Det har gjorts forskning kring felexpedieringar på apotek, om deras typer, bakomliggande orsaker och potentiella åtgärder mot dem. En svensk författning, kallad lex Maria, säger att alla händelser som orsakat eller hade kunnat orsaka allvarliga vårdskador skall utredas av vårdgivaren och anmälas till Inspektionen för vård och omsorg (IVO). IVO tar ett beslut i ärendet, som tillsammans med händelsen sammanfattas i ett särskilt beslutsdokument. Syftet med detta examensarbete var att undersöka vilka kategorier av felexpedieringar av läkemedel och andra produkter på apotek som kan leda till allvarliga vårdskador, och att ta reda på vilka av dessa kategorier som är vanligast förekommande. Detta gjordes genom att läsa samtliga lex Maria-beslut som tagits av IVO under 2016 gällande händelser på apotek. Felen som beskrevs i besluten kategoriserades utifrån ett antal kategorier som bestämts utifrån tidigare forskning kring felexpedieringar. Sammanlagt lästes 39 beslut. I dessa förekom följande kategorier av felexpedieringar, ordnade med den vanligaste först: fel läkemedel, fel dos, missat att upptäcka och korrigera förskrivarfel, fel styrka, fel patient, obehörig patient, uteblivet läkemedel, etikett på fel läkemedel, skrivit fel i datorn, fel kvantitet, fel läkemedelsform, fel iordningställning, fel tid, fel på verbal information, inte expedierat författningsmässigt. Flera av besluten sattes i mer än en av kategorierna. De fyra första kategorierna utgjorde tillsammans 60 % av de identifierade felen. Examensarbetets resultat, som till stor del stämmer överens med resultat från tidigare forskning, indikerar att lex Maria-anmälningar från apotek kan vara representativa för felexpedieringar överlag, och inte bara de som kan leda till allvarliga vårdskador. Informationen om felexpedieringar som kom fram i studien kan vara av nytta för farmaceuter och annan apotekspersonal för att de ska undvika fel vid arbete på apotek. Examensarbetets upplägg och resultat ger många uppslag till framtida forskning om felexpedieringar, inklusive deras konsekvenser, bakomliggande orsaker, och potentiella åtgärder. Dessa studier skulle vara lättare att göra om det fanns mer centralt sammanställd och allmänt tillgänglig statistik och information om felexpedieringar i Sverige, inte bara om de som kan leda till allvarliga vårdskador.

AIM: To conduct a systematic literature review on the existing literature on the prevalence of medication errors across the medicines management system in primary care; To explore the systems of error management in primary care; to investigate the prevalence and nature of medication errors in children, 0-12 years, and in older patients, ≥65 years, in primary care; and to explore community pharmacists' interventions on medicines-related problems. METHODS: 1) Systematic literature review; 2) Questionnaire survey of Primary Care Trusts (PCTs), Clinical Commissioning Groups (CCGs) and NHS Area Teams; 3) Retrospective review of the electronic medical records of a random sample of older patients, ≥65 years old, and children 0-12 years old, from 2 general practices in Luton and Bedford CCGs, England; 4) Prospective observation of community pharmacists' interventions on medicines-related problems and prescribing errors from 3 community pharmacies in Luton and Bedford CCGs in England. DATA ANALYSIS: Quantitative data from records review were analysed using Microsoft Excel on data extracted from an Access database. Statistical tests of significance were performed as necessary. Descriptive statistics were conducted on quantitative data from the studies and inductive qualitative analyses were conducted on aspects of the questionnaire survey. RESULTS: • The systematic literature review demonstrated that medication errors are common, and occur at every stage of the medication management system in primary care, with error rates between ≤1% and ≥90%, depending on the part of the system studied and the definitions and methods used. There is some evidence that the prescribing stage is the most susceptible, and that the elderly (over 65 years) and children (under 18 years) are more likely to experience significant errors, although very little research has focussed on these age groups. • The questionnaire survey of PCTS, CCGs and NHSE demonstrated that national and local systems for managing medication errors appeared chaotic, and need to be better integrated to improve error learning and prevention in general practice. • The retrospective review of patients' medical records in general practices demonstrated that prescribing and monitoring errors are common in older patients and in children. 2739 unique prescription items for 364 older patients ≥65 years old were reviewed, with prescribing and monitoring errors detected for 1 in 3 patients involving about 1 in 12 prescriptions. The factors associated with increased risk of errors were: number of unique medications prescribed, being ≥75 years old, being prescribed medications requiring monitoring, and medications from these therapeutic areas: corticosteroid, NSAID, diuretic, thyroid and antithyroid hormones, statins and ACE-I/ARB. 755 unique prescription items for 524 younger patients 0-12 years old were examined, with approximately 1 in 10 prescriptions and 1 in 5 patients being exposed to a prescribing error. Factors associated with increased risk of prescribing errors in younger patients were: being aged ≤10 years old, being prescribed three or more medications, and from similar therapeutic areas as above. Majority of the errors were of mild to moderate severity. • Community pharmacists performed critical interventions as the last healthcare professional defense within the medicines management system in primary care. However, this role is challenged by other dispensary duties including the physical aspects of dispensing and other administrative roles. CONCLUSION Prescribing and monitoring errors in general practice, and older patients and children may be more at risk compared to the rest of the population, though most errors detected were less severe. Factors associated with increased risk for errors in these age groups were multifaceted. The systems for periodic laboratory monitoring for routinely prescribed drugs, particularly in older patients, need to be reviewed and strengthened to reduce preventable hospital admissions. Antibiotic dosing in children in general practice needs to be regularly reviewed through continued professional developments and other avenues. As guidance on local arrangements for error reporting and learning systems are less standardised across primary care organisations, pertinent data from adverse prescribing events and near misses may be lost. Interventions for reducing errors should therefore explore how to strengthen local arrangements for error learning and clinical governance. Community pharmacists and/or primary care pharmacists provide an important defence within the medicines management system in primary care. Policy discussions and review around the role of the pharmacist in primary care are necessary to strengthen this defence, and harness the potential thereof.