A comparison of two methods of assessing the potential clinical importance of medication errors

Sandra Fahmy,
Sara Garfield,
Dominic Furniss,
Ann Blandford and
Bryony Dean FranklinEmail author View ORCID ID profile

Safety in Health20184:3

https://doi.org/10.1186/s40886-018-0071-3

Received: 13 December 2017

Accepted: 2 March 2018

Published: 9 March 2018

Abstract

Background

A wide range of methods have been used to assess the potential clinical importance of medication errors, but it is neither clear which should be used, nor how they compare. In this paper, we compare two methods of assessment, using a dataset of errors identified in the administration of intravenous infusions in English hospitals, to inform future comparisons between studies.

Methods

We assessed each of 155 errors identified in a study of intravenous infusion administration using two commonly used methods: an adapted form of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) method (an ordinal scale scored by local clinicians) and the Dean and Barber method (an interval scale ranging from 0 to 10 scored by a group of experts). We compared the two sets of scores using a scatter plot and calculated Spearman’s correlation coefficient.

Results

Using the NCC MERP method, 137 (88%) errors were rated C (‘an error occurred but was unlikely to cause harm despite reaching the patient’), 17 (11%) rated D (‘an error occurred that would be likely to have required increased monitoring’) and 1 (1%) rated E (‘an error occurred that would be likely to have caused temporary harm’). Errors ranged from 0 to 4.75 on the Dean and Barber scale with a mean of 1.7; 138 (89%) of errors were considered minor (scores of less than 3) and 17 (11%) as moderate (scores 3–7). Scores from the two methods were significantly but weakly correlated (correlation coefficient = 0.36, p = < 0.01).

Conclusion

Scores from the adapted NCC MERP and Dean and Barber methods are only weakly correlated in the assessment of medication administration errors. In the absence of a uniformly agreed standard method for assessing errors’ clinical importance, researchers should be aware that comparisons between studies are likely to have limitations.