The need for weight-based therapeutic interventions in children[97,99] and lack of readily available proprietary medicines in strengths suitable for paediatric dosing often necessitating titration have long

influenced medication safety in the paediatric setting. Moreover, the elderly and children use primary healthcare more than the rest of the population with implications for medication safety in the face of the ever-pressured healthcare system. There is therefore an urgent need for more research into medication safety among these patient populations. Previous researchers have identified the prescribing and administration stages as the most dangerous stages of the medicines management system.[15] Twenty-six of the 33 studies reviewed evaluated the prescribing stage MAPK inhibitor in keeping with this finding.

There is some suggestion in the existing literature that errors occur when patients take their medicines and that there is a need to prioritize processes at the patient end of the system for ERK inhibitor interventions.[8] This review showed that there is a shortage of studies at the ‘patient end of the system’ because of the obvious difficulties. Nonetheless, there is substantial evidence in practice that many patients may not be using their medicines as directed, resulting in therapeutic failure and hospital admissions.[100–102] Research and practice must therefore overcome the challenges of evaluating medication administration quality and safety in primary care to improve patient health outcomes. Although the use of varying error definitions by researchers in determining error rates has been previously identified,[8,36,37,103] this review has confirmed that this problem still exists. This is reflected in the wide range (<1–>90%) of error rates reported. Such variance in definitions and data capture could lead Avelestat (AZD9668) to erroneous evaluations of the system causes

of error. Attempts to develop common definitions for practice and research have been made,[36,56,99] and although more studies and practice in secondary care are adopting the use of these definitions,[104] there is still significant variation among the studies reviewed. One study[19] adapted a definition developed in secondary care for use in primary care but due to differences in the medication handling system between both settings, this approach may be burdensome, difficult to interpret and result in loss of important data. There is a need for a primary care practitioner-led definition of a prescribing error, where the highest error rates are recorded. This review has also demonstrated that error rates varied with the method of identification. For example, the highest error rate of 90.5% prescriptions[33] was recorded in Bahrain following the audit of paper prescriptions issued for paediatric patients from 20 primary healthcare centres.