Medication Errors Associated with Anticoagulants at a Tertiary Care Hospital in Saudi Arabia - A Retrospective Cohort Study

This study aimed to evaluate the types, frequency, severity, and contributing factors of medication errors associated with anticoagulants in a tertiary care hospital in Saudi Arabia, with particular focus on identifying patterns across different anticoagulant types and patient characteristics. A retrospective cohort study was conducted analyzing 630 anticoagulant-related medication errors reported between January 2021 and December 2023 at the Armed Forces Hospital Southern Region. Data were extracted from the hospitals electronic reporting systems (Datix and Intervention systems). Errors were classified according to type, subtype, severity (using the NCC MERP index), and contributing factors. Statistical analyses included descriptive statistics and logistic regression to identify associations between patient characteristics and error patterns. A total of 650 medication errors were reported during the study period. Prescribing errors were the most prevalent type (72.4%), with incorrect dosing being the predominant subtype (61.3%). Enoxaparin was associated with the highest number of errors (51.2%), followed by apixaban (25.2%) and warfarin (18.2%). The majority of errors (91.4%) were classified as category B (reached the patient but caused no harm). Elderly patients (70-84 years) experienced the highest frequency of errors, with a significant association between advanced age and error severity (OR 1.42 per decade increase, 95% CI: 1.28-1.57, p<0.001). Lack of knowledge (39.7%) and monitoring failure (33.4%) were identified as the primary contributing factors, with distinct patterns observed across different anticoagulants and error types. Anticoagulant-related medication errors remain a significant patient safety concern, with prescribing errors and incorrect dosing being particularly prevalent. Targeted interventions addressing knowledge gaps, monitoring processes, and the unique challenges of anticoagulant management in elderly patients are needed to enhance medication safety and improve patient outcomes.