Investigating the status of self-administrative medication errors and explaining its causes among illiterate and low-literate older adults with polypharmacy: a sequential mixed-methods study

Abstract

Introduction: Age-related changes prone older adults to multiple chronic diseases, followed by an increase in the number of medications. Polypharmacy exposes them to medication errors. In the meantime, illiterate and low-educated older people have more problems with their medicines. Medication errors are a major concern for health systems because they reduce treatment effectiveness and increase costs, and can be considered a threat to patient safety.

Aims: The aim of the present study was to determine the status of medication errors in illiterate and low-educated older adults with polypharmacy, and to explain the root causes of medication errors and provide a solution. Methods and Materials: This research was a follow-up sequential explanatory mixed method study that was conducted in three stages in the health centers of Tabriz in 2022. In the first step, a checklist of medication errors was developed using a fast literature review. Then, a cross-sectional study was conducted on 276 older adults to identify the frequency of medication errors and to identify common medication errors during the last six months. In the second stage, using a qualitative study, the opinions of 31 people including older adults, pharmacists, physicians, and caregivers (informal caregivers) were collected regarding the primary causes of medication errors. In the third stage, using the root cause analysis technique (RCA), the root causes of medication errors were identified in the combination and integration of the results of the quantitative and qualitative steps. Finally, solutions corresponding to medication errors were presented. Results: The results of the cross-sectional stage showed that the frequency of medication errors during the last six months was 69.2%. The five most common medication errors among the participants were forgetfulness, improper taking of medications with food, beverages, and herbs, taking the medication at an inappropriate time, and incorrect dosage (lower and higher dose). In the second stage, the primary causes of medication errors were categorized into seven categories including 26 subcategories using qualitative interviews. The main categories identified included age-related physical and psychological changes, poor medication self-management, wrong beliefs about medications, lack of functional independence, insufficient education and communication, health system deficiency, and problems related to medication production, supply, and demand. In the third stage, using the RCA approach in combining and integrating the previous stages and during the first round of the nominal group technique, 95 root causes of errors were identified and prioritized, then 46 prioritized root causes were selected. Finally, during the second round of the nominal group technique, solutions corresponding to priority root causes were presented. Conclusion: There is no single solution to error prevention. This study tried to introduce the hidden sources of errors by older adults by identifying the root causes of medication errors and by providing evidence-based solutions based on the opinions of all stakeholders in the field of medication consumption to help health policymakers in the formulation and development of the best interventions to reduce errors.