Assessment of the steps taken towards avoidance of medication errors among hypertensive outpatients attending a tertiary health care facility in Nigeria: a cross-sectional study

Introduction Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits Methods A cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The IBM SPSS Version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant Results A total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001) Conclusion Patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.


Introduction
Hypertension, a major public health problem, has been identified as a leading cause of morbidity and mortality worldwide [1,2].
Uncontrolled hypertension is the most common risk factor for the development of stroke, heart failure (HF), chronic kidney disease and coronary artery disease in sub-Saharan Africa [3,4]. However, these complications can be prevented by ensuring adequate blood pressure control through accurate and consistent use of drugs and non-drug therapy, as recommended by the healthcare professionals [5].
Medication errors in hypertensive patients may arise in the course of prescribing, dispensing or administration of drugs [6]. Admittedly, the provision of drug therapy by a healthcare professional to a patient is a complex process. Thus, medication error may occur at any step along the way, from prescribing to the ultimate provision of the drug to the patient [7]. In view of this, the National Coordinating Council for Medication Error and Prevention (NCCMERP) described medication errors as, "any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer.
Such events may be related to professional practice, health care products, procedures and systems including: prescribing; order communication; product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use" [8,9]. Unfortunately, medication errors account for up to a third of all medical errors in the hospital and may lead to adverse outcomes such as increased mortality rates, increased length of hospital stay and high medical expenses [10,11]. The responsibility for the prevention of medication errors involves not just the healthcare professionals and healthcare systems but also the patients themselves. To help curtail this incidence, patients are now being actively engaged in the management of their medications [12,13]. Thus, patients should not just be informed of the names of their medications but also the reasons for their use, time of administration, how much and how often to take it, duration of therapy, common side effects that could occur, what to do about missed doses, common interactions with other drugs or foods, and the correct dose. Hence, patients are well prepared to act as the final check in the system. When patients take an active and informed role in their healthcare, many errors can be prevented [14][15][16]. Against this backdrop, the general objective of this study was to assess the steps taken among hypertensive outpatients towards avoiding medication errors before, during and after clinic visits.

Methods
Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer [8,9]. The steps taken by the hypertensive patients to reduce medication errors before consulting with their doctors include knowing their last clinic visit, the complaints that brought them to the hospital, the name and phone number of the doctor they consulted, the number and names of the non-prescription drugs they are on.  (Table 3). The mean difference analysis using ANOVA showed a statistically significant difference between the mean scores on steps to avoid medication errors before consultation with doctors  Table 4). There were associations between patients' educational status and the steps taken to avoid medication errors before consultation (χ 2 = 13.164, P < 0.004), at the consultation room (χ 2 = 38.404, P < 0.005) and after consultation (χ 2 = 25.555, P < 0.001); with patients who had tertiary education taking the best steps to avoid medication errors at the different times (Table 5). There was an association between occupational status and steps taken to avoid medication errors at the consultation room (χ 2 = 23.992, P < 0.001) and after consultation with the doctor (χ 2 = 28.226, P < 0.005). Patients who were government-employed took the best steps towards avoiding medication errors during and after consultations with their doctors (Table 6).

Discussion
In this study, we found that before clinic visits, most of the patients knew their doctor's names, and were not on any non-prescribed

Conclusion
Patients that took good steps in avoiding medication errors before consulting with their doctors were likely to avoid errors in the consulting room. Also, patients that avoided medication errors at the consulting room were more likely to avoid medication errors thereafter. Those with tertiary education or the governmentemployed took the best steps in avoiding medication errors during and after consultation with their doctor. The involvement of patients in the management of their health care has been shown to reduce the incidence of medication errors in both inpatients and outpatients.
Hence, health care professionals should as a matter of necessity provide patients with adequate information pertaining to their drug therapy. Additionally, patients should be encouraged to report to their health professionals, any observed medication-related problems.

Competing interests
The authors declare no competing interests.

Authors' contributions
Kosisochi Chinwendu Amorha was involved with the conception, design of the study, data analysis and interpretation of the analysis, drafting the manuscript, revising the manuscript critically for intellectual content. Glory James was involved with the design of the study, acquisition of data, drafting and revising the manuscript critically for intellectual content. Chibueze Anosike was involved with the data analysis and interpretation of the analysis, drafting the manuscript, revising the manuscript critically for intellectual content.
Mathew Jegbefume Okonta was involved with the conception, design of the study and revising the manuscript critically for intellectual content. All the authors have read and agreed to the final manuscript.
study. We also appreciate all the respondents who gave their informed consent to participate in this study. Table 1: socio-demographic information