Quality of medication use in primary care—mapping the problem, working to a solution: a systematic review of the literature.

Sara Garfield; Nick Barber; Paul Walley; Alan Willson; Lina Eliasson

Review

Quality of medication use in primary care—mapping the problem, working to a solution: a systematic review of the literature.

October 21, 2009

Garfield S, Barber N, Walley P, et al. BMC Med. 2009;7:50.

View more articles from the same authors.

A systematic review using failure mode effects analysis methodology defined vulnerabilities in medication management in primary care.

PubMed citation

Free full text

Related Resources From the Same Author(s)

Patient involvement in medication safety in hospital: an exploratory study.

July 16, 2014

Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews.

February 10, 2021

Exploring the role of communications in quality improvement: a case study of the 1000 Lives Campaign in NHS Wales.

May 27, 2015

Carers' medication administration errors in the domiciliary setting: a systematic review.

February 8, 2017

Methodological variations and their effects on reported medication administration error rates.

February 27, 2013

Failure mode and effects analysis outputs: are they valid?

August 15, 2012

Failure mode and effects analysis: too little for too much?

April 18, 2012

Is failure mode and effect analysis reliable?

May 27, 2009

Paediatric dosing errors before and after electronic prescribing.

August 18, 2010

The incidence and nature of prescribing and medication administration errors in paediatric inpatients.

February 24, 2010

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

August 22, 2007

Exploring the sociotechnical intersection of patient safety and electronic health record implementation.

October 16, 2013

Medication errors with electronic prescribing (eP): two views of the same picture.

July 21, 2010

Electronic prescribing reduced prescribing errors in a pediatric renal outpatient clinic.

February 13, 2008

The influence of formulation and medicine delivery system on medication administration errors in care homes for older people.

January 30, 2011

How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience.

February 5, 2020

To what extent is the World Health Organization's Medication Safety Challenge being addressed in English hospital organizations? A descriptive study.

February 16, 2022

Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions.

September 2, 2009

Systematic review of medication errors in pediatric patients.

October 25, 2006

The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study.

May 14, 2014

Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase.

February 23, 2011

Resident and nurse perspectives on the use of secure text messaging systems.

October 19, 2022

Patient safety when receiving telephone advice in primary care - a Swedish qualitative interview study.

February 23, 2022

Measuring safety in older adult care homes: a scoping review of the international literature.

May 19, 2021

A review of significant events analysed in general practice: implications for the quality and safety of patient care.

October 14, 2009

Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people.

October 21, 2009

Prevention of fatal opioid overdose.

November 28, 2012

Medication regimen complexity and hospital readmission for an adverse drug event.

January 15, 2014

Case-based learning for patient safety: the Lessons Learnt program for UK junior doctors.

March 29, 2012

Patient safety attitudes and behaviors of graduating medical students.

September 21, 2011

Building capacity and capability for patient safety education: a train-the-trainers programme for senior doctors.

May 29, 2013

The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review.

July 15, 2015

The relationship between patients' perception of care and measures of hospital quality and safety.

June 23, 2010

Predicting potential postdischarge adverse drug events and 30-day unplanned hospital readmissions from medication regimen complexity.

December 3, 2014

Building a safer foundation: the Lessons Learnt patient safety training programme.

November 6, 2013

It’s time to consider national culture when designing team training initiatives in healthcare.

January 27, 2021

Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue.

August 5, 2009

Errors in medication history at hospital admission: prevalence and predicting factors.

June 20, 2012

Caregivers' perception of drug administration safety for pediatric oncology patients.

April 16, 2014

Recruitment of hospitals for a safety climate study: facilitators and barriers.

April 30, 2008

The effects of power, leadership and psychological safety on resident event reporting.

June 1, 2016

Implementing delivery room checklists and communication standards in a multi-neonatal ICU quality improvement collaborative.

August 3, 2016

Patient safety skills in primary care: a national survey of GP educators.

February 4, 2015

Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis.

October 14, 2020

Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: a systematic review and meta-analysis.

August 4, 2021

Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial.

March 9, 2011

Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code–assisted medication administration system.

January 26, 2011

Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region--bridging the gap between knowledge and practice.

August 29, 2007

Trends in anesthesia-related liability and lessons learned.

March 6, 2019

A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists.

August 7, 2013

Understanding the role of non-technical skills in patient safety.

April 25, 2012

Adverse drug events in hospitalized cardiac patients.

November 7, 2007

2017 update on pediatric medical overuse: a review.

April 4, 2018

Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial

October 16, 2019

From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions.

February 26, 2014

Are the World Health Organization's patient safety learning objectives still up-to-date: a group concept mapping study.

December 21, 2022

What constitutes a prescribing error in paediatrics?

October 19, 2005

Patient Safety Advisory: fentanyl counterfeit prescription medications that contain fentanyl and patient safety.

April 26, 2023

Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation.

October 5, 2011

Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study.

November 12, 2008

Implicit bias and caring for diverse populations: pediatric trainee attitudes and gaps in training.

September 22, 2021

Safety on an inpatient pediatric otolaryngology service: many small errors, few adverse events.

May 6, 2009

Unit of measurement used and parent medication dosing errors.

July 30, 2014

Potentially inappropriate opioid prescribing, overdose, and mortality in Massachusetts, 2011–2015.

October 3, 2018

Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study.

July 11, 2018

Predictors of adverse events and medical errors among adult inpatients of psychiatric units of acute care general hospitals.

January 30, 2019

Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.

March 30, 2022

Using Medical Emergency Teams to detect preventable adverse events.

September 9, 2009

Exploring safety systems for dispensing in community pharmacies: focusing on how staff relate to organizational components.

September 17, 2014

A trigger tool fails to identify serious errors and adverse events in pediatric otolaryngology.

October 27, 2010

Otolaryngologists' responses to errors and adverse events.

July 26, 2006

Patient safety improvement interventions in children's surgery: a systematic review.

November 16, 2016

Toward understanding errors in inpatient psychiatry: a qualitative inquiry.

April 14, 2010

Examining markers of safety in homecare using the international classification for patient safety.

June 12, 2013

Medication errors: immunisation.

September 27, 2006

Direct observation of depression screening: identifying diagnostic error and improving accuracy through unannounced standardized patients.

May 1, 2020

Safe implementation of standard concentration infusions in paediatric intensive care.

August 24, 2016

Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes.

September 7, 2011

Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study.

October 7, 2015

Hospital autopsy: endangered or extinct?

July 8, 2015

Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

January 20, 2016

The value of learning from near misses to improve patient safety: a scoping review.

January 25, 2023

Using the medication error prioritization system to improve patient safety.

March 2, 2016

How does the law recognize and deal with medical errors?

September 2, 2009

The impact of team processes on psychiatric case management.

October 24, 2007

A common body of care: the ethics and politics of teamwork in the operating theater are inseparable.

July 19, 2006

Interventions to improve follow-up of laboratory test results pending at discharge: a systematic review.

March 14, 2018

Medication safety in the neonatal intensive care unit: big measures for our smallest patients.

March 8, 2017

Impact of the World Health Organization surgical safety checklist on patient safety.

June 12, 2019

Patient involvement in patient safety: the health-care professional's perspective.

November 7, 2012

The causes of their death appear (unto our shame perpetual): why root cause analysis is not the best model for error investigation in mental health services.

May 6, 2015

Implementing computerized physician order management at a community hospital.

February 6, 2008

A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients.

December 6, 2006

The problem with the '5 whys.'

September 14, 2016

Maintaining safety in the dialysis facility.

May 27, 2015

Patient safety: this is public health.

August 20, 2014

Burnout and sources of stress among health care risk managers and patient safety personnel during the COVID-19 pandemic: a pilot study.

July 7, 2021

Disruptive behavior affects hospital financial health.

December 22, 2010

Managing disruptive behaviors in the health care setting: focus on obstetrics services.

May 18, 2011

The quality and economic impact of disruptive behaviors on clinical outcomes of patient care.

May 4, 2011

Related Resources

Identifying failure modes in telemedicine: an instructional needs assessment.

August 9, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Annual Perspective

Patient Safety in the Ambulatory Care Setting

August 5, 2022

ISMP List of High-Alert Medications in Community/Ambulatory Healthcare.

October 1, 2021

Medical Office Survey on Patient Safety Culture.

September 1, 2021

Overcoming COVID-19: what can human factors and ergonomics offer?

May 6, 2020

The global burden of diagnostic errors in primary care.

August 24, 2016

A systematic review of patient safety measures in adult primary care.

May 18, 2016

How safe is primary care? A systematic review.

January 13, 2016

Patient safety and quality improvement: reducing risk of harm.

October 21, 2015

AHRQ Health Literacy Universal Precautions Toolkit. 2nd edition.

July 1, 2015

Tools for primary care patient safety: a narrative review.

November 26, 2014

Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments.

October 29, 2014

Interview

In Conversation With… Urmimala Sarkar, MD, MPH

August 1, 2014

Laboratory test ordering and results management systems: a qualitative study of safety risks identified by administrators in general practice.

March 12, 2014

"Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care.

March 5, 2014

The PROMISES Project.

February 5, 2014

The effects of electronic prescribing by community-based providers on ambulatory medication safety.

December 4, 2013

Enhance patient safety by identifying and minimizing risk exposures affecting nurse practitioner practice.

November 20, 2013

Patient Safety Toolkits.

October 30, 2013

Safety in home care: a mapping review of the international literature.

October 23, 2013

Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.

August 21, 2013

A typology of electronic health record workarounds in small-to-medium size primary care practices.

August 21, 2013

What patients think doctors know: beliefs about provider knowledge as barriers to safe medication use.

August 14, 2013

The epidemiology of malpractice claims in primary care: a systematic review.

July 31, 2013

Office-based physicians are responding to incentives and assistance by adopting and using electronic health records.

July 24, 2013

Resilient actions in the diagnostic process and system performance.

July 17, 2013

Information technology interventions to improve medication safety in primary care: a systematic review.

July 10, 2013

Advanced practice nursing students' identification of patient safety issues in ambulatory care.

April 10, 2013

Engaging Patients in Improving Ambulatory Care.

April 3, 2013

See More About The Topic

Ambulatory Care

Health Care Executives and Administrators

Safety Scientists

Family Medicine

Primary Care

Quality of medication use in primary care—mapping the problem, working to a solution: a systematic review of the literature.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Quality of medication use in primary care—mapping the problem, working to a solution: a systematic review of the literature.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

PSNet Log in

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site