Evidence map›Paper›PMID 42598606›Full record

Observational studySaudi medical journal2026

Patterns and Determinants of Medication Errors Across the Medication-Use Process:

Nawaf S Alqurashi, Mazen S Alshehri, Mohammed J Almalki, Mustafa M Muradkhudhari, Rozan M Radwan, Mohammed M Aldurdunji, Saleh A Almazam, Ohood K Almuzaini, Saad M Wali

Abstract readObservational Study
In one paragraph

Observational study in Saudi medical journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Nawaf S AlqurashiPharmaceutical Care Department, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia.
Mazen S AlshehriPharmaceutical Care Department, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia.
Mohammed J AlmalkiPharmaceutical Care Department, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia.
Mustafa M MuradkhudhariPharmaceutical Care Department, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia.
Rozan M RadwanPharmaceutical Care Department, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia.
Mohammed M AldurdunjiPharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
Saleh A AlmazamPharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
Ohood K AlmuzainiPharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
Saad M WaliPharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.ORCID 0009-0006-0080-4799

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: To characterize medication errors across the full workflow and identify stage-specific predictors in a tertiary care setting. Medication errors remain a major global patient safety concern, with limited comprehensive analyses across all stages of the medication-use process in Saudi Arabia. Methods: A retrospective observational study was conducted using medication error reports from Al-Noor Specialist Hospital, Makkah, between January 2023 and August 2025. Errors were classified by stage and severity using the National Coordinating Council for Medication Error Reporting and Prevention index. Multivariable logistic regression was performed to identify predictors associated with each stage. Results: A total of 6,546 errors were analyzed. Most occurred during prescribing (65.5%), followed by transcribing (26.5%) and monitoring (4.4%). Incorrect or missing dose was the most common error (38.2%). Ordering-stage incidents accounted for 95.5% of reports. Pharmacists identified 86.3% of errors, and 93.5% did not reach patients (Category B). Antibiotics (32.8%) and cardiovascular medications (22.5%) were most frequently involved. Stage-specific predictors varied, with nurse detection strongly associated with administration-stage errors (odds ratio = 7.10; 95% Confidence Intervals: 2.94-16.9). Conclusion: Prescribing errors predominated, while pharmacists played a key role in error interception. Targeted, system-level interventions addressing prescribing practices and stage-specific risks are essential to improving medication safety.

Indexed as

Medication ErrorsTertiary Care CentersHumansRetrospective StudiesSaudi ArabiaMedication errorsMedication-use processPatient safetySaudi ArabiaTertiary care hospital

Identifiers

PMID42598606
PMCPMC13471504

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.