Under-reporting of medication errors remains a significant challenge globally, hindering efforts to improve patient safety and learn from adverse events. Recognising this, researchers have developed a theory-informed multicomponent intervention, the Medication Error Reporting Enhancement Program (MERP), aimed at improving according to a study published in Frontiers in Pharmacology. This program seeks to promote more consistent and accurate medication error reporting among healthcare professionals, particularly within Chinese hospitals.
The Critical Need for Enhanced Medication Error Reporting
Medication errors, defined by the US National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) as “any preventable event that may cause or lead to inappropriate medication use or patient harm,” pose a substantial threat to patient safety. Globally, studies suggest that approximately 1 in 10 patients may experience harm during healthcare, with a notable proportion being medication-related. These errors also carry a considerable economic burden, with global costs estimated at US$42 billion annually.
Effective medication error reporting and learning systems are essential for identifying risks, understanding contributing factors, and supporting organisational learning to prevent future harm. However, under-reporting is common. In China, despite policies and quality management requirements for medication safety reporting, national data indicate implementation gaps.
Previous research has suggested that improvements in medication error reporting can be achieved through changes in reporting systems, workflow, and safety culture. Interventions such as electronic reporting tools, standardised processes, staff education, and non-punitive safety initiatives have been associated with increased reporting. The involvement of pharmacists in these multicomponent interventions, through education, reporting support, and medication review, has been observed to strengthen reporting performance and medication safety.
A Theory-Informed Approach to Intervention Development
The development of MERP utilised a systematic, theory-driven approach, addressing limitations in existing literature that often consists of single-site studies with varied outcomes, making it difficult to identify effective components or ensure reproducibility. The researchers employed a structured intervention development process guided by the Behaviour Change Wheel (BCW), which involved three stages:
- Understanding the Target Behaviour: This stage involved mapping determinants of medication error reporting, identified through qualitative interviews using the Theoretical Domains Framework (TDF), to components of the Capability-Opportunity-Motivation Behavior Model (COM-B). This process helped to clarify what needed to change to improve reporting.
- Identifying Intervention Options: Candidate intervention functions were selected by linking priority behavioural determinants to BCW guidance. These options were then appraised using the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity). This led to the identification of seven intervention functions and four policy categories to support implementation.
- Specifying Intervention Content and Delivery: Behaviour Change Techniques (BCTs) were selected using BCT Taxonomy v1 (BCTTv1) and refined through stakeholder workshops. The final program was documented using the Template for Intervention Description and Replication (TIDieR) checklist to enhance transparency and replicability.
This systematic methodology aimed to create a robust, context-appropriate, and reproducibly specified intervention blueprint, rather than simply evaluating effectiveness.
The Medication Error Reporting Enhancement Program (MERP)
The resulting MERP is a pharmacist-led multicomponent intervention designed to address various determinants of reporting behaviour. The intervention architecture comprises:
- Seven Intervention Functions: Education, training, persuasion, incentivisation, environmental restructuring, modelling, and enablement.
- Four Policy Categories: Communication/marketing, regulation, service provision, and fiscal measures (conditional on resources).
The content of MERP was specified using 14 BCTs, operationalised into a clear program. This comprehensive approach acknowledges that reporting behaviour is influenced by factors beyond knowledge and skills, including workload, organisational hierarchy, social influences, and concerns about blame. By developing a locally adapted, theory-informed, and clearly specified intervention, MERP aims to address barriers specific to the Chinese hospital context.
Looking Ahead
The Medication Error Reporting Enhancement Program (MERP) offers a transparent and theoretically grounded blueprint for improving medication error reporting. Its development through a rigorous, theory-informed process provides a strong foundation for future pilot testing and effectiveness-implementation evaluation. While its potential transferability to other safety-reporting behaviours is theoretical and mechanism-based, it warrants empirical testing in diverse healthcare settings to further enhance patient safety globally.
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