Global burden of preventable medication-related harm in health care: a systematic review

A series of WHO initiatives, such as the Global Patient Safety Challenge: Medication Without Harm and the Global Patient Safety Action Plan 2021-
2030, address patient harm associated with use of medications. Medication-related harm is considered preventable if it occurs as a result of an identifiable,
modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines. Understanding the prevalence, nature
and severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety. This report presents an updated systematic review and meta-analysis of studies of the prevalence, nature and severity of preventable medication-related harm in the
international literature including in low- and middle-income countries (LMICs). A total of 100 studies were included in the review, involving 487 162 patients. Of
these reports, 70 were from high-income countries (HICs) and 30 from LMICs. The results were as follows. Global prevalence and severity of preventable
medication-related harm: The pooled prevalence of preventable medication-related harm in all 100 studies was 5% (1 in 20 patients). One fourth of the harm was severe or potentially life-threatening. Geographical distribution of preventable medication-related harm: The prevalence of preventable medication-related harm was 7% in 30 studies in LMICs and 4% (3–5%, one in 25 patients) in 70 studies in HICs. The highest prevalence rates of preventable medication-related harm were in the African (9%) and South-East Asian regions (9%). Health care settings in which the most vulnerable patients are managed for preventable medication-related harm: Globally, the highest prevalence rates
for preventable medication-related harm are for patients managed in geriatric care units (17%) and among patients in highly specialized or surgical care (9%).
Stages of medication at which most preventable medication-related harm occurs: Globally about half (53%) of all preventable medication-related harm
occurred at the “ordering/prescribing” stage and 36% at the monitoring/reporting” stage. In LMICs, almost 80% of preventable medication-related harm occurred during the “ordering/prescribing” stage. Medicines that contribute most to medication- related harm: Antibacterials, antipsychotics,
cardiovascular medications, drugs for functional gastrointestinal disorders, endocrine therapy, hypnotics, sedatives and non-steroidal anti-
inflammatory products contributed most to medication-related harm globally.
Way forward: The analysis showed that at least one in 20 patients are affected by preventable medication-related harm globally and that more than one fourth
of preventable harm is severe or life-threatening. The prevalence of preventable medication-related harm in LMICs was almost twice as high as in HICs;
however, few data were available on the severity and nature of medication-related harm in LMICs. A prerequisite for the success of future strategies
to mitigate preventable medication-related harm in LMICs would be to encourage reporting of any preventable medication-related harm and commission high-quality studies with standard methods for assessing and reporting such harm and also studies of the underlying causes for designing interventions that are most likely to work in LMICs. There is also an urgent need to implement improvement strategies in settings in which patients are managed, especially those who are vulnerable to preventable medication related harm, such as geriatric care and surgical care settings. Finally, most of the evidence summarized in this report was produced in hospitals and should be strengthened with more research in major specialties, including primary care, and mental health.