Analysis of Strategies To Reduce Medication Errors In Hospitals: A Literature Review

Medication errors are a critical issue in healthcare and can have a serious impact on patients.


INTRODUCTION
Medications play a very important role in the delivery of health care and contribute significantly to health improvement when used correctly and appropriately.However, it is important to remember that medication can also be a frequent cause of error and has the potential to cause adverse events in the healthcare process (Roughead et all, 2016).Reports from the United States Pharmacopoeia indicate that more than one million cases of medication errors occur in the hospital setting, with an estimated death toll of around 7,000 as a result of medication errors.Medication error (ME) is an adverse patient event, resulting from the use of drugs while in the care of health workers, which could have been prevented (Timbongol, 2016).
Medication errors can occur at any phase of treatment, involving prescribing, transcribing, dispensing, and administration (Ministry of Health, 2014).Errors in administering medication can lead to adverse consequences such as damage, serious risks, and even death, which can be triggered by a lack of manpower and inadequacy in managing administration in the process of writing prescriptions or administering drugs (International Alliance Of Patients Organizations, 2018).Hospitals as health care centers have a very important role in maintaining patient safety (Rikomah, 2017).The term "patient safety" refers to a method hospitals utilize to improve the safety of patient care and reduce the likelihood of patients suffering harm from medical mistakes (Salawati, 2020).The reduction of medication errors in hospitals is very crucial, therefore, efforts to reduce medication errors in hospitals are urgent to ensure the safety and quality of health services to patients.This is the fundamental basis that gives urgency and significance in conducting this study.The goal of this research is to identify effective methods for decreasing medical blunders in healthcare facilities.

RESEARCH METHOD
This research was conducted through the literature review method.According to Leedy, a literature review is an explanation that must include statements from previous researchers regarding similar research conducted.Therefore, the literature review is based on the steps of development research (Wibowo, 2021).Data was collected through searching various articles, journals, and scientific publications related to strategies to reduce medication errors in hospitals.Data collection was done by identifying and evaluating the strategies that have been proposed, the steps to implement them, and the results and benefits achieved from the implementation of these strategies.The main data sources were Google Scholar, PubMed, and ScienceDirect, which are leading platforms for scientific publications and medical research.Articles were only included if they were published within the previous 10 years, were written in either Indonesian or English, and had titles and abstracts that were directly related to the issue of ways to prevent drug mistakes in hospitals.Data collected from the literature study were analyzed comprehensively.

RESULTS AND DISCUSSION
All articles compiled in this literature review used data extraction tables to detail information related to previous studies that focused on strategies to reduce medication errors in hospitals.
The following are the research points obtained from these 10 articles.Electronic prescribing has a significant role in reducing errors in the prescription writing process, while addressing errors arising from doctors' medical decisions requires additional support systems and clinical pharmacy intervention to improve medication safety.Perceptions of the benefits of an electronic prescription system were found to have a greater impact on its implementation than perceptions of its convenience (Widiastuti & Dwiprahasto, 2014).This finding is in line with research conducted by Indriani (2019), which shows that many hospitals and health institutions have turned to digital technology as a solution.One such solution is the Electronic Medication Management (EMM) System, which plays a role in improving the quality and safety of medication management in the hospital environment.EMM covers various stages of patient care, from prescriptions by doctors, drug orders issued by pharmacists, to drug administration by nurses.As a further recommendation to improve drug safety at Awal Bros Hospital Batam, the implementation of unit-dose dispensing system (UDD) and the use of barcode technology can be considered (Yulianti et al., 2019).
Patient safety training represents a very important investment in the healthcare sector.The aim is to protect and improve the well-being of patients, while also improving the overall quality of medical care.One of the ways taken to prevent medication errors is through patient safety training.For example, the use of effective SBAR communication in nurses has been shown to reduce the rate of injection medication errors at PKU Muhammadiyah Yogyakarta Hospital Unit II based on the principles of correct patient, service, drug, time, assessment, information, and evaluation (Fatimah & Rosa, 2016).
Another study (Samaranayake et al., 2013) showed that preventive measures at each stage of the medication use process can help reduce most errors.Most medication errors reach patients due to the lack of safeguards to prevent them.Therefore, more interventions are needed to prevent medication errors.The results of this study are consistent with the findings of (Maharjana et al., 2014) which showed that the use of read-back guidance with checklists as a form of effective communication can reduce medication record filling errors in medical records that have the potential to cause medication errors, with a decrease from 45.54% to 10.17%.
Several important steps have been identified to address recurrent medication errors in hospitals, as found in the study (Kusumahati et al., 2018).These include the expansion of more thorough prescription writing, closer collaboration between pharmacists and doctors, and education or learning aimed at improving knowledge.Furthermore, in an effort to overcome medication errors at NU Hospital Demak Regency, a patient safety program is implemented through a recording and reporting system, as well as monitoring and evaluation according to guidelines (Aziz et al., 2018).It is also important to prevent medical errors by identifying potential failures in services before they occur, as found in the study (Setiasih & Junadi, 2017).This can be achieved through understanding the quality of nurses' human resources (HR) by measuring their level of knowledge, attitude, and behavior related to medical errors.

LIMITATION OF THE STUDY
If additional databases had been searched, it's possible that more relevant results would have been found for this literature review.Only ten papers published in the recent decade were selected for this study, demonstrating the paucity of research on hospital medication error prevention measures and the need for more investigation.

CONCLUSIONS AND SUGGESTIONS
The results of the study showed that some of the strategies to reduce medication errors in hospitals include the use of electronic prescriptions, application of the right patient principle, monitoring activities, unit-dose dispensing (UDD) system, read-back guidelines utilizing checklists, implementation of Electronic Medication Management System (EMM), thoroughness in prescription preparation, patient safety programs, evaluation of nurses' knowledge level, attitude, and behavior related to medication errors and preventive measures at each stage of medication use.Future researchers who are interested in continuing the study in analyzing strategies to reduce medication errors in hospitals, here are some suggestions that can be considered: 1. Human Factors in Medication Error Examines the role of human factors in the occurrence of medication errors, including fatigue, stress, and interactions between members of the healthcare team.How these factors can be identified and managed to reduce the risk of errors.

Comparative Research
Conduct comparative research between hospitals in different countries or regions, to see how differences in health systems and regulations affect the medication error reduction strategies implemented.

Figure
Figure 1.PRISMA-LvR Research Diagram errors are the drug taking and data entry stages, How to overcome repeated medication errors indicates system errors, it is necessary to monitor to be tested in the outpatient department, especially for BPJS patients in preventing failures in the hospital.be avoided by taking precautions at every step of using a drug.Due to a lack of safeguards, many drug mistakes end up in the hands of the patient.Therefore, more interventions are needed to prevent medication medical errors that occur in hospitals are to identify potential failures of services before they occur, this can be done by knowing the quality of human resources (HR) of nurses by measuring the level of knowledge, attitudes and behavior of nurses about medical errors.