ArticleTherapeutic advances in drug safety2023
Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study.
Article in Therapeutic advances in drug safety, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Interventions to improve patient safety during the COVID-19 pandemic: a systematic review.BMJ open quality · 2025Pooled it
- Global research trends of home pharmaceutical care: a bibliometric analysis via CiteSpace.Frontiers in medicine · 2025Pooled it
- Causes and types of voluntarily reported unintentional medication discrepancies in care transitions: a cross-sectional study.International journal of clinical pharmacy · 2026Article
- Structuring medication safety narratives: development and evaluation of the medication-related incident reports annotation scheme.Frontiers in digital health · 2026Article
- Systems Thinking in Mental Health Patient Safety: A Narrative Review of Complex Adaptive Systems.Journal of evaluation in clinical practice · 2025Review
- Risk Management of Medication Errors: Improving the Quality of Pharmacotherapeutic Practice.Pharmacology research & perspectives · 2025Article
- Patient safety in eye care: a multi-method analysis of reported incidents involving implementation of care and clinical assessment in England and Wales.Eye (London, England) · 2025Article
- Measures and tools assessing medication self-management capability in older people across the hospital-to-home transition: a systematic scoping review.BMC geriatrics · 2025Article
- Risk prediction model for severe potential drug-drug interactions in colorectal cancer patients: a real-world data study.Frontiers in pharmacology · 2025Article
- Characteristics and causes of reported clozapine-related medication errors: analysis of the Ministry of Health database in Saudi Arabia.International journal of clinical pharmacy · 2024Article
- Estimating the impact on patient safety of enabling the digital transfer of patients' prescription information in the English NHS.BMJ quality & safety · 2024Article
- Construction of a Multi-Label Classifier for Extracting Multiple Incident Factors From Medication Incident Reports in Residential Care Facilities: Natural Language Processing Approach.JMIR medical informatics · 2024Article
- Exploring the Use of Persuasive System Design Principles to Enhance Medication Incident Reporting and Learning Systems: Scoping Reviews and Persuasive Design Assessment.JMIR human factors · 2024Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Improving medication safety during transition of care is an international healthcare priority. While existing research reveals that medication-related incidents and associated harms may be common following hospital discharge, there is limited information about their nature and contributory factors at a national level which is crucial to inform improvement strategy. Aim: To characterise the nature and contributory factors of medication-related incidents during transition of care from secondary to primary care. Method: A retrospective analysis of medication incidents reported to the National Reporting and Learning System (NRLS) in England and Wales between 2015 and 2019. Descriptive analysis identified the frequency and nature of incidents and content analysis of free text data, coded using the Patient Safety Research Group (PISA) classification, examined the contributory factors and outcome of incidents. Results: A total of 1121 medication-related incident reports underwent analysis. Most incidents involved patients over 65 years old (55%, Conclusion: Medication incidents after hospital discharge are associated with patient harm. Several targets were identified for future research that could support the development of remedial interventions, including commonly observed medication classes, older adults, increase patient engagement, and improve shared care agreement for medication monitoring post hospital discharge. Plain language summary:
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