Frequency and nature of medication errors and adverse drug ...
Frequency and nature of medication errors and adverse drug events in mental health hospitals: a systematic review Short version of title: Medication errors and adverse drug events in mental health hospitalsGhadah H Alshehri MPharm1Richard N Keers PhD1,2,3Darren M Ashcroft PhD1,21Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom, M13 9PT2NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom M13 9PT.3Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom M8 5RBTel: (+44)161 275 2415, Email: ghadah.alshehri@postgrad.manchester.ac.ukAcknowledgements: Ghadah H Alshehri gratefully acknowledges the Princess Nora Bint Abdul Rahman University for funding her PhD programme at the University of Manchester. Conflict of interest: All authors declare that they have no conflict of interest. This article does not contain any studies with human participants or animals performed by any of the authors. Tables and figuresFigure 1: Flow diagram of the systematic process applied in medication error studies. Table 1: Characteristics of studies examining medication errors and adverse drug events in mental health hospitalsTable 2: Quality assessment criteria applied to the included studiesAbstract Background Little is known about the frequency and nature of medication errors (MEs) and adverse drug events (ADEs) that occur in mental health hospitals.Objective: This systematic review aims to provide an up-to-date and critical appraisal of the epidemiology and nature of MEs and ADEs in this setting. MethodTen electronic databases were searched including: MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Scopus, British Nursing Index, ASSIA, Web of Science, and Cochrane Database of Systematic Reviews (1999 to October 2016). Studies that examined the rate of MEs or ADEs in mental health hospitals were included and quality appraisal of the included studies was conducted. ResultIn total, 20 studies were identified. The rate of MEs ranged from 10.6 to 17.5 per 1000 patient-days (n= 2) and ADEs from 10.0-42.0 per 1000 patient-days (n=2) with 13.0 -17.3% of ADEs found to be preventable. ADEs were rated as clinically significant (66.0-71.0%), serious (28.0-31.0%), or life threatening (1.4-2.0%). Prescribing errors occurred in 4.5-6.3% of newly written or omitted prescription items (n=3); dispensing errors occurred in 4.6% of opportunities for error (n=1) and in 8.8% of patients (n=1); medication administration errors in 3.3-48.0% of opportunities for error (n=5). MEs and ADEs frequently associated with psychotropic, with atypical antipsychotic drugs commonly involved. Variability in study setting and data collection methods limited direct comparisons between studies. Conclusion Medication errors occur frequently in mental health hospitals and are associated with risk of patient harm. Effective interventions are needed to target these events and improve patient safety. Key points:Medication errors (MEs) and adverse drug events (ADEs) are common in mental health hospitalsPsychotropic medication was often involved in MEs and accounted for the majority of harm associated with medication use. Further research is needed to examine the rate of ADEs, dispensing errors and unintentional medication discrepancies at interface between primary and secondary care mental health settings. Future research is needed to examine the organisational and system context and its influence on medication safety in mental health settings so that effective interventions can be implemented. IntroductionThe prevention of medication errors (MEs) and adverse drug events (ADEs) in hospitals is recognised internationally as an important health care priority ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1" ExcludeYear="1"><RecNum>13367</RecNum><DisplayText>[1]</DisplayText><record><rec-number>13367</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13367</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>World Health Organization. World alliance for patient safety.Geneva: WHO; 2005. . Accessed 15 April 2016</title></titles><dates></dates><urls></urls></record></Cite></EndNote>[1]. A systematic review of eight studies from the US, UK, New Zealand, Australia, and Canada found that the median incidence rate of in-hospital adverse events was 9.2% of patients, with ADEs found to be common, accounting for 15.1% of adverse events ADDIN EN.CITE <EndNote><Cite><Author>de Vries</Author><Year>2008</Year><RecNum>13293</RecNum><DisplayText>[2]</DisplayText><record><rec-number>13293</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13293</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>de Vries, Eefje N</author><author>Ramrattan, Maya A</author><author>Smorenburg, Susanne M</author><author>Gouma, Dirk J</author><author>Boermeester, Marja A</author></authors></contributors><titles><title>The incidence and nature of in-hospital adverse events: a systematic review</title><secondary-title>Quality and Safety in Health Care</secondary-title></titles><periodical><full-title>Quality and Safety in Health Care</full-title></periodical><pages>216-223</pages><volume>17</volume><number>3</number><dates><year>2008</year></dates><isbn>2044-5423</isbn><urls></urls></record></Cite></EndNote>[2]. Other systematic reviews have examined the frequency of prescribing errors (PEs), medication administration errors (MAEs) and dispensing errors (DEs) in hospitals worldwide, with reported median rates of error being 7% (inter-quartile range (IQR) 2.0–14.0%) of medication orders, 19.0% (IQR 8.6-28.3%) of total opportunities for error, and a range of 0.1- 2.7% for items dispensed, respectively PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXdpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [3-5]. Whilst these reviews have contributed to our understanding of the extent and nature of medication-related problems in general hospitals, these estimates cannot be assumed to represent more specialist settings, such as mental health hospitals, where different patient population characteristics and ways of working may create distinct medication safety challenges than those seen in general hospital settings PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZXJ0PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [8, 10, 11]. In addition, mental health care practice also differs with regard to the unique medicines related legislation, such as the UK Mental Health Act 1983 (amended 2007), that requires strict documentation of prescribing practice and allows administration of treatment for mental disorders against the patient’s will ADDIN EN.CITE <EndNote><Cite><RecNum>13489</RecNum><DisplayText>[12]</DisplayText><record><rec-number>13489</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13489</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">The National Archives.Mental Health Act 2007. . Accessed 1 feb 2017</style></title></titles><dates></dates><urls></urls></record></Cite></EndNote>[12]. The type of medications used and the way in which these medicines are managed in mental health may also create unique safety challenges compared to general hospitals. For example, psychotropic medication such as antipsychotics, antidepressants and benzodiazepines are used frequently in the hospitalised mental health population, many of which contribute to physical health problems such as impaired glucose tolerance, dyslipidaemia, sexual dysfunction and extrapyramidal side effects PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZXJ0PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [6, 9, 13, 14]. Polypharmacy ADDIN EN.CITE <EndNote><Cite><Author>Kukreja</Author><Year>2013</Year><RecNum>13491</RecNum><DisplayText>[15]</DisplayText><record><rec-number>13491</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13491</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Kukreja, Sanjay</style></author><author><style face="normal" font="Times New Roman" size="10">Kalra, Gurvinder</style></author><author><style face="normal" font="Times New Roman" size="10">Shah, Nilesh</style></author><author><style face="normal" font="Times New Roman" size="10">Shrivastava, Amresh</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">Polypharmacy In Psychiatry: A Review</style></title><secondary-title><style face="normal" font="Times New Roman" size="10">Mens Sana Monographs</style></secondary-title></titles><periodical><full-title>Mens Sana Monographs</full-title></periodical><pages><style face="normal" font="Times New Roman" size="10">82-99</style></pages><volume><style face="normal" font="Times New Roman" size="10">11</style></volume><number><style face="normal" font="Times New Roman" size="10">1</style></number><dates><year><style face="normal" font="Times New Roman" size="10">2013</style></year></dates><pub-location><style face="normal" font="Times New Roman" size="10">India</style></pub-location><accession-num>PMC3653237</accession-num><urls><related-urls><url>;[15], high dose antipsychotic prescribing ADDIN EN.CITE <EndNote><Cite><Author>Centorrino</Author><Year>2004</Year><RecNum>13368</RecNum><DisplayText>[16, 17]</DisplayText><record><rec-number>13368</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13368</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Centorrino, Franca</author><author>Goren, Jessica L</author><author>Hennen, John</author><author>Salvatore, Paola</author><author>Kelleher, James P</author><author>Baldessarini, Ross J</author></authors></contributors><titles><title>Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>700-706</pages><volume>161</volume><number>4</number><dates><year>2004</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite><Cite><Author>Lelliott</Author><Year>2002</Year><RecNum>13369</RecNum><record><rec-number>13369</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13369</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lelliott, Paul</author><author>Paton, Carol</author><author>Harrington, Maria</author><author>Konsolaki, Maria</author><author>Sensky, Tom</author><author>Okocha, Chike</author></authors></contributors><titles><title>The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients</title><secondary-title>The Psychiatrist</secondary-title></titles><periodical><full-title>The Psychiatrist</full-title></periodical><pages>411-414</pages><volume>26</volume><number>11</number><dates><year>2002</year></dates><isbn>1758-3209</isbn><urls></urls></record></Cite></EndNote>[16, 17] and drug-drug/disease interactions are also prevalent in the mental health population ADDIN EN.CITE <EndNote><Cite><Author>Sinclair</Author><Year>2010</Year><RecNum>13496</RecNum><DisplayText>[18]</DisplayText><record><rec-number>13496</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13496</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Sinclair, Lindsey I</style></author><author><style face="normal" font="Times New Roman" size="10">Davies, Simon JC</style></author><author><style face="normal" font="Times New Roman" size="10">Parton, Graham</style></author><author><style face="normal" font="Times New Roman" size="10">Potokar, John P</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">Drug–drug interactions in general hospital and psychiatric hospital in-patients prescribed psychotropic medications</style></title><secondary-title><style face="normal" font="Times New Roman" size="10">Int J Psychiatry Clin Pract</style></secondary-title></titles><periodical><full-title>Int J Psychiatry Clin Pract</full-title></periodical><pages><style face="normal" font="Times New Roman" size="10">212-219</style></pages><volume><style face="normal" font="Times New Roman" size="10">14</style></volume><number><style face="normal" font="Times New Roman" size="10">3</style></number><dates><year><style face="normal" font="Times New Roman" size="10">2010</style></year></dates><urls></urls></record></Cite></EndNote>[18], which can increase the risk of medication- related problems. 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ADDIN EN.CITE.DATA [19-21]. Whilst informative, these reviews are now outdated as more recent publications relating to ME and ADE in mental health hospitals have emergedPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db3R0bmV5PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA [20, 21] or were specific to elderly patients ADDIN EN.CITE <EndNote><Cite><Author>Maidment</Author><Year>2008</Year><RecNum>13270</RecNum><DisplayText>[21]</DisplayText><record><rec-number>13270</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13270</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Maidment, Ian D</author><author>Haw, Camilla</author><author>Stubbs, Jean</author><author>Fox, Chris</author><author>Katona, Cornelius</author><author>Franklin, Bryony Dean</author></authors></contributors><titles><title>Medication errors in older people with mental health problems: a review</title><secondary-title>International journal of geriatric psychiatry</secondary-title></titles><pages>564-573</pages><volume>23</volume><number>6</number><dates><year>2008</year></dates><isbn>1099-1166</isbn><urls></urls></record></Cite></EndNote>[21], which limits understanding across wider mental health settings and populations. Some of these earlier reviews also included studies that reported error rates based on incident report data PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5JdG88L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA [26, 27], which are known to underestimate error rates substantially ADDIN EN.CITE <EndNote><Cite><Author>Meyer-Massetti</Author><Year>2011</Year><RecNum>13423</RecNum><DisplayText>[28]</DisplayText><record><rec-number>13423</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13423</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Meyer-Massetti, Carla</style></author><author><style face="normal" font="Times New Roman" size="10">Cheng, Christine M</style></author><author><style face="normal" font="Times New Roman" size="10">Schwappach, David LB</style></author><author><style face="normal" font="Times New Roman" size="10">Paulsen, Lynn</style></author><author><style face="normal" font="Times New Roman" size="10">Ide, Brigid</style></author><author><style face="normal" font="Times New Roman" size="10">Meier, Christoph R</style></author><author><style face="normal" font="Times New Roman" size="10">Guglielmo, B Joseph</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">Systematic review of medication safety assessment methods</style></title><secondary-title><style face="normal" font="Times New Roman" size="10">Am J Health Syst Pharm</style></secondary-title></titles><pages><style face="normal" font="Times New Roman" size="10">227-240</style></pages><volume><style face="normal" font="Times New Roman" size="10">68</style></volume><number><style face="normal" font="Times New Roman" size="10">3</style></number><dates><year><style face="normal" font="Times New Roman" size="10">2011</style></year></dates><isbn>1079-2082</isbn><urls></urls></record></Cite></EndNote>[28], or focussed exclusively on MEs without consideration of ADEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWlkbWVudDwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+
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ADDIN EN.CITE.DATA [20, 21]. Therefore, the aim of this systematic review was to provide an up-to-date and critical assessment of the frequency and nature of ME and ADE in mental health hospitals. MethodDefinitions ADEs were defined as: “any injury resulting from medical intervention related to a drug” ADDIN EN.CITE <EndNote><Cite><Author>Bates</Author><Year>1995</Year><RecNum>13314</RecNum><DisplayText>[29, 30]</DisplayText><record><rec-number>13314</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13314</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bates, David W</author><author>Cullen, David J</author><author>Laird, Nan</author><author>Petersen, Laura A</author><author>Small, Stephen D</author><author>Servi, Deborah</author><author>Laffel, Glenn</author><author>Sweitzer, Bobbie J</author><author>Shea, Brian F</author><author>Hallisey, Robert</author></authors></contributors><titles><title>Incidence of adverse drug events and potential adverse drug events: implications for prevention</title><secondary-title>Jama</secondary-title></titles><pages>29-34</pages><volume>274</volume><number>1</number><dates><year>1995</year></dates><isbn>0098-7484</isbn><urls></urls></record></Cite><Cite><Author>Bates</Author><Year>1999</Year><RecNum>13372</RecNum><record><rec-number>13372</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13372</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bates, David W</author><author>Miller, Elizabeth B</author><author>Cullen, David J</author><author>Burdick, Lisa</author><author>Williams, Lawrence</author><author>Laird, Nan</author><author>Petersen, Laura A</author><author>Small, Stephen D</author><author>Sweitzer, Bobbie J</author><author>Vander Vliet, Martha</author></authors></contributors><titles><title>Patient risk factors for adverse drug events in hospitalized patients</title><secondary-title>Archives of internal medicine</secondary-title></titles><periodical><full-title>Archives of internal medicine</full-title></periodical><pages>2553-2560</pages><volume>159</volume><number>21</number><dates><year>1999</year></dates><isbn>0003-9926</isbn><urls></urls></record></Cite></EndNote>[29, 30] and those associated with medication errors classified as preventable adverse drug events (pADEs). Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) as: “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labelling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use” ADDIN EN.CITE <EndNote><Cite><RecNum>13389</RecNum><DisplayText>[31]</DisplayText><record><rec-number>13389</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13389</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">National Coordinating Council for Medication Error Reporting and Prevention. About Medication Errors: What is a Medication Error.2015. . Accessed 2 Feb 2016</style></title></titles><dates></dates><urls></urls></record></Cite></EndNote>[31]. Unintentional medication discrepancies were also examined and defined as “unexplained differences in documented medication regimens at the point of transition of care” ADDIN EN.CITE <EndNote><Cite><Author>Mueller</Author><Year>2012</Year><RecNum>13498</RecNum><DisplayText>[32]</DisplayText><record><rec-number>13498</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13498</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Mueller, Stephanie K</style></author><author><style face="normal" font="Times New Roman" size="10">Sponsler, Kelly Cunningham</style></author><author><style face="normal" font="Times New Roman" size="10">Kripalani, Sunil</style></author><author><style face="normal" font="Times New Roman" size="10">Schnipper, Jeffrey L</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">Hospital-based medication reconciliation practices: a systematic review</style></title><secondary-title><style face="normal" font="Times New Roman" size="10">Arch Intern Med</style></secondary-title></titles><periodical><full-title>Arch Intern Med</full-title></periodical><pages><style face="normal" font="Times New Roman" size="10">1057-1069</style></pages><volume><style face="normal" font="Times New Roman" size="10">172</style></volume><number><style face="normal" font="Times New Roman" size="10">14</style></number><dates><year><style face="normal" font="Times New Roman" size="10">2012</style></year></dates><urls></urls></record></Cite></EndNote>[32]. Search strategy We searched ten electronic databases from January 1999 to October 2016: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINHAL), International Pharmaceutical Abstracts (IPA), PsycINFO, Scopus, British Nursing Index (BNI), Applied Social Science Index and Abstract (ASSIA), Web of Science, and Cochrane Database of Systematic Reviews. The start date of the search was selected to coincide with the publication of the landmark report To Err Is Human: Building a Safer Health System ADDIN EN.CITE <EndNote><Cite><Author>Kohn</Author><Year>1999</Year><RecNum>13298</RecNum><DisplayText>[33]</DisplayText><record><rec-number>13298</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13298</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Kohn, Linda T</style></author><author><style face="normal" font="Times New Roman" size="10">Corrigan, Janet M</style></author><author><style face="normal" font="Times New Roman" size="10">Donaldson, Molla S</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">To err is human: building a safer health system</style></title></titles><volume><style face="normal" font="Times New Roman" size="10">6</style></volume><dates><year><style face="normal" font="Times New Roman" size="10">1999</style></year></dates><pub-location><style face="normal" font="Times New Roman" size="10"> Washington, D.C</style></pub-location><publisher><style face="normal" font="Times New Roman" size="10">National Academies Press</style></publisher><isbn>0309261740</isbn><urls></urls></record></Cite></EndNote>[33], which is generally considered to have instigated extensive patient safety research ADDIN EN.CITE <EndNote><Cite><Author>Stelfox</Author><Year>2006</Year><RecNum>13316</RecNum><DisplayText>[34]</DisplayText><record><rec-number>13316</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13316</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stelfox, Henry Thomas</author><author>Palmisani, Stefano</author><author>Scurlock, Corey</author><author>Orav, E John</author><author>Bates, David W</author></authors></contributors><titles><title>The “To Err is Human” report and the patient safety literature</title><secondary-title>Quality and Safety in Health Care</secondary-title></titles><periodical><full-title>Quality and Safety in Health Care</full-title></periodical><pages>174-178</pages><volume>15</volume><number>3</number><dates><year>2006</year></dates><isbn>2044-5423</isbn><urls></urls></record></Cite></EndNote>[34], and to also ensure that the included studies related to current medication safety practices in mental health hospitals. For each database, the search keywords used were divided into three groups: error-related terms (including error(s), medication error(s), medical error, drug error, treatment error, therapeutic error, medication safety, drug safety, drug-related problem, adverse drug event, preventable adverse drug event, potential adverse drug event, near miss, medication incident, clinical incident, drug incident, incident report, prescribing error, prescription error, administration error, dispensing error, transcription error, omission, discrepancy); epidemiology-related terms (including rate, prevalence, incidence); and setting-related terms (including psychiatry, psychiatric hospital, mental health hospital, adult psychiatry, child psychiatry, adolescent psychiatry, geriatric psychiatry, and forensic psychiatry). The reference lists of all included articles and relevant reviews were also examined to identify any additional studies that could be eligible for inclusion. Any additional studies identified by the project team were also included as long as they fulfilled the study’s inclusion criteria. Study authors were contacted when additional information was required. Inclusion and exclusion criteria Inclusion criteria: studies published between 1999 to October 2016 that reported the rate of ME/ADE in one or more stage(s) of the treatment process (prescribing, administration, transcription, dispensing and monitoring) for patients in mental health hospitals (in-patient and outpatient services). Studies that examined the rate of unintentional medication discrepancies at the point of transition of care between mental health hospitals and other settings (such as primary care) were also included. However, studies that failed to differentiate between intentional and unintentional discrepancies using a robust method (e.g. by contacting the medical team) were not included. In addition, studies that examined the impact of interventions on ME or ADE rates were only included if a baseline error rate could be determined. Conference abstracts were also included if they provided sufficient data that allowed for the rate of ME or ADE to be calculated. Exclusion criteria: studies that utilised incident reports as the primary source of collecting data were excluded (as they greatly underestimate the error rate) ADDIN EN.CITE <EndNote><Cite><Author>Meyer-Massetti</Author><Year>2011</Year><RecNum>13423</RecNum><DisplayText>[28]</DisplayText><record><rec-number>13423</rec-number><foreign-keys><key app="EN" db-id="zfvrwwsp1asf5yetafovp2rnt9t9erv05f5v">13423</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Times New Roman" size="10">Meyer-Massetti, Carla</style></author><author><style face="normal" font="Times New Roman" size="10">Cheng, Christine M</style></author><author><style face="normal" font="Times New Roman" size="10">Schwappach, David LB</style></author><author><style face="normal" font="Times New Roman" size="10">Paulsen, Lynn</style></author><author><style face="normal" font="Times New Roman" size="10">Ide, Brigid</style></author><author><style face="normal" font="Times New Roman" size="10">Meier, Christoph R</style></author><author><style face="normal" font="Times New Roman" size="10">Guglielmo, B Joseph</style></author></authors></contributors><titles><title><style face="normal" font="Times New Roman" size="10">Systematic review of medication safety assessment methods</style></title><secondary-title><style face="normal" font="Times New Roman" size="10">Am J Health Syst Pharm</style></secondary-title></titles><pages><style face="normal" font="Times New Roman" size="10">227-240</style></pages><volume><style face="normal" font="Times New Roman" size="10">68</style></volume><number><style face="normal" font="Times New Roman" size="10">3</style></number><dates><year><style face="normal" font="Times New Roman" size="10">2011</style></year></dates><isbn>1079-2082</isbn><urls></urls></record></Cite></EndNote>[28], as were those that used an estimated denominator to calculate the rate of ME or ADE (as the provided rate may not be reflective of the actual rate) ADDIN EN.CITE <EndNote><Cite><Author>Lewis</Author><Year>2009</Year><RecNum>13318</RecNum><DisplayText>[3]</DisplayText><record><rec-number>13318</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13318</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lewis, Penny J</author><author>Dornan, Tim</author><author>Taylor, David</author><author>Tully, Mary P</author><author>Wass, Val</author><author>Ashcroft, Darren M</author></authors></contributors><titles><title>Prevalence, incidence and nature of prescribing errors in hospital inpatients</title><secondary-title>Drug Safety</secondary-title></titles><periodical><full-title>Drug safety</full-title></periodical><pages>379-389</pages><volume>32</volume><number>5</number><dates><year>2009</year></dates><isbn>0114-5916</isbn><urls></urls></record></Cite></EndNote>[3]. Studies that reported ME or ADE rates for a single drug, single drug class or disease were excluded, as were studies that only examined specific prescribing, administration, transcription or dispensing error subtypes such as wrong dose. Studies that reported the rate of potentially inappropriate prescribing (PIP) in mental health hospitals were excluded, as they were not considered to be medication errors ADDIN EN.CITE <EndNote><Cite><Author>Buetow</Author><Year>1996</Year><RecNum>13292</RecNum><DisplayText>[35]</DisplayText><record><rec-number>13292</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13292</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buetow, Stephen A</author><author>Sibbald, Bonnie</author><author>Cantrill, Judith A</author><author>Halliwell, Shirley</author></authors></contributors><titles><title>Prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom, 1980–95: systematic literature review</title><secondary-title>BMJ</secondary-title></titles><periodical><full-title>Bmj</full-title></periodical><pages>1371-1374</pages><volume>313</volume><number>7069</number><dates><year>1996</year><pub-dates><date>1996-11-30 08:00:00</date></pub-dates></dates><urls></urls><electronic-resource-num>10.1136/bmj.313.7069.1371</electronic-resource-num></record></Cite></EndNote>[35]. Whilst review articles were excluded, we screened the reference lists of any identified reviews to identify other relevant studies. Data extraction A standardized data collection form was developed and used to collect information concerning: publication year; country of origin; study setting; definitions used; study design (retrospective or prospective); and error detection method. In addition, information related to the main findings of the study, including the rate of ME or ADE (including the rate of pADEs), type of denominator used, type of errors, class of medication involved, and severity of reported errors, was also retrieved. For each study, data was extracted by two of the authors independently, with any disagreements in extraction being resolved by discussion between all authors.Quality assessmentThe quality of the included studies was assessed on the basis of criteria originally developed by Allan and Barker ADDIN EN.CITE <EndNote><Cite><Author>Allan</Author><Year>1990</Year><RecNum>13302</RecNum><DisplayText>[36]</DisplayText><record><rec-number>13302</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13302</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allan, EL</author><author>Barker, KN</author></authors></contributors><titles><title>Fundamentals of medication error research</title><secondary-title>American Journal of Health-System Pharmacy</secondary-title></titles><periodical><full-title>American Journal of Health-System Pharmacy</full-title></periodical><pages>555-571</pages><volume>47</volume><number>3</number><dates><year>1990</year></dates><isbn>1079-2082</isbn><urls></urls></record></Cite></EndNote>[36], which has been used in other systematic reviews of medication safety PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaGFsZWI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [37-39], including one in mental health settings ADDIN EN.CITE <EndNote><Cite><Author>Maidment</Author><Year>2008</Year><RecNum>13270</RecNum><DisplayText>[21]</DisplayText><record><rec-number>13270</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13270</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Maidment, Ian D</author><author>Haw, Camilla</author><author>Stubbs, Jean</author><author>Fox, Chris</author><author>Katona, Cornelius</author><author>Franklin, Bryony Dean</author></authors></contributors><titles><title>Medication errors in older people with mental health problems: a review</title><secondary-title>International journal of geriatric psychiatry</secondary-title></titles><pages>564-573</pages><volume>23</volume><number>6</number><dates><year>2008</year></dates><isbn>1099-1166</isbn><urls></urls></record></Cite></EndNote>[21]. The criteria require a clear description of the following: aim/objectives of the study; outcome definition; error categories specified; error categories defined (applicable for general ME studies only); denominator; data collection method; study setting; validity and reliability measures used; and consideration of study limitations.Data analysis The included studies were heterogeneous in nature, which prevented any meta-analysis of data. Although a comparable denominator (opportunities for error) was observed among studies reporting medication administration error rates, differences in study setting and types of administration error being studied meant that pooled analysis was not appropriate; therefore, the findings were summarised narratively. The percentage rate of ME was determined by dividing the number of actual errors that occurred or number of patients/prescriptions affected by MEs by the total number of prescriptions/patients/OE multiplied by 100. The rate of ADE/pADE per 1000 patient days was calculated by dividing number of ADEs/pADEs by the total number of patient days multiplied by 1000. Literature search resultsIn all, 20 unique studies were included in this systematic review, as shown in Fig. 1. Six studies examined overall ME ratesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [42-44]. In total, 14 studies reported data on the rate of PE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
Y051bT4xMzI4NjwvUmVjTnVtPjxEaXNwbGF5VGV4dD5bMjQsIDI1LCA0MCwgNDItNTJdPC9EaXNw
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ADDIN EN.CITE.DATA [24, 25, 40, 42-52] , one on unintentional discrepancies ADDIN EN.CITE <EndNote><Cite><Author>Brownlie</Author><Year>2014</Year><RecNum>13275</RecNum><DisplayText>[53]</DisplayText><record><rec-number>13275</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13275</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brownlie, Kay</author><author>Schneider, Carl</author><author>Culliford, Roger</author><author>Fox, Chris</author><author>Boukouvalas, Alexis</author><author>Willan, Cathy</author><author>Maidment, Ian D</author></authors></contributors><titles><title>Medication reconciliation by a pharmacy technician in a mental health assessment unit</title><secondary-title>International journal of clinical pharmacy</secondary-title></titles><periodical><full-title>International journal of clinical pharmacy</full-title></periodical><pages>303-309</pages><volume>36</volume><number>2</number><dates><year>2014</year></dates><isbn>2210-7703</isbn><urls></urls></record></Cite></EndNote>[53], and eight on MAEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db3R0bmV5PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA [22, 23, 40, 42, 44, 45, 54, 55]. A summary of the characteristics of the included studies is presented in Table 1.Quality assessmentThe aim and objectives for each study were clearly stated and definitions provided for MEs/ADEs in all (n=16, 80%) but four studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [43, 46, 52, 53] ME categories were specified in all ME studies, and defined in one study ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]. The denominators were explicitly described in all studies. The data collection method and study setting were also described clearly in all studies. A process of validation to confirm the error had occurred was applied in eleven (55%) studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [43, 51, 55]. Conference abstract made quality assessment of study reporting a challenging task, as the nature of abstracts precludes sufficient information for such an assessment. A summary of the quality assessment criteria is shown in Table 2.Fig. 1 Flow diagram of the systematic process applied in medication error studies -9944101120140Identification00Identification-9944104320540Eligibility00Eligibility-9944105920740Included00Included-9944102720340Screening00Screening1558290113030Records retrieved from electronic search (n = 41,631)00Records retrieved from electronic search (n = 41,631)2679065201930004441825133985Number of duplicates removed(n = 19,450)00Number of duplicates removed(n = 19,450)2678747207645001433112145001Records of titles screened (n = 22,181)00Records of titles screened (n = 22,181)2678927128104004282440158750Records excluded (n = 21,361)00Records excluded (n = 21,361)270065542354500186436021590Records for abstract screened(n = 820)(n = )00Records for abstract screened(n = 820)(n = )38963601181735Full-text articles excluded, with reasons (n = 26)4 review articles11 studies with no denominator/error given 2 discrepancy studies without using a robust method to distinguish between intentional/unintentional discrepancies1 study used estimated denominator 3 studies that relied solely on incident report as method for collecting data1 study on single mental health disease 2 Potential inappropriate prescribing studies2 abstract that did not provide sufficient data for inclusion00Full-text articles excluded, with reasons (n = 26)4 review articles11 studies with no denominator/error given 2 discrepancy studies without using a robust method to distinguish between intentional/unintentional discrepancies1 study used estimated denominator 3 studies that relied solely on incident report as method for collecting data1 study on single mental health disease 2 Potential inappropriate prescribing studies2 abstract that did not provide sufficient data for inclusion18643602369185Studies included in systematic review (n =20)Including 3 conference abstracts00Studies included in systematic review (n =20)Including 3 conference abstracts269748017214850353695961390Additional records identified through other sources (n = 11)9 studies from reference list screening2 conference abstract suggested by project team 00Additional records identified through other sources (n = 11)9 studies from reference list screening2 conference abstract suggested by project team 158623020466050027120852049780004126731365125Records excluded (n = 785)00Records excluded (n = 785)26739857162800026758904222750018662651035685Full-text articles assessed for eligibility (n =35)00Full-text articles assessed for eligibility (n =35)Frequency of medication errors and adverse drug eventsOverall Rates of Medication Errors and Adverse Drug Events Six studies reported an overall ME rate covering all stages of the medication treatment process from prescribing through to dispensing (Table 1). Of these, two studies examined both MEs and ADEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BeWFuaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [42, 44].Two studies with similar denominators reported an overall ME rate of 10.6–17.5 per 1000 patient-days PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40, 41]. Other studies found that MEs occurred in 2.4% of complete prescriptions checked (in a paediatric outpatient setting) ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43], 17.4% of total OE ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44] and in 61.4% of patients ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]. MEs commonly occurred during prescribing PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BeWFuaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [42, 44, 45] and also occurred due to a lack of treatment monitoring ADDIN EN.CITE <EndNote><Cite><Author>Ayani</Author><Year>2016</Year><RecNum>13332</RecNum><DisplayText>[41]</DisplayText><record><rec-number>13332</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayani, Nobutaka</author><author>Sakuma, Mio</author><author>Morimoto, Takeshi</author><author>Kikuchi, Toshiaki</author><author>Watanabe, Koichiro</author><author>Narumoto, Jin</author><author>Fukui, Kenji</author></authors></contributors><titles><title>The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>303</pages><volume>16</volume><number>1</number><dates><year>2016</year></dates><pub-location>London</pub-location><publisher>BioMed Central</publisher><isbn>1471-244X</isbn><accession-num>PMC5004271</accession-num><urls><related-urls><url>;[41]. Psychotropic therapy was most often associated with error (41.0–68.0%), particularly involving atypical antipsychotics (19.3–32.0%) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tw7hyZW5zZW48L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA [40, 43, 44]. In child outpatient settings, methylphenidate and trihexyphenidyl were most frequently associated with error ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. The assessment of potential severity was carried out either by using the NCCMERP criteria ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42] or based on methods used in other published studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40]. The study from Japan ADDIN EN.CITE <EndNote><Cite><Author>Ayani</Author><Year>2016</Year><RecNum>13332</RecNum><DisplayText>[41]</DisplayText><record><rec-number>13332</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayani, Nobutaka</author><author>Sakuma, Mio</author><author>Morimoto, Takeshi</author><author>Kikuchi, Toshiaki</author><author>Watanabe, Koichiro</author><author>Narumoto, Jin</author><author>Fukui, Kenji</author></authors></contributors><titles><title>The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>303</pages><volume>16</volume><number>1</number><dates><year>2016</year></dates><pub-location>London</pub-location><publisher>BioMed Central</publisher><isbn>1471-244X</isbn><accession-num>PMC5004271</accession-num><urls><related-urls><url>;[41] found the incidence rate of ADEs was higher in medical care units—where psychiatric patients with physical comorbidities are more likely to be treated—than in acute and nursing units. Psychotropic medicines were commonly involved with ADEs (79.8–92.0%), including the pADE subset (58.4–68%). Atypical antipsychotic medicines were the most common psychotropic class associated with ADEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BeWFuaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [40]USA:Academic psychiatrichospital inNewEnglandarea(inpatient)P (6 months)AdultChartreview,incidentreport,nurse–pharmacyreports203 MEs19,180 pt-days 10.6 per 1000 pt-daysSignificant 50.7; serious 44.8; life-threatening 4.4Grasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45]USA:AugustaMentalHealthInstitute, aState psychiatrichospital(inpatient)R(5Months)AdultChart review 239 PEs 498 TEs 1443MAEsa1448 pt-days156 PE per 1000 pt-days344 TE per 1000 pt-days997 MAE per 1000 pt-days Low 19.0; moderate 23.0; high 58.0bSirithongthavonet al. ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]Thailand:tertiarypsychiatriccarehospital (outpatient)P(12 months)PaediatricChart review180 MEsc7444Prescriptions2.4% of prescription Not assessedS?rensen et al. ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]Denmark: 3psychiatricwards atAalborgUniversityHospital(inpatient)P/R(4 months)AdultDirectobservation,unannouncedcontrolvisits, chartreview189 MEs1082 OEs17.4% of total OEsNon-significant 17.4; Significant 28; serious 42.3; life-threatening 2.1Hema et al. ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]India:psychiatrydepartmentof JSSHospital(inpatientandoutpatient)P (6 months)AdultChart review215 MEs in 102pts166 ptsd61.4% of pts experienced MEsCategory A 0Category B 19.0Category C 80.0Category D 0.9Ayani et al. ADDIN EN.CITE <EndNote><Cite><Author>Ayani</Author><Year>2016</Year><RecNum>13332</RecNum><DisplayText>[41]</DisplayText><record><rec-number>13332</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayani, Nobutaka</author><author>Sakuma, Mio</author><author>Morimoto, Takeshi</author><author>Kikuchi, Toshiaki</author><author>Watanabe, Koichiro</author><author>Narumoto, Jin</author><author>Fukui, Kenji</author></authors></contributors><titles><title>The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>303</pages><volume>16</volume><number>1</number><dates><year>2016</year></dates><pub-location>London</pub-location><publisher>BioMed Central</publisher><isbn>1471-244X</isbn><accession-num>PMC5004271</accession-num><urls><related-urls><url>;[41]Japan: 1Psychiatric hospital and 1 tertiaryCare teachinghospital(inpatient)R (1 year)AdultChartreview,incidentreport,laboratoryresult398 MEs22,733 pt-days17.5 per 1000 pt-days Not assessedPrescribing error Nirodi andMitchell ADDIN EN.CITE <EndNote><Cite><Author>Nirodi</Author><Year>2002</Year><RecNum>13175</RecNum><DisplayText>[46]</DisplayText><record><rec-number>13175</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nirodi, P</author><author>Mitchell, AJ</author></authors></contributors><titles><title>The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly</title><secondary-title>Aging & mental health</secondary-title></titles><pages>191-196</pages><volume>6</volume><number>2</number><dates><year>2002</year></dates><isbn>1360-7863</isbn><urls></urls></record></Cite></EndNote>[46]UK: 2psychiatricinpatientunits (inpatient)R (7 years)ElderlyChart review92 pts experienced PEs112 pts 82.1% of pts experienced PEseNot assessedGrasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2002</Year><RecNum>13254</RecNum><DisplayText>[52]</DisplayText><record><rec-number>13254</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13254</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, Benjamin C</author><author>Genest, Robert</author><author>Yung, Kathryn</author><author>Arnold, Charles</author></authors></contributors><titles><title>Reducing errors in discharge medication lists by using personal digital assistants</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>1325-1326</pages><volume>53</volume><number>10</number><dates><year>2002</year></dates><isbn>1075-2730</isbn><urls></urls></record></Cite></EndNote>[52]USA: Augusta Mental Health Institute, astate psychiatrichospital (inpatient)R (4 months)AdultChart review20 medication lists affected by PEs110 dischargemedicationlists18.0% of discharge medication lists affected by PEsNot assessedHaw andStubbs ADDIN EN.CITE <EndNote><Cite><Author>Haw</Author><Year>2003</Year><RecNum>9391</RecNum><DisplayText>[48]</DisplayText><record><rec-number>9391</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">9391</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haw, C.</author><author>Stubbs, J.</author></authors></contributors><auth-address>(Haw, Stubbs) St. Andrew's Hospital, Northampton, United Kingdom</auth-address><titles><title>Prescribing errors at a psychiatric hospital</title><secondary-title>Pharmacy in Practice</secondary-title></titles><pages>64-66</pages><volume>13</volume><number>2</number><dates><year>2003</year></dates><accession-num>2005101999</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[48]UK: StAndrew’shospital(inpatient)P (1 month)AdultChart review311 PEs in 50 prescription items 2274prescriptionitems2.2% of prescription items affected by PEs55.6 minimal clinical significance: 35.7 clinically significant, 8.7 could cause potential harm; 0 potentially life-threateningGrasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45]USA: Augusta Mental Health Institute, aState psychiatricHospital (inpatient)R (5Months)AdultChart review239 PEs1448 pt-days 165.5 PE per 1000 pt-daysNot assessedStubbs et al. ADDIN EN.CITE <EndNote><Cite><Author>Stubbs</Author><Year>2006</Year><RecNum>13285</RecNum><DisplayText>[47]</DisplayText><record><rec-number>13285</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13285</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stubbs, Jean</author><author>Haw, Camilla</author><author>Taylor, David</author></authors></contributors><auth-address>Stubbs,Jean. St Andrew's Hospital, Northampton, UK.</auth-address><titles><title>Prescription errors in psychiatry - a multi-centre study</title><secondary-title>Journal of Psychopharmacology</secondary-title></titles><pages>553-61</pages><volume>20</volume><number>4</number><dates><year>2006</year></dates><accession-num>16401663</accession-num><work-type>Multicenter Study</work-type><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[47]UK: 9centres (8acute ormentalhealthtrusts andoneindependentpsychiatrichospital)(inpatient)P (1 week)AdultChart review523 PEs in 523 prescription items 22,036prescriptionitems2.4% of prescription items affected by PEs47.8 negligible 45.9 minor; 3.3 serious; 1.0 fatalShawahna andUr-Rahman ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>Shawahna</Author><RecNum>13253</RecNum><DisplayText>[50]</DisplayText><record><rec-number>13253</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13253</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shawahna, Ramzi</author></authors></contributors><titles><title>Prescribing errors in psychiatry department: An audit from a hospital in Lahore</title><secondary-title>Journal of Pakistan Psychiatric Society.</secondary-title></titles><periodical><full-title>Journal of Pakistan Psychiatric Society.</full-title></periodical><pages>31</pages><volume>5</volume><number>1</number><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>[50]Pakistan:psychiatrydepartmentin ahospital inLahore(inpatient)P (15 days)AdultChart review33 PEs in 77 prescription items84prescriptionitems91.6% of prescription items affected by PEseNot assessedJhanjee et al. ADDIN EN.CITE <EndNote><Cite><Author>Jhanjee</Author><Year>2012</Year><RecNum>13248</RecNum><DisplayText>[49]</DisplayText><record><rec-number>13248</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13248</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jhanjee, Anurag</author><author>Bhatia, MS</author><author>Oberoi, Anant</author><author>Srivastava, Shruti</author></authors></contributors><titles><title>Medication errors in psychiatric practice—A Cross-sectional Study</title></titles><dates><year>2012</year></dates><urls></urls></record></Cite></EndNote>[49]India: psychiatryoutpatientdepartmentof GuruTeghBahadurhospital inDelhi(outpatient)P (Mar 2009to Nov2011)AdultChart review1131 PEsc899 PEsc648Prescriptions464antipsychoticonlyprescriptions175.0 per 100 prescription ef 193.7 per 100 antipsychotic only prescriptions efNot assessedS?rensen et al. ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]Denmark: 3psychiatricwards atAalborgUniversityHospital(inpatient)R (4 months)AdultChart review10 PEs267 OE4.0% of total OESignificant 40.0; serious 40.0; life-threatening 20.0Keers et al. ADDIN EN.CITE <EndNote><Cite><Author>Keers</Author><Year>2014</Year><RecNum>13286</RecNum><DisplayText>[24]</DisplayText><record><rec-number>13286</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13286</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keers, Richard N</author><author>Williams, Steven D</author><author>Vattakatuchery, Joe J</author><author>Brown, Petra</author><author>Miller, Joan</author><author>Prescott, Lorraine</author><author>Ashcroft, Darren M</author></authors></contributors><titles><title>Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study</title><secondary-title>BMJ open</secondary-title></titles><periodical><full-title>BMJ open</full-title></periodical><pages>e006084</pages><volume>4</volume><number>9</number><dates><year>2014</year></dates><isbn>2044-6055</isbn><urls></urls></record></Cite></EndNote>[24]UK: 3mentalhealth NHStrusts basedin NorthWest ofEngland(inpatient)P (10 days)Adult Chart review288 PEs in 281 newlywritten,or omitteditems 4427 ofnewly writtenor omittedprescriptionitems6.3% (95% CI5.6–7.1) ofnewly writtenor omittedprescriptionitems affected by PEsMinor 43.8;significant 49.3; serious 6.6; life-threatening 0.3Keers et al. 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ADDIN EN.CITE.DATA [25]UK: 3 Mental health NHS trust basedin North West ofEngland(inpatient)P (6 weeks)AdultChart review74 PEs in 74 newly written or omitted items (dischargeprescriptiononly)1456 newlywritten oromitted items5.1% (95% CI4.0–6.2) of newly written or omitted items affected by PEsMinor 27; significant 67.6, severe 5.4; life threatening 0Scott et al. ADDIN EN.CITE <EndNote><Cite><Year>2016</Year><RecNum>13345</RecNum><DisplayText>[51]</DisplayText><record><rec-number>13345</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13345</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Scott H, Brown D, Herreraa H.Prevalence and nature of prescribing errors in a mental health setting: analysis of preliminary data from a prospective study</title><secondary-title>International Journal of Pharmacy Practice</secondary-title></titles><periodical><full-title>International Journal of Pharmacy Practice</full-title></periodical><pages>3:8–13</pages><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>[51]UK: NR(inpatient)P (NR)AdultChart review288 PEs in 231newlyprescribed,or omitteditems5127 newlywritten oromitted items4.5% (95% CI4.0–5.1) ofnewlyprescribed,or omitteditems affected by PEsNot assessedHema et al. ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]India: psychiatrydepartment of JSShospital (inpatientand outpatient)P (6 months)Adult Chart review59 PEs in 47 inpatients13 PEs in 12 outpatients 90 inpatientsd 12 outpatientsd 52.2% of inpatients experienced PEse100% of outpatients experienced PEseNot assessedRothschild etal. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40]USA:Academic psychiatrichospital inNewEnglandarea(inpatient)P (6 months)AdultChartreview,incidentreport,nurse–pharmacyreports138 PEs19,180 pt-days7.2 PE per 1000 pt-dayse Not assessed Sirithongthavonet al. ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]Thailand:tertiarypsychiatriccarehospital (outpatient)P (12 months)PaediatricChart review68 PEsc 7444Prescriptions0.9% of prescriptionseNot assessedTranscription errorGrasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45]USA: Augusta Mental Health Institute, aState psychiatricHospital (inpatient)R (5Months)AdultChart review498 TEs1448 pt-days 344 TE per 1000 pt-days Not assessedRothschild etal. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40]USA:Academic psychiatrichospital inNewEnglandarea(inpatient)P (6 months)AdultChartreview,incidentreport,nurse–pharmacyreports40 TEs19,180 pt-days2.1 TE per 1000 pt-dayse Not assessed Sirithongthavonet al. ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]Thailand:tertiarypsychiatriccarehospital (outpatient)P (12 months)PaediatricChart review86 TEsc7444Prescriptions1.1% of prescriptionse Not assessedUnintentional medication discrepancy Brownlie et al. ADDIN EN.CITE <EndNote><Cite><Author>Brownlie</Author><Year>2014</Year><RecNum>13275</RecNum><DisplayText>[53]</DisplayText><record><rec-number>13275</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13275</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brownlie, Kay</author><author>Schneider, Carl</author><author>Culliford, Roger</author><author>Fox, Chris</author><author>Boukouvalas, Alexis</author><author>Willan, Cathy</author><author>Maidment, Ian D</author></authors></contributors><titles><title>Medication reconciliation by a pharmacy technician in a mental health assessment unit</title><secondary-title>International journal of clinical pharmacy</secondary-title></titles><periodical><full-title>International journal of clinical pharmacy</full-title></periodical><pages>303-309</pages><volume>36</volume><number>2</number><dates><year>2014</year></dates><isbn>2210-7703</isbn><urls></urls></record></Cite></EndNote>[53]UK: SouthEssexPartnershipUniversity NHSFoundationTrustAssessmentUnit(inpatient)P (3 months)AdultChart review601 unintentionaldiscrepancies in 212 admissions377 ptadmissions56.0% of admissions affected by unintentional medication discrepanciesIf error corrected:62.3 minor; 37.7 moderate.If discrepancy continued to primary care: 23 minor; 76.3 moderateMedication administration error Grasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45]USA:Augusta MentalHealth Institute, aState psychiatricHospital (inpatient)R (5months)AdultChart review1443 MAEs1448 pt-days997 MAE per 1000 pt-daysNot assessedHaw et al. ADDIN EN.CITE <EndNote><Cite><Author>Haw</Author><Year>2007</Year><RecNum>13279</RecNum><DisplayText>[54]</DisplayText><record><rec-number>13279</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haw, C.</author><author>Stubbs, J.</author><author>Dickens, G.</author></authors></contributors><auth-address>(Haw, Stubbs, Dickens) St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, United Kingdom</auth-address><titles><title>An observational study of medication administration errors in old-age psychiatric inpatients</title><secondary-title>International Journal for Quality in Health Care</secondary-title></titles><periodical><full-title>International Journal for Quality in Health Care</full-title></periodical><pages>210-216</pages><volume>19</volume><number>4</number><dates><year>2007</year></dates><accession-num>2007398605</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[54]UK: 2 long staywards at St. Andrew’sHospital(inpatient)P (4 weeks)ElderlyDirectobservation,chart review,incidentreport369 MAEs1423 OE25.9% of total OEDoubtful importance 69.0; minor 7.3, serious 0.3; could not be rated 23.3S?rensen et al. ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]Denmark: 3 psychiatricwards at AalborgUniversity Hospital(inpatient)R(4 months)AdultDirectobservation142 MAEs340 OE42.0% of total OENon-significant 20.0; significant 27.0; serious 51.0; life-threatening 1.0Cottney ADDIN EN.CITE <EndNote><Cite><Author>Cottney</Author><Year>2014</Year><RecNum>13266</RecNum><DisplayText>[22]</DisplayText><record><rec-number>13266</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13266</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cottney, Alan</author></authors></contributors><titles><title>Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet</title><secondary-title>BMJ quality improvement reports</secondary-title></titles><pages>u204237. w1843</pages><volume>3</volume><number>1</number><dates><year>2014</year></dates><isbn>2050-1315</isbn><urls></urls></record></Cite></EndNote>[22]UK: 21-bed acuteMental health wardat East LondonNHS FoundationTrust (inpatient)P (3 weeks)AdultDirectobservation138 MAEs1542 OE8.9% of total OENegligible 40.0; 60.0 minorCottney andInnes ADDIN EN.CITE <EndNote><Cite><Author>Cottney</Author><Year>2015</Year><RecNum>13278</RecNum><DisplayText>[23]</DisplayText><record><rec-number>13278</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13278</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cottney, Alan</author><author>Innes, James</author></authors></contributors><auth-address>Cottney, Alan: alan.cottney@</auth-address><titles><title>Medication-administration errors in an urban mental health hospital: A direct observation study</title><secondary-title>International Journal of Mental Health Nursing</secondary-title></titles><pages>65-74</pages><volume>24</volume><number>1</number><dates><year>2015</year></dates><accession-num>Peer Reviewed Journal: 2015-01382-008</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[23]UK: 43 wards in East London NationalHealth Trust (inpatient)P (NR)AdultDirectobservation139 MAEs4177 OE3.3% of total OENegligible 19.0, minor 71.0, serious 11.0; fatal 0Abduldaeem etal. ADDIN EN.CITE <EndNote><Cite><Year>2016</Year><RecNum>13344</RecNum><DisplayText>[55]</DisplayText><record><rec-number>13344</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13344</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Abduldaeem H,Masters K, Patel N, Donyai P. A direct observation study of medication administration errors in a mental health inpatient setting.</title><secondary-title>International Journal of Pharmacy Practice </secondary-title></titles><periodical><full-title>International Journal of Pharmacy Practice</full-title></periodical><pages>4–15</pages><volume> 24</volume><number>1</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>[55]UK: 2 acuteMental health wards inPharmacy BerkshireHealthcare NHSfoundation trust(inpatient)P (NR)AdultDirectobservation153 MAEs317 OE48.0% of total OENot assessedHema et al. ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]India: psychiatry department of JSS Hospital (inpatient)P (6 months)Adult Chart review133 MAEs in 88 pts 90 patientsd 97.7% of inpatients experienced MAEseNot assessedRothschild etal. 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ADDIN EN.CITE.DATA [40]USA:Academic psychiatrichospital inNew England area(inpatient)P (6 months)AdultChartreview,incidentreport,nurse–pharmacyreports20 MAEs 19,180 pt-days1.0 MAE per 1000 pt-dayse Not assessed Dispensing error S?rensen et al. ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]Denmark: 3 psychiatricwards at AalborgUniversity Hospital (inpatient)P (4 months)AdultDirectobservation,unannouncedcontrol visit18 DEs391 OE4.6% of total OENon-significant 22.2; significant 61.0; serious 33.0; life-threatening 0Hema et al. ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]India: Psychiatry department of JSSHospital (inpatient)P (6 months)Adult Chart review10 DEs in 8 pts90 patientsd8.8% of pts experienced DEseNot assessedSirithongthavonet al. ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]Thailand: tertiaryPsychiatric care hospital (outpatient)P (12 months)PaediatricChart review17 DEsc7444Prescriptions0.2% of prescriptionseNot assessedAdverse drug events Rothschild etal. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40]USA: 172-Bed academicpsychiatrichospital inNew EnglandArea (inpatient)P (6 months)AdultChartreview,incidentreport,nurse–pharmacyreports191 ADEs,25 pADEs19,180 pt-days 10 ADEs per 1000 pt-days;1.3 pADE per 1000 pt-days ADE: significant 66.0; serious 31.0; life-threatening 2.0;fatal 0pADE: significant 68;serious 24; life-threatening 8Ayani et al. ADDIN EN.CITE <EndNote><Cite><Author>Ayani</Author><Year>2016</Year><RecNum>13332</RecNum><DisplayText>[41]</DisplayText><record><rec-number>13332</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayani, Nobutaka</author><author>Sakuma, Mio</author><author>Morimoto, Takeshi</author><author>Kikuchi, Toshiaki</author><author>Watanabe, Koichiro</author><author>Narumoto, Jin</author><author>Fukui, Kenji</author></authors></contributors><titles><title>The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>303</pages><volume>16</volume><number>1</number><dates><year>2016</year></dates><pub-location>London</pub-location><publisher>BioMed Central</publisher><isbn>1471-244X</isbn><accession-num>PMC5004271</accession-num><urls><related-urls><url>;[41]Japan: psychiatricunits at one psychiatrichospital and one tertiary care teaching hospital (inpatient)R (1 year)AdultChartreview,incidentreport,laboratoryresult955 ADEs,166 pADEs22,733 pt-days42 ADE per 1000 pt-days7.3 pADE per 1000 pt-daysADE: significant 71.0; serious 28.0; life-threatening 1.4, fatal 0pADEs: NRADE(s) adverse drug event(s), CI confidence interval, DE(s) dispensing error(s), MAE(s) medication administration error(s), ME(s) medication error(s), NR reported, OE opportunity for error, P prospective, pADE(s) preventable adverse drug event(s), PE(s) prescribing error(s), TE(s) transcription error(s), pt(s) patient(s), R retrospectivea The number of dispensing errors excluded as the study relied only in incident report to detect dispensing errorb The data presented include dispensing error severity datac The number of prescriptions affected by medication errors was not reportedd All included patients were received at least one antipsychotic agente Self-calculatedf There was more than one type of ME in prescriptions (the total number of MEs identified is more than the number of prescriptions/items examined)Table SEQ Table \* ARABIC 2 Quality assessment criteria applied to the included studiesReference/yearAim/objectivesME/ADE definitionError categories specifiedError categories definedDenominator definedData collection method describedStudy setting describedValidity measure applied to confirm the occurrence of errorReliability measures appliedaLimitation listedTotal score of criteria achieved (out of 10)Grasso et al. ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2002</Year><RecNum>13254</RecNum><DisplayText>[52]</DisplayText><record><rec-number>13254</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13254</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, Benjamin C</author><author>Genest, Robert</author><author>Yung, Kathryn</author><author>Arnold, Charles</author></authors></contributors><titles><title>Reducing errors in discharge medication lists by using personal digital assistants</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>1325-1326</pages><volume>53</volume><number>10</number><dates><year>2002</year></dates><isbn>1075-2730</isbn><urls></urls></record></Cite></EndNote>[52]√X√X√√√XX√6Nirodi and Mitchell ADDIN EN.CITE <EndNote><Cite><Author>Nirodi</Author><Year>2002</Year><RecNum>13175</RecNum><DisplayText>[46]</DisplayText><record><rec-number>13175</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nirodi, P</author><author>Mitchell, AJ</author></authors></contributors><titles><title>The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly</title><secondary-title>Aging & mental health</secondary-title></titles><pages>191-196</pages><volume>6</volume><number>2</number><dates><year>2002</year></dates><isbn>1360-7863</isbn><urls></urls></record></Cite></EndNote>[46]√X√X√√√XX√6Haw and Stubbs ADDIN EN.CITE <EndNote><Cite><Author>Haw</Author><Year>2003</Year><RecNum>9391</RecNum><DisplayText>[48]</DisplayText><record><rec-number>9391</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">9391</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haw, C.</author><author>Stubbs, J.</author></authors></contributors><auth-address>(Haw, Stubbs) St. Andrew's Hospital, Northampton, United Kingdom</auth-address><titles><title>Prescribing errors at a psychiatric hospital</title><secondary-title>Pharmacy in Practice</secondary-title></titles><pages>64-66</pages><volume>13</volume><number>2</number><dates><year>2003</year></dates><accession-num>2005101999</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[48]√√√X√√√√XX7Grasso et al. 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ADDIN EN.CITE.DATA [24, 25, 47-51] used the PE definition proposed by Dean et al. ADDIN EN.CITE <EndNote><Cite><Author>Dean</Author><Year>2000</Year><RecNum>13304</RecNum><DisplayText>[56]</DisplayText><record><rec-number>13304</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dean, Bryony</author><author>Barber, N</author><author>Schachter, M</author></authors></contributors><titles><title>What is a prescribing error?</title><secondary-title>Quality in Health Care</secondary-title></titles><pages>232-237</pages><volume>9</volume><number>4</number><dates><year>2000</year></dates><isbn>2044-5423</isbn><urls></urls></record></Cite></EndNote>[56], namely ‘‘a clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is an unintentional significant (1) reduction in the probability of treatment being timely and effective or (2) increase in the risk of harm when compared with generally accepted practice’’. However, in the mental health setting, several additional clinical scenarios were added to adapt this definition, including prescribing a drug without registering a patient with the drug company and performing the necessary monitoring (e.g. for clozapine) or prescribing a drug to mental health patients without a Mental Health Act form authorization. One study ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44] used the definition of a PE by Lisby et al. ADDIN EN.CITE <EndNote><Cite><Author>Lisby</Author><Year>2005</Year><RecNum>13346</RecNum><DisplayText>[57]</DisplayText><record><rec-number>13346</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13346</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Mainz, Jan</author></authors></contributors><titles><title>Errors in the medication process: frequency, type, and potential clinical consequences</title><secondary-title>International Journal for Quality in Health Care</secondary-title></titles><periodical><full-title>International Journal for Quality in Health Care</full-title></periodical><pages>15-22</pages><volume>17</volume><number>1</number><dates><year>2005</year></dates><isbn>1353-4505</isbn><urls><related-urls><url>;[57], and the remaining six studies (42.8%) did not state any definition at all PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [40, 42, 43, 45, 46, 52]. The majority of studies (n = 10 [71.4%]) were conducted prospectively PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [43, 49] and another which took place across both inpatients and outpatients ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]. Chart review was the method used for detecting PEs by all studies except one study which also used incident reports and nurse/pharmacy staff reports PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [40, 43, 45] and physicians in one study ADDIN EN.CITE <EndNote><Cite><Author>Nirodi</Author><Year>2002</Year><RecNum>13175</RecNum><DisplayText>[46]</DisplayText><record><rec-number>13175</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nirodi, P</author><author>Mitchell, AJ</author></authors></contributors><titles><title>The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly</title><secondary-title>Aging & mental health</secondary-title></titles><pages>191-196</pages><volume>6</volume><number>2</number><dates><year>2002</year></dates><isbn>1360-7863</isbn><urls></urls></record></Cite></EndNote>[46]. Four studies did not specify the professional status of the data collectors PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tw7hyZW5zZW48L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA [42, 44, 49, 50]. The presence of PE was confirmed either by using one reviewer (medical director) in one study ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45] or a panel of healthcare professionals in four studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [42-44, 46, 47, 49, 50, 52]. Across the studies, there were differences in the types of denominator used to determine PE rates. Three studies (one focused on PEs on hospital discharge) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25] provided the PE rate per newly written or omitted item checked, the rate of which ranged from 4.5 to 6.3% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24, 25, 51]. A further three PE studies reported a rate of errors for all prescription items affected by PEs, with a rate range of 2.2–91.6% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGF3YWhuYTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+
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ADDIN EN.CITE.DATA [47, 48, 50]. A range of 52.2–82.1% of patients PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZW1hIFNhaGl0aGk8L0F1dGhvcj48WWVhcj4yMDE1PC9Z
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ADDIN EN.CITE.DATA [42, 46], 7.2–165 per 1000 patient-days ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44] (see Table 1). In paediatric outpatient setting, the rate of PE was 0.9% of complete prescriptions checked ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. Two studies from the UK found that senior physicians were more likely than more junior physicians to make PEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25]. The most frequent PEs reported involved the omission of regularly prescribed medication (12.5%) ADDIN EN.CITE <EndNote><Cite><Author>Keers</Author><Year>2014</Year><RecNum>13286</RecNum><DisplayText>[24]</DisplayText><record><rec-number>13286</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13286</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keers, Richard N</author><author>Williams, Steven D</author><author>Vattakatuchery, Joe J</author><author>Brown, Petra</author><author>Miller, Joan</author><author>Prescott, Lorraine</author><author>Ashcroft, Darren M</author></authors></contributors><titles><title>Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study</title><secondary-title>BMJ open</secondary-title></titles><periodical><full-title>BMJ open</full-title></periodical><pages>e006084</pages><volume>4</volume><number>9</number><dates><year>2014</year></dates><isbn>2044-6055</isbn><urls></urls></record></Cite></EndNote>[24], missing or incorrect dose (23.3%) ADDIN EN.CITE <EndNote><Cite><Year>2016</Year><RecNum>13345</RecNum><DisplayText>[51]</DisplayText><record><rec-number>13345</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13345</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Scott H, Brown D, Herreraa H.Prevalence and nature of prescribing errors in a mental health setting: analysis of preliminary data from a prospective study</title><secondary-title>International Journal of Pharmacy Practice</secondary-title></titles><periodical><full-title>International Journal of Pharmacy Practice</full-title></periodical><pages>3:8–13</pages><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>[51] and writing incomplete prescriptions PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdHViYnM8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [47, 48]. Three studies found that psychotropic therapies were more commonly associated with PEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24, 25, 44, 47].Unintentional Medication DiscrepancyOne study investigated the rate of unintentional discrepancy at the time of hospital admission for 382 patients ADDIN EN.CITE <EndNote><Cite><Author>Brownlie</Author><Year>2014</Year><RecNum>13275</RecNum><DisplayText>[53]</DisplayText><record><rec-number>13275</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13275</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brownlie, Kay</author><author>Schneider, Carl</author><author>Culliford, Roger</author><author>Fox, Chris</author><author>Boukouvalas, Alexis</author><author>Willan, Cathy</author><author>Maidment, Ian D</author></authors></contributors><titles><title>Medication reconciliation by a pharmacy technician in a mental health assessment unit</title><secondary-title>International journal of clinical pharmacy</secondary-title></titles><periodical><full-title>International journal of clinical pharmacy</full-title></periodical><pages>303-309</pages><volume>36</volume><number>2</number><dates><year>2014</year></dates><isbn>2210-7703</isbn><urls></urls></record></Cite></EndNote>[53]. Medication chart review was conducted prospectively by pharmacy technician to detect discrepancies. The medication discrepancies were validated by approaching the clinical team involved with each identified discrepancy. Fifty six percent of hospital admissions were associated with unintentional medication discrepancies. Increasing age and polypharmacy found to increase the risk of unintentional medication discrepancy at hospital admission. Drug omission was the most frequent type of discrepancy reported (77.2%) followed by wrong/unclear dose prescribed (7.0%). The potential severity of unintentional medication discrepancies was rated as moderate in 37.7% and minor in 62.3% of cases ADDIN EN.CITE <EndNote><Cite><Author>Brownlie</Author><Year>2014</Year><RecNum>13275</RecNum><DisplayText>[53]</DisplayText><record><rec-number>13275</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13275</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brownlie, Kay</author><author>Schneider, Carl</author><author>Culliford, Roger</author><author>Fox, Chris</author><author>Boukouvalas, Alexis</author><author>Willan, Cathy</author><author>Maidment, Ian D</author></authors></contributors><titles><title>Medication reconciliation by a pharmacy technician in a mental health assessment unit</title><secondary-title>International journal of clinical pharmacy</secondary-title></titles><periodical><full-title>International journal of clinical pharmacy</full-title></periodical><pages>303-309</pages><volume>36</volume><number>2</number><dates><year>2014</year></dates><isbn>2210-7703</isbn><urls></urls></record></Cite></EndNote>[53]. Transcription errorsThree studies investigated the rate of transcription errors with two studies conducted in the US PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [40, 45] and one study conducted in Thailand ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. Two studies used chart review to detect TEs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaXJpdGhvbmd0aGF2b3JuPC9BdXRob3I+PFllYXI+MjAw
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ADDIN EN.CITE.DATA [40, 45] except one study that took place in an outpatient paediatric setting ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. None of these studies provided a definition of transcription error. However, two studies specified transcription error categories PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaXJpdGhvbmd0aGF2b3JuPC9BdXRob3I+PFllYXI+MjAw
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ADDIN EN.CITE.DATA [40, 43] and the other used nurse and pharmacist data collectors ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45]. The reported rate of TE was between 1.1–344 per 1000 patient-days PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [40, 43, 45]. Situations in which the medication order was not transcribed ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45] or transcribed incorrectly PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFzc288L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [42, 45], while the other two studies used a combination of the above methods in addition to incident reports ADDIN EN.CITE <EndNote><Cite><Author>Haw</Author><Year>2007</Year><RecNum>13279</RecNum><DisplayText>[54]</DisplayText><record><rec-number>13279</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haw, C.</author><author>Stubbs, J.</author><author>Dickens, G.</author></authors></contributors><auth-address>(Haw, Stubbs, Dickens) St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, United Kingdom</auth-address><titles><title>An observational study of medication administration errors in old-age psychiatric inpatients</title><secondary-title>International Journal for Quality in Health Care</secondary-title></titles><periodical><full-title>International Journal for Quality in Health Care</full-title></periodical><pages>210-216</pages><volume>19</volume><number>4</number><dates><year>2007</year></dates><accession-num>2007398605</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[54] and nurse and pharmacy reports PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb3Roc2NoaWxkPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [22, 23] or by a medical director ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2003</Year><RecNum>13291</RecNum><DisplayText>[45]</DisplayText><record><rec-number>13291</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, B. C.</author><author>Genest, R.</author><author>Jordan, C. W.</author><author>Bates, D. W.</author></authors></contributors><auth-address>(Grasso, Jordan) Institute for Self-Directed Care, 95 India Street, Portland, ME 04101, United States (Bates) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States</auth-address><titles><title>Use of chart and record reviews to detect medication errors in a state psychiatric hospital</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>677-681</pages><volume>54</volume><number>5</number><dates><year>2003</year><pub-dates><date>01 May</date></pub-dates></dates><accession-num>2003252030</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[45], and the remaining two studies used a consensus meeting of the research team PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tw7hyZW5zZW48L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA [40, 45] or 97.7% of patients ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42]. One study found that greater numbers of interruptions, patients on the ward, doses administered, and medication doses due significantly increased the rate of MAEs ADDIN EN.CITE <EndNote><Cite><Author>Cottney</Author><Year>2015</Year><RecNum>13278</RecNum><DisplayText>[23]</DisplayText><record><rec-number>13278</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13278</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cottney, Alan</author><author>Innes, James</author></authors></contributors><auth-address>Cottney, Alan: alan.cottney@</auth-address><titles><title>Medication-administration errors in an urban mental health hospital: A direct observation study</title><secondary-title>International Journal of Mental Health Nursing</secondary-title></titles><pages>65-74</pages><volume>24</volume><number>1</number><dates><year>2015</year></dates><accession-num>Peer Reviewed Journal: 2015-01382-008</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[23]. Other factors, such as non-oral route of medication administration, presence of organic brain disease (e.g. dementia), swallowing difficulties or patients who regularly refused to take their medication were associated with MAEs in elderly patients ADDIN EN.CITE <EndNote><Cite><Author>Haw</Author><Year>2007</Year><RecNum>13279</RecNum><DisplayText>[54]</DisplayText><record><rec-number>13279</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haw, C.</author><author>Stubbs, J.</author><author>Dickens, G.</author></authors></contributors><auth-address>(Haw, Stubbs, Dickens) St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, United Kingdom</auth-address><titles><title>An observational study of medication administration errors in old-age psychiatric inpatients</title><secondary-title>International Journal for Quality in Health Care</secondary-title></titles><periodical><full-title>International Journal for Quality in Health Care</full-title></periodical><pages>210-216</pages><volume>19</volume><number>4</number><dates><year>2007</year></dates><accession-num>2007398605</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[54]. Wrong time errors (1.9–39.2%) and drug omissions (7.5–57%) were reported to be the two most common MAE types identified across the studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db3R0bmV5PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA [22, 23, 42, 44, 54, 55]. Only two studies examined whether psychotropic or non-psychotropic drugs were more likely to be related to MAEs; their conclusions were conflicting PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXc8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXc8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA [44, 54]. Severity ratings varied across the studies, with 7.3–71.0% classified as minor severity and 0.3–5.0% as potentially serious PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db3R0bmV5PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA [42, 44] and one took place in an outpatient paediatric setting ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. Dispensing errors were detected by direct observation and unannounced control visits in one study ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44] and by chart review in two studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaXJpdGhvbmd0aGF2b3JuPC9BdXRob3I+PFllYXI+MjAw
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ADDIN EN.CITE.DATA [42, 43]. In adult inpatient settings, DE reported rates were 4.6% of total OE ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44] and 8.8% of patients ADDIN EN.CITE <EndNote><Cite><Author>Hema Sahithi</Author><Year>2015</Year><RecNum>13258</RecNum><DisplayText>[42]</DisplayText><record><rec-number>13258</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hema Sahithi, K.</author><author>Mohammad, I.</author><author>Manoranjani Reddy, J.</author><author>Nandha Kishore, G.</author><author>Ramesh, M.</author><author>Sebastian, J.</author></authors></contributors><auth-address>(Hema Sahithi, Mohammad, Manoranjani Reddy, Nandha Kishore, Ramesh, Sebastian) Department of Pharmacy Practice, JSS College of Pharmacy, JSS University, Mysore, Karnataka 570 015, India</auth-address><titles><title>Assessment of medication errors in psychiatry practice in a tertiary care hospital</title><secondary-title>International Journal of Pharmaceutical Sciences and Research</secondary-title></titles><pages>226-232</pages><volume>6</volume><number>1</number><dates><year>2015</year></dates><accession-num>2015645700</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[42], while the reported rate in paediatric outpatient setting was 0.2% of complete prescriptions checked ADDIN EN.CITE <EndNote><Cite><Author>Sirithongthavorn</Author><Year>2009</Year><RecNum>13260</RecNum><DisplayText>[43]</DisplayText><record><rec-number>13260</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sirithongthavorn, S.</author><author>Narkpongphun, A.</author><author>Kamduang, N.</author><author>Isarapongs, P.</author><author>Kanjanarat, P.</author></authors></contributors><auth-address>(Sirithongthavorn, Narkpongphun, Kamduang, Isarapongs) Rajanagarindra Institute of Child Development, Mental Health Department, Ministry of Public Health, Chiang Mai, Thailand (Kanjanarat) Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand</auth-address><titles><title>Common types of medication errors of outpatient service in pediatric psychiatry care</title><secondary-title>Pharmacoepidemiology and Drug Safety (PDS)</secondary-title></titles><pages>S245-S246</pages><volume>18 (S1)</volume><dates><year>2009</year><pub-dates><date>August</date></pub-dates></dates><accession-num>70069413</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[43]. The most common types of DE were wrong medication brand (87.5%), dose omission (50.0%), and incorrect labelling of medication (22.0%) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tw7hyZW5zZW48L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA [42, 44]. The potential severity was assessed in one study using two senior clinical pharmacologists; 61.1% of DE were assessed as having potentially clinically significant effects, with the remainder classed as potentially serious ADDIN EN.CITE <EndNote><Cite><Author>S?rensen</Author><Year>2013</Year><RecNum>13274</RecNum><DisplayText>[44]</DisplayText><record><rec-number>13274</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13274</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S?rensen, Ann Lykkegaard</author><author>Lisby, Marianne</author><author>Nielsen, Lars Peter</author><author>Poulsen, Birgitte Klindt</author><author>Mainz, Jan</author></authors></contributors><titles><title>The medication process in a psychiatric hospital: are errors a potential threat to patient safety?</title><secondary-title>Risk management and healthcare policy</secondary-title></titles><pages>23-31</pages><volume>2013</volume><number>6</number><dates><year>2013</year></dates><isbn>1179-1594</isbn><urls></urls></record></Cite></EndNote>[44]. DiscussionOur systematic review found that MEs in mental health hospitals are common and do cause harm to psychiatric patients. Such risks affect multiple stages of the medication use process (prescribing, dispensing and administration) and are common at points of care transfer and outpatient hospital settings. Of the 20 studies identified, only two examined actual harm due to medication use. The reported ranges of ME and ADE rates in mental health hospitals appear to overlap with reported IQRs of MEs and ADEs in general hospitals PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXdpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [40, 41]; as no information is available from other countries, this should be considered an important target for future research. Overall, whilst the included studies varied in terms of outcome definitions and research methods, it is important to highlight the emerging consistency in study design that has been achieved in studies investigating ADE, PE and MAE emerging recently. For instance, in MAE studies based in the UK, consistency was achieved in terms of the data collection method (direct observation, a recognised gold standard) ADDIN EN.CITE <EndNote><Cite><Author>Dean</Author><Year>2001</Year><RecNum>13352</RecNum><DisplayText>[62]</DisplayText><record><rec-number>13352</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13352</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dean, Bryony</author><author>Barber, Nick</author></authors></contributors><titles><title>Validity and reliability of observational methods for studying medication administration errors</title><secondary-title>American Journal of Health-System Pharmacy</secondary-title></titles><periodical><full-title>American Journal of Health-System Pharmacy</full-title></periodical><pages>54-59</pages><volume>58</volume><number>1</number><dates><year>2001</year></dates><isbn>1079-2082</isbn><urls></urls></record></Cite></EndNote>[62] and denominator used (OE, the most common in the wider literature) ADDIN EN.CITE <EndNote><Cite><Author>Keers</Author><Year>2013</Year><RecNum>13319</RecNum><DisplayText>[4]</DisplayText><record><rec-number>13319</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13319</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keers, Richard N</author><author>Williams, Steven D</author><author>Cooke, Jonathan</author><author>Ashcroft, Darren M</author></authors></contributors><titles><title>Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence</title><secondary-title>Annals of Pharmacotherapy</secondary-title></titles><periodical><full-title>Annals of Pharmacotherapy</full-title></periodical><pages>237-256</pages><volume>47</volume><number>2</number><dates><year>2013</year></dates><isbn>1060-0280</isbn><urls></urls></record></Cite></EndNote>[4]. PE studies (also based in the UK) used similar PE definitions ADDIN EN.CITE <EndNote><Cite><Author>Dean</Author><Year>2000</Year><RecNum>13304</RecNum><DisplayText>[56]</DisplayText><record><rec-number>13304</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dean, Bryony</author><author>Barber, N</author><author>Schachter, M</author></authors></contributors><titles><title>What is a prescribing error?</title><secondary-title>Quality in Health Care</secondary-title></titles><pages>232-237</pages><volume>9</volume><number>4</number><dates><year>2000</year></dates><isbn>2044-5423</isbn><urls></urls></record></Cite></EndNote>[56], denominators (newly omitted and written items [n = 3 studies]) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [63-65]. Evidence from the UK found that a ME occurs in 69.0% and 43.0% of medications at the time of admission to and discharge from mental health hospitals, respectively ADDIN EN.CITE <EndNote><Cite><Author>Morcos</Author><Year>2002</Year><RecNum>13255</RecNum><DisplayText>[66]</DisplayText><record><rec-number>13255</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13255</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morcos, Salwa</author><author>Francis, Sally-Anne</author><author>Duggan, Catherine</author></authors></contributors><titles><title>Where are the weakest links? A descriptive study of discrepancies in prescribing between primary and secondary sectors of mental health service provision</title><secondary-title>The Psychiatrist</secondary-title></titles><periodical><full-title>The Psychiatrist</full-title></periodical><pages>371-374</pages><volume>26</volume><number>10</number><dates><year>2002</year></dates><isbn>1758-3209</isbn><urls></urls></record></Cite></EndNote>[66]. Other recent evidence from the USA suggests that 23.3% of psychiatric patients had at least one unintentional discrepancy at the time of hospital discharge ADDIN EN.CITE <EndNote><Cite><Author>Nelson</Author><Year>2010</Year><RecNum>13259</RecNum><DisplayText>[67]</DisplayText><record><rec-number>13259</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13259</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nelson, L. A.</author><author>Graham, M. R.</author><author>Schaefer, M. G.</author></authors></contributors><auth-address>(Nelson, Graham) University of Missouri-Kansas City, School of Pharmacy, United States (Graham, Schaefer) Kansas City Veterans Affairs Medical Center, United States</auth-address><titles><title>Characterization of medication discrepancies occurring at the time of discharge from a state psychiatric inpatient facility</title><secondary-title>Journal of Pharmacy Practice</secondary-title></titles><pages>153-154</pages><volume>23 (2)</volume><dates><year>2010</year><pub-dates><date>April</date></pub-dates></dates><accession-num>70465266</accession-num><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>[67]. These estimates clearly highlight the importance of medication reconciliation at care interfaces in mental health settings to improve safe care transfer ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1" ExcludeYear="1"><RecNum>13356</RecNum><DisplayText>[68, 69]</DisplayText><record><rec-number>13356</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13356</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>National Mental Health Development Unit. Getting the medicines right 2: medicines management in mental health crisis resolution and home treatment teams. 2010. Accessed 10 Sept 2016</title></titles><dates></dates><urls></urls></record></Cite><Cite ExcludeAuth="1" ExcludeYear="1"><RecNum>13357</RecNum><record><rec-number>13357</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13357</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>The Joint Commission . National patient safety goals. 2015. . Accessed 10 Sept 2016</title></titles><dates></dates><urls></urls></record></Cite></EndNote>[68, 69]. This is supported by recent studies reporting on the clinical benefit of medication reconciliation at the mental healthcare interface PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb3Jjb3M8L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [22, 52, 73]. A study based in a US psychiatric hospital found that using a personal digital assistant (PDA) reduced the rate of MEs in discharge lists from 18.0 to 8.0% ADDIN EN.CITE <EndNote><Cite><Author>Grasso</Author><Year>2002</Year><RecNum>13254</RecNum><DisplayText>[52]</DisplayText><record><rec-number>13254</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13254</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grasso, Benjamin C</author><author>Genest, Robert</author><author>Yung, Kathryn</author><author>Arnold, Charles</author></authors></contributors><titles><title>Reducing errors in discharge medication lists by using personal digital assistants</title><secondary-title>Psychiatric Services</secondary-title></titles><pages>1325-1326</pages><volume>53</volume><number>10</number><dates><year>2002</year></dates><isbn>1075-2730</isbn><urls></urls></record></Cite></EndNote>[52]. Another study investigated the effectiveness of implementing a provider order entry (POE) programme to reduce error in mental health hospitals ADDIN EN.CITE <EndNote><Cite><Author>Jayaram</Author><Year>2011</Year><RecNum>13359</RecNum><DisplayText>[73]</DisplayText><record><rec-number>13359</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13359</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jayaram, Geetha</author><author>Doyle, Daniel</author><author>Steinwachs, Donald</author><author>Samuels, Jack</author></authors></contributors><titles><title>Identifying and reducing medication errors in psychiatry: creating a culture of safety through the use of an adverse event reporting mechanism</title><secondary-title>Journal of Psychiatric Practice</secondary-title></titles><periodical><full-title>Journal of Psychiatric Practice</full-title></periodical><pages>81-88</pages><volume>17</volume><number>2</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>[73]. However, none of these studies described the type of MEs involved or their potential to cause harm to patients. Another UK-based study examined the impact on the rate of MAEs of implementing an automated dispensing cabinet in a mental health hospital; it found the cabinet to be associated with a reduction in MAE rate from 8.9 to 7.2% as well as a reduction in the time spent by nurses administering medication from 2.9 to 2.3 min per dose ADDIN EN.CITE <EndNote><Cite><Author>Cottney</Author><Year>2014</Year><RecNum>13266</RecNum><DisplayText>[22]</DisplayText><record><rec-number>13266</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13266</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cottney, Alan</author></authors></contributors><titles><title>Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet</title><secondary-title>BMJ quality improvement reports</secondary-title></titles><pages>u204237. w1843</pages><volume>3</volume><number>1</number><dates><year>2014</year></dates><isbn>2050-1315</isbn><urls></urls></record></Cite></EndNote>[22]. However, implementing a successful intervention to reduce the number of MEs in a hospital is largely based on understanding the causes and risk factors associated with their occurrence PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [74-76]. Although this is beyond the scope of this study, some of the included studies highlighted some of the risk factors associated with the occurrence of MEs in mental health hospitals PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWVyczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [23-25], and the first in-depth qualitative study of the causes of MAEs in this setting has emerged ADDIN EN.CITE <EndNote><Cite><Author>Keers</Author><Year>2016</Year><RecNum>13323</RecNum><DisplayText>[77]</DisplayText><record><rec-number>13323</rec-number><foreign-keys><key app="EN" db-id="5et2pd9xr55dw3eapfw5p05nz992spzz0p0w">13323</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keers, RN</author><author>Placido, M</author><author>Bennett, K</author><author>Clayton, K</author><author>Brown, P</author><author>Ashcroft, DM</author></authors></contributors><titles><title>Understanding the Causes of Medication Administration Errors in a Mental Health Hospital Using Qualitative Interviews with the Critical Incident Technique</title><secondary-title>Pharmacoepidemiology and Drug Safety</secondary-title></titles><periodical><full-title>Pharmacoepidemiology and drug safety</full-title></periodical><pages>3-23</pages><volume>25</volume><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>[77]. Future qualitative studies are needed to identify the root causes and risk factors associated with MEs and ADEs in mental health hospitals to help design effective remedial interventions. To our knowledge, this is the most up-to-date systematic appraisal of the evidence examining the frequency, nature and severity of MEs and ADEs in mental health hospitals. A comprehensive search strategy was used to identify eligible studies from a wide range of databases without language restriction, and the reference lists of included studies and relevant review papers were manually searched. Moreover, our inclusion criteria with respect to study designs were stricter than previously published systematic reviews PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWlkbWVudDwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+
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ADDIN EN.CITE.DATA [20, 21], as we excluded studies based only on incident reports as the sole method of data collection. However, we were faced with a number of limitations in the studies identified—heterogeneity in the denominator used, the population involved, and the outcome definition—which limited the opportunity for direct comparisons between different studies. In addition, studies differed in the way they presented the classification of drugs involved in MEs/ADEs, with some not reporting any at all. Likewise, different schemes were used to classify error subtypes. This can be seen, for example, in some MAE studies that considered nurses’ behaviour, such as unauthorized tablet crushing or failure to report patient identity, as an MAE whereas other studies did not—all of which eventually affected the reported MAE frequency. With this in mind, these specific study limitations should be considered when drawing conclusions from the findings of this review. ConclusionMEs and ADEs are common in mental health hospitals. Medication safety interventions should target risks associated with psychotropic medicines, especially at the prescribing and administration stages of the medicine use process. Further research is required to investigate the rate of DEs, unintentional discrepancies and ADEs in mental health hospitals. Future research should examine the underlying causes of MEs and ADEs so theory-based interventions can be developed and evaluated to improve patient safety in this specialist healthcare setting.References ADDIN EN.REFLIST 1.World Health Organization. World alliance for patient safety.Geneva: WHO; 2005. . Accessed 15 April 2016.2.de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Quality and Safety in Health Care. 2008;17(3):216-23.3.Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. 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