionals need to be vigilant , pay attention to details, and report any incident of medication administration errors to learn from them.^41,42 The healthcare institution needs to address the errors systemically through the provision of necessary training, employment of adequate staff, and creation of a just and trusting culture, among others.^{31,32,36,37,38,57}

Education and/or training are the most recommended interventions needed to address medication administration errors from the studies in the two countries.^{31,32,36,37,40,41} This is the first critical step needed to proffer solutions to medication administration errors. Awareness has to be created on medication administration errors and their untoward effect on patient safety. Healthcare professionals need to be trained on practices that will ensure medication administration errors are averted. Also, it will be good to provide the necessary education on medication errors to students in the healthcare discipline to prepare them ahead for the prevention or reduction of the errors in their professional practice.⁴

Creating a reporting system for medication administration errors was highly recommended by studies from the two countries.^38,40,41,42 A reporting system will permit learning from incidents to prevent future occurrences and harm.⁵² Proper drug labelling and packaging were also highly recommended.^31,34,38,42 This can help ensure the error will not be due to illegibility or look-alike medicines.⁵⁶ The proper labelling and packaging will ensure that a design has been made that will prevent healthcare professionals from making errors. Such a design is the basis of the importance of ergonomics in healthcare.^58,59

The need for integration of pharmacists into clinical rotation in the ward has been recommended in developed and developing countries.^60,61,62,63 It was recommended by three studies in Indonesia for the prevention of medication administration errors.^31,34,35 Therefore, attention should be drawn to the integration of pharmacists into clinical rotation in developing countries as is the experience in some developed countries.^61,62,63 Also, adequate staffing recommended by studies from Indonesia and Nigeria is essential to prevent medicine administration errors.^31,38,41 It will ensure enough staff are available and prevent errors that might occur from the fatigue of a short-staffed institution.

Having four agreements in recommended interventions on medicine administration errors reveals that the occurrence of these errors has some similar root causes in the two countries involved. It attests to the fact that medication administration error is a global menace and has no boundaries.^8,11 However, there may be some peculiarities with the healthcare system of the countries involved. This is revealed by the recommendations that were singly received from studies in each country.

Conclusion

There were identified interventions on medication administration errors from the included studies in Indonesia. Recommended interventions for medication administration errors were seen in the included studies in Nigeria and Indonesia. As medication administration errors still abound in these countries, a combination of any of these interventions should be employed to prevent, reduce, and eliminate medication administration errors in their healthcare institutions.

Competing Interests

The authors have no conflict of interest.

Authors’ Contributions

Conceptualization: Dosunmu OO. Data curation: Dosunmu OO. Formal analysis: Dosunmu OO, Dwinta E, and Fatimah FS. Funding acquisition: None. Methodology: Dosunmu OO, Dwinta E. Project administration: Dosunmu OO, Dwinta E, and Fatimah FS. Writing – original draft: Dosunmu OO. Writing – review and editing: Dwinta E, and Fatimah FS.