Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors

Binny Thomas, Vibhu Paudyal, Katie MacLure, Abdulrouf Pallivalapila, James McLay, Wessam El Kassem, Moza Al Hail, Derek Stewart* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

48 Citations (Scopus)
14 Downloads (Pure)


Purpose The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors. Methods CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason's Accident Causation model. Results Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of 'medication error' were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per 'total number of medication orders'/ 'number of prescriptions', the median across all studies was 10% (IQR 2-35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason's model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9). Conclusion There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors' prevalence, severity, outcomes and contributory factors is warranted.

Original languageEnglish
Pages (from-to)1269-1282
Number of pages14
JournalEuropean Journal of Clinical Pharmacology
Issue number9
Early online date24 May 2019
Publication statusPublished - Sept 2019

Bibliographical note

Acknowledgements Open Access funding provided by the Qatar National Library. The authors would like to acknowledge the contribution of Doua Al Saad to quality assessment.
Funding This systematic review was undertaken as part of the selffunded PhD at Robert Gordon University, UK.


  • Medication errors
  • Prescribing errors
  • Error causation
  • Systematic review
  • Middle East
  • CARE


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