Skip to main content

Research Repository

Advanced Search

Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors.

Thomas, Binny; Paudyal, Vibhu; MacLure, Katie; Pallivalapila, Abdulrouf; McLay, James; El Kassem, Wessam; Al Hail, Moza; Stewart, Derek


Binny Thomas

Vibhu Paudyal

Katie MacLure

Abdulrouf Pallivalapila

James McLay

Wessam El Kassem

Moza Al Hail

Derek Stewart


Purpose: The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors. Methods: CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason’s Accident Causation model. Results: Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of ‘medication error’ were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per ‘total number of medication orders’/ ‘number of prescriptions’, the median across all studies was 10% (IQR 2–35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason’s model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9). Conclusion: There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors’ prevalence, severity, outcomes and contributory factors is warranted.


THOMAS, B., PAUDYAL, V., MACLURE, K., PALLIVALAPILA, A., MCLAY, J., EL KASSEM, W., AL HAIL, M. and STEWART, D. 2019. Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors. European journal of clinical pharmacology [online], 75(9), pages 1269-1282. Available from:

Journal Article Type Article
Acceptance Date May 2, 2019
Online Publication Date May 24, 2019
Publication Date Sep 30, 2019
Deposit Date Jun 14, 2019
Publicly Available Date Jun 17, 2019
Journal European Journal of Clinical Pharmacology
Print ISSN 0031-6970
Electronic ISSN 1432-1041
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 75
Issue 9
Pages 1269-1282
Keywords Medication errors; Prescribing errors; Error causation; Systematic review; Middle East
Public URL


You might also like

Downloadable Citations