Medical Errors and their effective Factors in Iranian Physicians: A Systematic Review

Medical errors and their consequences are one of the most important factors threatening patient safety in the health system of all countries, the incidence of which is increasing alarmingly (3, 4). Today, reducing the incidence of medical errors has become a global challenge (5). Despite all efforts to improve and maintain the safety of patients due to medical errors, various communities suffer a lot of financial and human costs and losses every year (6). In the global classification of causes leading to death, medical errors are one of the top ten causes (7). So that one out of every ten hospitalized patients is injured due to medical errors while receiving health care; about 7% of them lead to death (8). Therefore, considering the importance of the issue, this study was conducted with the aim of systematically reviewing, identifying and collecting information about the occurrence of various medical errors in physicians in Iran as an example of a developing society.

This systematic review study in 2019 using search tools in SID, Magiran, Iran Doc, Scopus, Proquest, Pub Meb, web of science, Springer, Cochrane, Elsevier, Science Direct and Google scholar databases has systematically reviewed the studies conducted on the types of medical errors in Iranian physicians from the beginning of the establishment of each of the above scientific bases until August 1, 2019. The search strategy was retrieved and prepared for related studies using PICO-related search terms (patient or population, intervention, control, or comparison and results). In the article search process, MeSH-compliant keywords including Prevalence, error(s) or mistake(s), prescription, physician(s), Surgery or Surgeons, physician(s) error(s) or mistake(s), surgical error(s) or surgeon(s), administration(s) error(s) or mistake(s), medication or drug error(s) or mistake(s), prescribing error(s) or mistake(s), wrong dose(s), wrong medication(s) and Iran or Iranian and Persian equivalent keywords were used. The Cochrane Handbook for Systematic Reviews for Intervention Studies and the PRISMA statement were used to design this study and refine the articles (51). To collect information from the considered articles, Cochran data extraction form for systematic review was used which included the first author, year of publication, nationality of researchers, study design, type of research, sampling method, sample size, research tool and summary of important study findings. An Excel-designed form was used to collect data. Data according to their nature were analyzed and written in a narrative and thematic manner. The following selection criteria were used to find related articles from databases: 1) articles that had full text and were written in Persian or English, 2) articles were published in the field of medical errors only in physicians and the factors affecting it. Of course, it is worth mentioning that in articles in which medical error was simultaneously examined in physicians and nurses, information about physicians was extracted. Gray resources related to unpublished results in dissertations and articles published in low-credit sources were not reviewed due to access problems and insufficient credit. Also, articles on meta-analysis, systematic review, quality, posters, speeches and letters to the editor that were found in the field of various medical errors were excluded from the study.

A total of 15 articles were found, including: 3 Persian articles and 12 English articles. According to the findings of the present study, the prevalence of medical errors in Iranian physicians ranged from 38.1 to 65% (3, 9, 16-18). The most common types of medical errors were prescription error with 17.3% and medication error with 1.98 errors per patient, respectively (4, 28). The most important factors affecting the occurrence of medical errors include:  the education level and type of specialization of physicians (2), low number of physicians and high number of patients (10), lack of proper training of medical staff (9), staff performance, management levels and executive shortcomings (4), long night shift (17), physicians 'handwriting and how to record patients' information in medical records (8), lack of cooperation between physicians in different wards (10), employment in overcrowded hospital wards (4) and the lack of comprehensive treatment guidelines and violations of existing laws (23,10). The results of this systematic review showed that various interventions have been performed to reduce the incidence of medical errors, which can be divided into three areas: the study of the intervention role of clinical pharmacists (18, 28), the use of software for recording clinical prescriptions systematically by a physician or nurse (25,29,30) and other types of interventions (23). Use of clinical prescription registration software by the nurse can increase the acceptability of physicians' performance by warning and recommending and significantly reduce the medication dose error in the neonatal ward compared to the computer recording of information by a physician. In care systems where the physician opposes the implementation of computerized clinical information recording software by himself but nurses tend to computerized clinical information registration and have the necessary ability to implement it, computer software for recording patient information by the nurse can Should be considered as an appropriate alternative method for entering patient information in hospitals (29).

This systematic review showed that in general, the incidence of medical errors in Iranian physicians during the clinical care process is high. Also, the most common type of medical errors in our country's hospitals is the error of a doctor's prescription and then medication errors (9, 17). Unfortunately, despite all the efforts of the Iranian health system to reduce the occurrence of medical errors, the incidence rate is still significant, although it seems lower than the global rate. Of course, the lower rate of medical errors in Iran than the global rate can also be due to under-reporting of errors (9). Therefore, in order to reduce the incidence of medical errors, preventive approaches such as paying more attention to the importance of the interventional role of clinical pharmacists and providing conditions for their wider productivity (18, 28), using more efficient techniques to predict, diagnose and reduce the incidence of medical errors such as Sherpa technique (3,10) as well as the use of intelligent electronic technologies to reduce clinical errors such as systematic registration of clinical information by physicians and nurses (25,29,30) and design, implementation and evaluation of more appropriate intervention approaches to improve the reporting status of medical errors in physicians (9).