Medical emergency response related to MedicAtion InciDents ( MERRMAID ): a case series and lessons to improve medication safety

BACKGROUND: Evidence suggests that some medical emergencies in hospital are associated with preventable medication errors or adverse reactions. AIM: The purpose of this case series was to investigate and describe the proportion of Medical Emergency Response Team (MERT) activations that are medication-related, the degree of preventability and underlying contributing factors. METHOD: This retrospective case series included a review of MERT activations collected from an Australian tertiary hospital by two separate multidisciplinary teams. Initial review by the research team identified those that were potentially medication-related; these cases were then reviewed by an expert panel to determine the degree of causation and preventability and to identify errors within the medication management cycle and their underlying factors. The main outcome measures were the proportion of preventable medication-related MERT activations. The secondary outcome included descriptions of medications, medication errors in the context of the medication management cycle and consideration of factors underlying the errors including pharmacy review contributing to these activations. RESULTS: Fifteen per cent (17/117) of MERT activations reviewed were medication-related, and 65% (11/17) of those were deemed preventable. The omission of medications due to errors in prescribing, administration, pharmacy review or supply stage was the main contributor to preventable medication-related MERT activations (7/11, 64%). Cardiovascular medications, predominantly metoprolol, were most implicated in preventable medication-related MERT activations. CONCLUSIONS: Medication adverse events due to potentially error-prone steps in medication management processes are a common cause of inpatient MERT activations, presenting a considerable preventable burden to patients and healthcare resources.