{
  "abstract": "Objectives Medication errors are a leading source of preventable harm in healthcare, affecting approximately 1 in 30 patients, with a substantial proportion resulting in severe outcomes. In response, the European Association of Hospital Pharmacists convened a Special Interest Group (SIG) to propose comprehensive and sustainable strategies for reducing these errors across Europe, employing a systems approach.Methods 89 anonymised medication error reports, and empirical data from the SIG members’ daily practice, were analysed to identify root causes, classified into system-level and individual errors. Expert subgroups then linked root causes to targeted preventive measures. A literature review was conducted, searching PubMed and Embase databases, to assess existing standards and identify gaps in medication safety practices, which informed the analysis.Results Analysis revealed that governance deficiencies and inconsistent implementation of existing legal standards contribute significantly to medication errors. System-level issues, including inadequate oversight, understaffing and insufficient technical infrastructures, along with individual errors from cognitive lapses, were prevalent. The literature review supported these findings and highlighted the variability in medication safety practices across systems, underscoring the importance of strategic improvements in healthcare policies.Conclusions Findings highlight the critical need for robust governance, comprehensive policy frameworks and enhanced safety cultures to prevent medication errors. Automation and improved human–machine interfaces are recommended to mitigate active failures and enhance system reliability. This systems-thinking approach, supported by strengthening legislation and better resource allocation, is essential for reducing medication errors and improving patient safety.",
  "authors": [
    {
      "affiliations": [
        "Pharmacy, Ulster University Faculty of Life and Health Sciences, Coleraine, UK"
      ],
      "name": "Sonja Guntschnig"
    },
    {
      "affiliations": [
        "Pharmacy, Hospital da Senhora da Oliveira Guimarães, Guimaraes, Braga, Portugal"
      ],
      "name": "Renata Barbosa"
    },
    {
      "affiliations": [
        "Health, Bern University of Applied Sciences, Bern, BE, Switzerland"
      ],
      "name": "Helena Jenzer"
    },
    {
      "affiliations": [
        "Hospital Pharmacy Modernisation Team, NHS England, London, UK"
      ],
      "name": "Matthew Greening"
    },
    {
      "affiliations": [
        "Pharmacy, Tallaght University Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Jennifer Hayde"
    },
    {
      "affiliations": [
        "Portiuncula University Hospital, Ballinasloe, County Galway, Ireland"
      ],
      "name": "Helen Heery"
    },
    {
      "affiliations": [
        "NHS England, London, UK",
        "Son Espases University Hospital, Palma, Spain"
      ],
      "name": "Maria Cristina Iglesias Serrano"
    },
    {
      "affiliations": [
        "Hospital Pharmacy, National Institute of Cardiovascular Diseases, Bratislava, Slovakia"
      ],
      "name": "Kristína Lajtmanová"
    },
    {
      "affiliations": [
        "Antiblastic Drugs Unit (UFA), ASST della Valle Olona, Nerviano, Milan, Italy"
      ],
      "name": "Elisabetta Rossin"
    },
    {
      "affiliations": [
        "Chief Hospital Pharmacist, Public Health Care Institution University Paediatric Clinic, Skopje, North Macedonia"
      ],
      "name": "Slagjana Tentova-Peceva"
    },
    {
      "affiliations": [
        "Policy & Advocacy, European Association of Hospital Pharmacists, Brussels, Belgium"
      ],
      "name": "Stephanie Kohl"
    },
    {
      "affiliations": [
        "Oslo University Hospital, Oslo, Norway",
        "The Faculty of Mathematics and Natural Sciences, Department of Pharmacy, University of Oslo, Oslo, Norway"
      ],
      "name": "Alma Mulac"
    }
  ],
  "title": "Tackling medication errors: how a systems approach improves patient safety",
  "uid": "6065c560-58e3-5f57-870a-ddf9d9477576"
}