Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran (Drs Khammarnia, Ansari-Moghaddam, and Setoodehzadeh and Mss Rezaei and Peyvand); and Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, England, United Kingdom (Dr Clark).
Qual Manag Health Care. 2021;30(3):166-175. doi: 10.1097/QMH.0000000000000304.
Medical errors (MEs) are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems, especially in developing countries. The aim of this study was to determine the rate of ME in Iran.
This is a systematic literature review and meta-analysis of extracted data. The databases MEDLINE, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib were searched in Persian and English, using a combination of medical subject heading terms ("Medical Error" [Mesh] OR "Medication error" [Mesh] OR "Hospital Error" AND ("Iran" [Mesh]) for observational and interventional studies that reported ME rate in Iran from January 1995 to April 2019. We followed the STROBE checklist for the purpose of this review.
The search yielded a total of 435 records, of which 74 articles were included in the systematic review. The rate of MEs in Iran was determined as 0.35%. The rates of errors among physicians and nurses were 31% and 37%, respectively. The error rates during the medication process, including prescription, recording, and administration, were 31%, 27%, and 35%, respectively. Also, incidence of MEs in night shifts was higher than in any other shift (odds ratio [OR] = 38%; 95% confidence interval [CI]: 31%-45%). Moreover, newer nurses were responsible for more errors within hospitals than other nurses (OR = 57%; 95% CI: 41%-80%). The rate of reported error after the Health Transformation Plan was higher than before the Health Transformation Plan (OR = 40%; CI: 33%-49% vs OR = 30%; CI: 25%-35%).
This systematic review has demonstrated the high ME rate in Iranian hospitals. Based on the error rate attributed solely to night shifts, more attention to the holistic treatment process is required. Errors can be decreased through a variety of strategies, such as training clinical and support staff regarding safe practices and updating and adapting systems and technologies.
医疗差错是影响医院服务质量和降低医疗保健系统患者安全的主要因素之一，尤其是在发展中国家。本研究旨在确定伊朗的医疗差错发生率。
这是一项对提取数据进行系统评价和荟萃分析的研究。我们在 Persian 和 English 中检索了 MEDLINE、EMBASE、Scopus、Cochrane、SID、Magiran 和 Medlib 数据库，使用了医学主题词（"Medical Error" [Mesh] 或 "Medication error" [Mesh] 或 "Hospital Error" 和 "Iran" [Mesh]）的组合，以检索 1995 年 1 月至 2019 年 4 月间报告伊朗医疗差错发生率的观察性和干预性研究。我们遵循 STROBE 清单的要求进行了本次综述。
共检索到 435 篇文献，其中有 74 篇文章纳入系统评价。伊朗的医疗差错发生率为 0.35%。医生和护士的差错率分别为 31%和 37%。在药物治疗过程中，包括处方、记录和给药，差错率分别为 31%、27%和 35%。此外，夜班发生医疗差错的几率高于其他班次（比值比[OR] = 38%；95%置信区间[CI]：31%-45%）。此外，与其他护士相比，新入职的护士在医院内更容易发生差错（OR = 57%；95% CI：41%-80%）。医改计划实施后报告的差错率高于医改计划实施前（OR = 40%；CI：33%-49% 比 OR = 30%；CI：25%-35%）。
本系统评价显示，伊朗医院的医疗差错发生率较高。仅基于夜班发生的差错率，就需要更加关注整体治疗过程。通过培训临床和支持人员有关安全操作、更新和调整系统和技术等多种策略，可以减少差错。
