Identification and prevention of medication errors as a contribution towards risk management in general practice
According to recent research, medication errors are the most common of all errors made in the family practice (Presentation: "Core problems of medication safety in family practice health care - empirical findings and strategies" [PDF]). However, precisely how frequently and for what reason such errors are made is unknown. The aim of a research project sponsored by the Federal Ministry for Education and Research (BMBF project funding reference number: 01GK0302) between 2005 and 2009 was to find out more about medication errors in family practices.
In order to discover the causes of errors and to develop strategies on how they could be avoided, medication errors made in anticoagulant therapy (Marcumar©, phenprocoumon) were analysed by examining patient records and speaking to general practitioners and patients.
Two further trials have now been completed:
Cluster-randomised intervention trial on raising prescription safety among patients with chronic renal insufficiency undergoing treatment in general practice [ISRCTN02900734]
In this randomised-controlled study, the focus is on the avoidance of dosage errors among patients suffering from renal function deterioration. For six months, an electronic decision support system was tested in 21 family practices. The system facilitated the calculation of creatinine clearance and automatically suggested an adjustment to the medication dosage where necessary. The preliminary results of this trial were presented at a Symposium of the German Drug Utilisation Research Group (GAA) in November 2007 (Presentation [PDF])) and at the 42nd Congress of the German Society of General Practice and Family Medicine in September 2008. It is further planned that the results should be published internationally.
Appropriateness of medication prescriptions for elderly patients receiving multimedication in the family practice
The risk of medication errors rises in line with the age of patients, the number of their illnesses and the number of their prescribed medications. In cooperation with the Department of Clinical Pharmacology and Pharmacoepidemiology at the University of Heidelberg, we conducted a prospective observational study on the subject. 20 family practices from the German state of Hesse and eastern Westphalia took part in the study with 10 elderly and patients with multiple morbidity respectively, as did a nursing home. According to the available data, these patients in particular take their medications in a very different manner to the way their physicians have prescribed. To a significant degree, they also take potentially inappropriate medication as a result of insufficient account being taken of renal function, existing co-morbidities, the so-called Beers criteria and potential drug interactions. The preliminary results of our study were presented at the 41st and 42nd Annual Meetings of the DEGAM German Society of General Practice and Family Medicine (2007 and 2008), the 2007 GAA Symposium mentioned above and the autumn meeting of the European General Practice Research Network (2008) [PDF].
Publications
Harder S, Saal K, Blauth E, Beyer M, Gerlach FM (2009) Appropriateness and surveillance of medication in a cohort of diabetic patients on polypharmacy. Int Journal of Clinical Pharmacology and Therapeutics 47(2):89-95 [link]
Saal K, Hoffmann B, Blauth E, Rohe J, Beyer M, Harder S, Gerlach FM (2009) Analyse des Behandlungsprozesses bei der oralen Antikoagulationstherapie zur Identifikation von Sicherheitsproblemen in der hausärztlichen Versorgung. Zeitschrift für Allgemeinmedizin 85(4): 148-155
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