School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham, B15 2TT, UK.
Pharmaceutical Care Department, King Fahad Military Medical Complex (KFMMC), Medical Department, Ministry of Defense, Dhahran, Saudi Arabia.
Int J Clin Pharm. 2022 Aug;44(4):1057-1066. doi: 10.1007/s11096-022-01448-x. Epub 2022 Jun 22.
Direct oral anticoagulants (DOACs) have become preferable for the management of thromboembolic events. Recent publications have however identified high volume of medication errors related to DOACs. There is limited literature on why and how such errors occur or happen in clinical practice.
This study aimed to explore views, experiences, contributory factors related to DOACs medication errors from the perspectives of healthcare professionals.
Semi-structured interviews using online videoconferencing were conducted with physicians and nurses from tertiary care hospitals in three different regions in Saudi Arabia. Questions included views, experiences and perceived factors contributing to errors. Interviews were transcribed verbatim and were thematically analyzed using MAXQDA Analytics Pro 2020 (VERBI Software).
The semi-structured interviews (n = 34) included physicians (n = 20) and nurses (n = 14) until data saturation was achieved. The analysis identified five themes: Factors related to healthcare professionals (e.g. knowledge, confidence and access to guidelines); Factors related to patients (e.g. comorbidity, polypharmacy, medication review, and communication barriers); Factors related to organization (e.g. guidelines, safety culture and incidents reporting system); Factors related to the DOACs medications (e.g. lack of availability of antidotes and dosing issues); and Strategies for error prevention/mitigation (e.g. the need for professional training and routine medication review).
Healthcare professionals identified errors in relation to DOACs as multifactorial including their own and patient lack of knowledge, lack of clinical guidelines and organizational factors including safety culture. Medication review and reconciliation on discharge were key strategies suggested to reduce DOACs related errors. These strategies support the role of pharmacists as direct patients care providers to minimize DOACs errors.
直接口服抗凝剂（DOAC）已成为治疗血栓栓塞事件的首选药物。然而，最近的出版物指出，与 DOAC 相关的药物错误数量很高。关于为什么以及如何在临床实践中发生此类错误的文献有限。
本研究旨在从医疗保健专业人员的角度探讨与 DOAC 药物错误相关的观点、经验和促成因素。
使用在线视频会议对沙特阿拉伯三个不同地区的三级保健医院的医生和护士进行了半结构式访谈。问题包括对错误的看法、经验和感知因素。访谈逐字转录，并使用 MAXQDA Analytics Pro 2020（VERBI Software）进行主题分析。
半结构式访谈（n=34）包括医生（n=20）和护士（n=14），直到达到数据饱和。分析确定了五个主题：与医疗保健专业人员相关的因素（例如，知识、信心和获取指南）；与患者相关的因素（例如，合并症、多种药物治疗、药物审查和沟通障碍）；与组织相关的因素（例如，指南、安全文化和事件报告系统）；与 DOAC 药物相关的因素（例如，缺乏解毒剂和剂量问题）；以及预防/减轻错误的策略（例如，需要专业培训和常规药物审查）。
医疗保健专业人员将 DOAC 相关错误确定为多因素的，包括他们自己和患者缺乏知识、缺乏临床指南以及组织因素，包括安全文化。药物审查和出院时的药物调整是减少 DOAC 相关错误的关键策略。这些策略支持药剂师作为直接为患者提供护理的提供者的作用，以最大程度地减少 DOAC 错误。
