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Incidence and prevalence of intravenous medication errors in the UK: a systematic review
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  • Published on:
    Re: Incidence and prevalence of intravenous medication errors in the United Kingdom: A Systematic Review; Refined Data
    • Adam B Sutherland, Honorary Clinical Lecturer Division of Pharmacy & Optometry; Faculty of Biology, Medicine & Health, The University of Manchester

    We thank Dr Jones and Professor Franklin’s insightful and constructive response to our systematic review of the incidence and prevalence of intravenous medication errors in the UK. We appreciate and are grateful for their consideration and the opportunity to respond to their observation.

    They are absolutely right to suggest that this is an example of both the limitations of our systematic review methodology, and the importance of grey literature accessing wider datasets as part of these reviews. Our protocol allowed us to contact authors of papers for more detailed data, however did not provide for occasions where authors were not contactable, and did not include grey literature. Two independent data extractors flagged that the data in the original publication [1] was ambiguous. When it was clear that further data was not accessible through direct contact with the author a consensus decision was taken to present only the data that we could reliably associate with IV medication errors from the paper and acknowledge this limitation.

    As the correspondents rightly suggest, by supplanting the thesis data into the analysis, we identify 1773 intravenous doses, and 789 errors, resulting in a weighted prevalence estimate of 451/1000 administrations (95% CI 420–482), however the limitations related to the definition and operationalisation of errors, and how they affect estimates still hold, particularly around the impact of including “wrong time” errors into the...

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    Conflict of Interest:
    ABS has received research grant funding from BD U.K. Limited for work on IV medication safety and Drug Error Reduction Software, and honoraria for chairing symposia on IV medication safety.
  • Published on:
    Re: "Incidence and prevalence of intravenous medication errors in the UK: a systematic review”: refined data
    • Matthew D Jones, Senior Lecturer Department of Pharmacy and Pharmacology, University of Bath
    • Other Contributors:
      • Bryony D Franklin, Professor of Medication Safety

    We read this article with great interest. Given differences among countries in preparation and administration practices for intravenous medicines, it is an important contribution to the literature.

    Sutherland et al. state that their calculation of the incidence of intravenous medication errors may be an underestimate (1), as they were not able to clearly differentiate intravenous from non-intravenous administrations in the study by Ghaleb et al. (2) We are writing to highlight refined data related to the Ghaleb et al. study, which will be useful to readers interested in interpreting the review’s findings.

    Specifically, Table 2 of the review reports that in the Ghaleb et al. study, 85 infusions (5.5%) of a total of 1,554 contained at least one error. However, the Ghaleb et al. study reports data relating to all routes of administration, and not just the intravenous route (2). The total of 1,554 observed doses therefore includes both intravenous and other routes of administration, with the number of intravenous doses not reported in the published paper. Consequently, the incidence of intravenous medication errors reported Table 2 for the Ghaleb et al. study is artificially low. This is likely to considerably influence the systematic review’s pooled estimate of the incidence of intravenous medication errors, (1) as Ghaleb et al. (2) contributes 60% of the observations included in this calculation.

    The PhD thesis on which the paper by Ghaleb et al. is bas...

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    Conflict of Interest:
    MDJ has received an honorarium from B Braun Medical Ltd for speaking at an educational symposium on injectable medicines safety. BDF has received honoraria from Pfizer for organising and chairing two educational symposia on medication safety, and recently supervised a PhD student who was part funded by Cerner, an electronic health record systems vendor.