Burden of risks in the analogue and digitally-supported medication use process and potential for solutions to increase patient safety in the hospital: a mixed method study

Abstract Background: Medication errors are common in hospitals. Our aim was to investigate risks of the analogue and digitally-supported medication use process and potential for solutions.Methods: A mixed-method study including a structured literature search, and questionnaires based on the Delphi method was conducted. To identify major risks, a literature search was supplemented by risks from Critical-Incident-Reporting-System cases and risks from experts’ know-how. First, all risks were structured into main and sub-risks and second, risks were grouped into risk clusters. Third, experts were asked to assess risk clusters regarding likelihood of occurrence and impact on patient safety and regarding potential for solutions to strengthen the competence of health care professionals and potential for solutions in digitalization.Results: Overall, 160 main risks and 542 sub-risks were identified. Main risks were grouped into 43 risk clusters. In total, 33 experts (56% female, 50% with >20 years professional-experience) ranked the likelihood of occurrence and the impact on patient safety to 15 top risk clusters regarding the following process steps: admission (n=4), prescribing (n=3), verifying (n=1), preparing/dispensing (n=3), administering (n=1), discharge (n=1), health care professional competence (n=1), and patient (n=1). In total 28 experts (64% female, 43% with >20 years professional-experience) mostly suggested awareness building and training, strengthening of networking, and involvement of pharmacists at point-of-care as solutions to strengthen health care professional competence. For solutions in digitalization a digital medication list, digital warning systems, barcode-technology, and digital support in integrated care were suggested.Conclusions: A multitude of different risks was identified in the medication use process. To increase patient safety and to minimize potential errors, different solutions to strengthen health care professional competence as well as digital solutions exist. As a next step, health care professional competence and digital solutions will be investigated more deeply to derive specific recommendations for intra-hospital clinical practice use.