Types, Trends, and Patterns of Reported Antimicrobial Errors in a Tertiary Care Hospital in Saudi Arabia

Background Antimicrobial medication errors (AMEs) pose critical threats to patient safety and fuel the global rise of antimicrobial resistance. This study retrospectively examines AMEs between 2022 and 2024 at a tertiary care hospital in Riyadh, Saudi Arabia, along with its affiliated community health centers. Objectives The study aimed to identify prescribing vulnerabilities, assess severity outcomes, and propose targeted interventions to enhance safety and stewardship practices. Methods This retrospective cohort study was employed to analyze AME, utilizing electronic health records, pharmacy databases, and institutional incident reporting systems reviewed by the Medication Safety Committee across the prescribing, transcribing, dispensing, and administration phases. Data were stratified by type, severity category, drug class, duration, location, and staff role with cross-validation through pharmacy audits. Results Prescribing errors consistently dominated across all 3 years, 71.4% (2022), 66.7% (2023), and 68.0% (2024), indicating entrenched clinical vulnerabilities. Dispensing errors steadily decreased over the study period, while supply and logistic errors spiked to 6.3% in 2023 before declining in 2024. Augmentin, cefazolin, azithromycin, amoxicillin, meropenem, and vancomycin were the most error-prone agents. Near-miss incidents (Category B) comprised the majority of reports, and hazardous conditions (Category A) rose notably in 2024. Multidisciplinary error reporting showed pharmacists and physicians as primary identifiers. The heatmap highlights declining errors in inpatient units, rising risks in community centers. Conclusion The analysis highlights persistent prescribing risks and emerging operational challenges in a tertiary care hospital’s antimicrobial management. Targeted education, enhanced digital systems, and site-specific interventions are essential for mitigating errors and aligning with global stewardship frameworks.