Long-Term Follow-Up of patient education programs for medication administration errors
DOI:
https://doi.org/10.5281/zenodo.22814988Keywords:
medication errors, patient education, long-term follow-up, medication adherence, self-administrationAbstract
Background: Preventable medication administration errors remain a leading source of inpatient and home-care harm, and one-time education for nurses, patients, and caregivers has shown inconsistent durability once initial training effects fade.
Objective: This review synthesizes long-term follow-up evidence on structured patient education programs targeting medication administration errors, focusing on studies with outcome assessment beyond six months.
Methods: We synthesized peer-reviewed cohort studies, randomized and quasi-experimental trials, and long-term follow-up reports addressing patient- and caregiver-directed medication education, self-administration training, and sustained error-rate outcomes.
Findings: Structured education combined with teach-back and reinforcement sustains reductions in administration error rates for six to twelve months in several cohorts, but gains attenuate without booster sessions or ongoing pharmacist-led reinforcement; technology-supported adherence aids and simplified regimen counseling extend durability further in chronic-disease populations.
Conclusions: Long-term reduction in medication administration errors after patient education is achievable but not self-sustaining; programs that embed periodic reinforcement, teach-back verification, and simplified medication schedules show the most durable long-term effect, while single-session interventions decay within a year.
References
Kohn, L.T., Corrigan, J.M., Donaldson, M.S. (2000) To Err Is Human: Building a Safer Health System. National Academies Press, Washington, DC.
Keers, R.N., Williams, S.D., Cooke, J., Ashcroft, D.M. (2013) Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2): 237-256. DOI: 10.1345/aph.1R147
Barker, K.N., Flynn, E.A., Pepper, G.A., Bates, D.W., Mikeal, R.L. (2002) Medication errors observed in 36 health care facilities. Archives of Internal Medicine, 162(16): 1897-1903. DOI: 10.1001/archinte.162.16.1897
Westbrook, J.I., Woods, A., Rob, M.I., Dunsmuir, W.T., Day, R.O. (2010) Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8): 683-690. DOI: 10.1001/archinternmed.2010.65
Kripalani, S., Jackson, A.T., Schnipper, J.L., Coleman, E.A. (2007) Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. Journal of Hospital Medicine, 2(5): 314-323. DOI: 10.1002/jhm.228
Poon, E.G., Keohane, C.A., Yoon, C.S., Ditmore, M., Bane, A., Levtzion-Korach, O., et al. (2010) Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18): 1698-1707. DOI: 10.1056/NEJMsa0907115
Armitage, G. (2008) Double checking medicines: defence against error or contributory factor? Journal of Evaluation in Clinical Practice, 14(4): 513-519. DOI: 10.1111/j.1365-2753.2008.00996.x
Al-Rashed, S.A., Wright, D.J., Roebuck, N., Sunter, W., Chrystyn, H. (2002) The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. British Journal of Clinical Pharmacology, 54(6): 657-664. DOI: 10.1046/j.1365-2125.2002.01707.x
Wright, J., Emerson, A., Stephens, M., Lennan, E. (2006) Maintaining patients' independence and preventing hospital-acquired errors: a review of self-administration of medicines schemes. British Journal of Community Nursing, 11(6): 256-261.
Schnipper, J.L., Kirwin, J.L., Cotugno, M.C., Wahlstrom, S.A., Brown, B.A., Tarvin, E., et al. (2006) Role of pharmacist counseling in preventing adverse drug events after hospitalization. Archives of Internal Medicine, 166(5): 565-571. DOI: 10.1001/archinte.166.5.565
Kwan, J.L., Lo, L., Sampson, M., Shojania, K.G. (2013) Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of Internal Medicine, 158(5 Pt 2): 397-403. DOI: 10.7326/0003-4819-158-5-201303051-00006
Trief, P.M., Cibula, D., Rodriguez, E., Akel, B., Weinstock, R.S. (2016) Incorrect insulin administration: a problem that warrants attention. Clinical Diabetes, 34(1): 25-33. DOI: 10.2337/diaclin.34.1.25
Negarandeh, R., Mahmoodi, H., Noktehdan, H., Heshmat, R., Shakibazadeh, E. (2013) Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Primary Care Diabetes, 7(2): 111-118. DOI: 10.1016/j.pcd.2012.11.001
Basheti, I.A., Armour, C.L., Bosnic-Anticevich, S.Z., Reddel, H.K. (2007) Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Education and Counseling, 68(2): 111-122. DOI: 10.1016/j.pec.2007.05.011
Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., et al. (2003) Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1): 83-90. DOI: 10.1001/archinte.163.1.83
Katz, M.G., Kripalani, S., Weiss, B.D. (2006) Use of pictorial aids in medication instructions: a review of the literature. American Journal of Health-System Pharmacy, 63(23): 2391-2397. DOI: 10.2146/ajhp060162
Davis, T.C., Wolf, M.S., Bass, P.F., Middlebrooks, M., Kennen, E., Baker, D.W., et al. (2006) Low literacy impairs comprehension of prescription drug warning labels. Journal of General Internal Medicine, 21(8): 847-851. DOI: 10.1111/j.1525-1497.2006.00529.x
Wolf, M.S., Davis, T.C., Shrank, W., Rapp, D.N., Bass, P.F., Connor, U.M., et al. (2007) To err is human: patient misinterpretations of prescription drug label instructions. Patient Education and Counseling, 67(3): 293-300. DOI: 10.1016/j.pec.2007.03.024
Yin, H.S., Dreyer, B.P., van Schaick, L., Foltin, G.L., Dinglas, C., Mendelsohn, A.L. (2007) Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Archives of Pediatrics and Adolescent Medicine, 161(2): 181-187. DOI: 10.1001/archpedi.161.2.181
Zolnierek, K.B., DiMatteo, M.R. (2009) Physician communication and patient adherence to treatment: a meta-analysis. Medical Care, 47(8): 826-834. DOI: 10.1097/MLR.0b013e31819a5acc
George, J., Elliott, R.A., Stewart, D.C. (2008) A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs and Aging, 25(4): 307-324. DOI: 10.2165/00002512-200825040-00004
Al-Aqeel, S., Gershuni, O., Al-Sabhan, J., Hiligsmann, M. (2018) Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database of Systematic Reviews, 10: CD008312. DOI: 10.1002/14651858.CD008312.pub3
Elliott, R.A., Barber, N., Clifford, S., Horne, R., Hartley, E. (2008) The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharmacy World and Science, 30(1): 17-23. DOI: 10.1007/s11096-007-9134-y
Wu, S., Vahle, J.L., Sung, J. (2016) Effect of mobile phone text messaging interventions on medication adherence in patients with chronic disease: a systematic review and meta-analysis. JMIR mHealth and uHealth, 4(3): e104.
Zedler, B.K., Kakad, P., Colilla, S., Murrelle, L., Shah, N.R. (2011) Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clinical Therapeutics, 33(1): 62-73. DOI: 10.1016/j.clinthera.2011.02.003
Viswanathan, M., Kahwati, L.C., Golin, C.E., Blalock, S.J., Coker-Schwimmer, E., Posey, R., et al. (2015) Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Internal Medicine, 175(1): 76-87. DOI: 10.1001/jamainternmed.2014.5841
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., et al. (2014) Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, 11: CD000011. DOI: 10.1002/14651858.CD000011.pub4
Look, K.A., Stone, J.A. (2015) Medication management activities performed by informal caregivers of older adults. Research in Social and Administrative Pharmacy, 11(4): 505-518. DOI: 10.1016/j.sapharm.2014.10.005
Boren, S.A., Wakefield, B.J., Gunlock, T.L., Wakefield, D.S. (2009) Heart failure self-management education: a systematic review of the evidence. International Journal of Evidence-Based Healthcare, 7(3): 159-168. DOI: 10.1111/j.1744-1609.2009.00134.x
Coleman, E.A., Parry, C., Chalmers, S., Min, S.J. (2006) The care transitions intervention: results of a randomized controlled trial. Archives of Internal Medicine, 166(17): 1822-1828. DOI: 10.1001/archinte.166.17.1822
Manias, E., Williams, A., Liew, D. (2014) Interventions to reduce medication errors in adult intensive care: a systematic review. British Journal of Clinical Pharmacology, 77(2): 259-273. DOI: 10.1111/bcp.12184
Sears, K., Goldsworthy, S., Goodman, W.M. (2013) The relationship between simulation in nursing education and medication safety. Journal of Nursing Education, 49(1): 52-55. DOI: 10.3928/01484834-20090918-12
Anderson, P., Townsend, T. (2010) Medication errors: don't let them happen to you. American Nurse Today, 5(3): 23-27.
Hughes, R.G., Blegen, M.A. (2008) Medication administration safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality, Rockville, MD.
World Health Organization (2017) Medication Without Harm: WHO Global Patient Safety Challenge. World Health Organization, Geneva.
Nguyen, T.M., La Caze, A., Cottrell, N. (2014) What are validated self-report adherence scales really measuring?: a systematic review. British Journal of Clinical Pharmacology, 77(3): 427-445. DOI: 10.1111/bcp.12194
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Liam Nolan, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
