Medication errors in a residential care facility for adults with intellectual disabilities and in a psychiatric hospital

OBJECTIVE: To describe the characteristics of medication errors (MEs) occurring in the hospital care and medico-social sectors, both caring for individuals with mental health disorders, and operating under different medication-use regulations. METHODS: We conducted a retrospective cross-sectional study using ME reports from a psychiatric hospital (hospital care sector) and a specialized residential care facility for individuals with intellectual disabilities (medico-social sector) in France (2014-2021). MEs were analyzed using the ALARM method to identify their types, stages of occurrence and interception, consequences, drugs involved, and root causes. Prevalence odds ratios were calculated to assess the risks of specific types of MEs based on care setting. RESULTS: In the hospital care sector, MEs occurred most frequently at the prescribing stage (55.4%), with a higher proportion of potential error or risk of error (55.7%), and were predominantly intercepted during medication order review by the pharmacist (78.1%). The most common ME types were wrong dose (31.3%) and wrong drug (29.4%) errors, and severity was low (A-C classification: 75.3%), however, three deaths were reported. In the medico-social sector, MEs occurred predominantly at the administration stage (75%) and were mostly actual errors (81.6%), including wrong resident (43.4%), omissions (21.1%), and wrong time (17.1%) errors. No harmful or fatal MEs occurred, most required monitoring without harm (67.1%). Being a resident in the medico-social sector was associated with significantly higher risks of wrong resident errors (POR: 5.44; 95% CI: 3.25-9.11), particularly among those with cognitive impairment (112.50; 95% CI: 55.54-239.3), errors at the administration stage (6.58; 95% CI: 3.84-11.62), wrong time (5.30; 95% CI: 2.48-11.01), especially involving psychotropic drugs (3.98; 95% CI: 2.35-6.93). CONCLUSION: This study highlights major differences in the types and circumstances of MEs between the hospital care and medico-social sectors for individuals with mental health disorders. Regulatory and organizational frameworks in the medico-social sector should evolve, as in hospitals, to enhance medication safety.