gms | German Medical Science

Context: Medication errors account for 11-35% of errors in primary care. This estimate basically derives from the retrospective analysis of routine data. Little is known about the types of errors or their underlying causes in general practice.

Aim of the Study: To get to know more about types and possible causes of errors by systematically analysing the medical treatment for antihypertensive therapy and oral anticoagulation in general practice.

Material and Methods: For a fixed period of 12 months, data were collected and analyzed by chart audit. Additionally, every patient was interviewed by telephone. A list of criteria deriving from evidence-based guidelines as well as pharmacological databases for the review of drug interactions and contraindications were used and consensus with a clinical pharmacologist reached. Findings were discussed with the general practitioner and afterwards categorized as intended deviations, which were reasonable, rule- or knowledge-based mistakes, or violations, and unintended deviations, classified as slips or lapses.

Results: Seventeen general practices with 252 patients participated in the study. 10.6% of medication errors were lapses such as the lack of laboratory monitoring of medications. 13.4% slips occurred like the documentation of a wrong diagnosis which may lead to wrong treatment or assessment. Most errors, 38.5% were due to rule-based mistakes – the general practitioner attempting to monitor the kidney function by checking the serume creatinine level instead of calculating the kidney function. Violations such as the intramuscular application of NSAIR were found in 6.3%. Knowledge-based mistakes were rarely found (3.9%).

Conclusions: By tracking causes of errors or error prone activities it will be possible to develop instruments to reduce the number of lapses and slips in primary care. Such aids will fit into software programmes used in primary care. These instruments should be evaluated further.