Inter-rater reliability of medication error classification in a voluntary patient safety incident reporting system HaiPro in Finland.

BACKGROUND: Medication errors are common in healthcare. Medication error reporting systems can be established for learning from medication errors and risk prone processes, and their data can be analysed and used for improving medication processes in healthcare organisations. However, data reliability testing is crucial to avoid biases in data interpretation and misleading findings informing patient safety improvement. OBJECTIVE: To assess the inter-rater reliability of medication error classifications in a voluntary patient safety incident reporting system (HaiPro) widely used in Finland, and to explore reported medication errors and their contributing factors. METHOD: The data consisted of medication errors (n = 32 592), including near misses, reported by 36 Finnish healthcare organisations in 2007-2009. The reliability of the original classifications was tested by an independent researcher reclassifying a random sample of errors (1%, n = 288) based on narratives. The inter-rater reliability of agreement (κ) of the classifications was calculated to describe the degree of conformity between the researcher and the original data classifiers. Descriptive statistics were used to describe the medication errors. RESULTS: The inter-rater reliability between the researcher and the original data classifiers was acceptable (κ ≥ 0.41) in 11 of 42 (26%) medication error classes. Thus, these errors could be pooled from different healthcare units for the exploration of medication errors at the level of all reporting organisations. Contributing factors were identified in 48% (n = 137) of the medication error narratives in the random sample (n = 288). The most commonly reported errors were dispensing errors (34%, n = 10 906), administration errors 25% (n = 7972), and documentation errors 17% (n = 5641). CONCLUSIONS: The data classified by different classifiers can be pooled for some of the medication error classes. Consistency of the classification and the quality of narratives need improvement, as well as reporting and classification of contributing factors to provide high quality information on medication errors.

A national approach to medicines information research: A systematic review.

BACKGROUND: The Finnish Medicines Agency Fimea published the first National Medicines Information (MI) strategy in 2012. For the purpose of implementing the MI strategy into practice by the national MI Network, a comprehensive inventory of MI research in Finland was needed. OBJECTIVE: To systematically review literature on MI research conducted in Finland by analyzing and classifying the studies, and identifying the gaps in MI research. METHODS: Medline, Scopus and Medic databases were searched for peer-reviewed MI publications by using key word screening criteria. The search and extraction process followed PRISMA Guidelines and covered the period from January 2000 to June 2016. Included studies were content analyzed according to MI practices identified, trends over time in research methodology and theory. RESULTS: Included publications (n = 126) applied a variety of research methods, most often cross-sectional surveys (n = 51, 40% of all studies), but more than half of the studies were qualitative (n = 68, 54%). Twelve were intervention studies of which 6 were randomized and had a control group. Studies were categorized into: patient counseling in different settings (n = 45); MI sources and needs of medicine users (n = 25); healthcare professionals' (HCPs) competence in patient counseling and pharmacotherapy (n = 25); MI sources and needs of HCPs (n = 23); MI education and literacy (n = 13); and MI policies and strategies (n = 3). Most of the studies were descriptive, and only 6 studies applied a theory. CONCLUSIONS: Regardless of some methodological pitfalls, MI research conducted in Finland since 2000 provides multifaceted understanding of MI practices and their development needs. Research should shift towards larger research lines having a stronger theory base and study designs to deepen the understanding of MI practices and behaviors, and effectiveness of MI in different healthcare settings. Future research should cover also the use of electronic MI sources and services which apply modern information technology to clinical decision making and medication reviews, national MI policy, MI literacy, MI needs of HCPs and consumers.