To achieve the WHO (World Health Organization) five years strategy to reduce medication-related errors by 50% throughout the world [31], subsequent (inter)national data generation is important. Hence, we assessed the national burden of medication errors in Ethiopia.
The overall medication error in Ethiopian hospitals was 57.6%. From medication administration and prescription perspectives, the estimated error was 58.4% and 55.8%, respectively. This finding was higher than a national survey study in Nigeria (47%) [32]. This discrepancy might be due to medication errors were recorded based on professionals report in case of a study in Nigeria, but data were collected through observation and assessing the prescribed sheets in all included studies of the current meta-analysis. Likewise, the result of this meta-analysis was higher than the report in Iranian hospitals (31.8%) [10] and United states or United Kingdom (2-14%) [33], which relatively well-established and equipped health systems are available in developed countries. They also implement a web-based error reporting surveillance system [34]. Strengthening the error reporting system is important to encourages safe medication administration and prescription practices, and improve the quality of clinical care services [35]. In Ethiopia, however, error reporting trend needs improvement given that only 57.4% medication administration errors were reported [36].
Furthermore, in Ethiopia, one study showed that only 30.4% of medical doctors adhered to the code of ethics [37] though 75.7% of medical doctors have good knowledge about code of ethics [38]. Non-adherence to professional ethics might lead to medication errors that cause harm to the patient, person who made the error, and/or healthcare system at large [39]. In addition, health professions who make errors may feel a variety of adverse emotions after medical errors. It is thought that the pervasive culture of perfectionism and individual blame in health disciplines plays a considerable role in these negative feelings [40]. This may further provoke them to make subsequent medication errors.
Healthcare providers should the standard guideline to minimize harms caused by errors [41]. However, the high proportions of medication prescription and administration errors in Ethiopian hospitals are most likely committed by physicians and nurses, respectively. In this meta-analysis, we showed that, illegible handwriting (99.4%), error of omission (38%), wrong dose (38.5%), and wrong combination of drugs (28.7%) were common prescription errors made by physicians. In addition, missed doses (57.0%), technical error (47%), wrong time (35.0%), and wrong dose (30.0%) were frequent medication administration errors most likely made by nurses. These might also be due to high work load, distraction, absence of medication preparation room, unavailability of medication administration guideline, lack of job site training, and inappropriate health worker to patient ratio [17, 18, 20].
Lack of motivation of health workers, unfavorable working environment, working at various health facilities simultaneously, low public awareness about medication errors, lack of integration of medico-legal issues course in to the country education system, weak system in reporting unethical conducts, absence of standardized monitoring tool, and weak collaboration among key stakeholders might have their own contribution to the high proportion of medication error in Ethiopia. Furthermore, WHO recommended measures [42], like establishing well-standardized infrastructure (electronic networks, information technology-based reporting and communication systems for prospective use (computerized physician prescription systems), barcode medication administration, and medical-chart oriented error registration are still a big problem in Ethiopia. Nurse-physician communication is low as a single study showed in Ethiopia [43].
Quality improvement and patient safety intervention strategies for the prevention and management of medication errors are necessary for Ethiopia [44]. For instance, strong medico-legal rules, inter-and intra-professional communication, job aids system based reminders, computerization and automation, shift-to-shift handoffs [45], and wristband bar-code medication scanning could decrease medication errors [46], which are less likely to be implemented in Ethiopia.
Generally, medication errors are common in Ethiopia though there are great opportunities to reduce these events. Appointing qualified and capable inspectors, implementing advanced medication administration and prescription technologies, providing continues sensitizing training to clinician, developing culture of error reporting habit, and improving prescribers’ hand writing skill are some of practicable interventions in Ethiopia. Clinicians, researchers, and policy makers need to collaborate to minimize errors committed during medication prescription and administration phase.
Strength and limitations
No differences based on study country, study design, and no study with poor quality. Besides, we did subgroup analysis for further potential sources of variation. However, I-square showed the presence of statistical heterogeneity across studies though possible sources of heterogeneity resolved in the meta-analysis.