INCIDENCE AND PREVALENCE OF PRESCRIBING ERRORS IN SAUDI ARABIA: A SYSTEMATIC STUDY Original Article FARAH KAIS ALHOMOUD 1 , WALAA ALNEMARI 2 , HADEEL ALFAHMI 3 , FATEN ALHOMOUD 4 , EJAZ CHEEMA 5 1,4,5 Department of Clinical and Pharmacy Practice, School of Pharmacy, Umm Al-Qura University, Al-Taif Road, Mecca 24382, Saudi Arabia, 4 Department of Clinical Pharmacy and Pharmacy Practice, College of Clinical Pharmacy, University of Dammam, Saudi Arabia 2,3 Received: 31 Aug 2016 Revised and Accepted: 15 0ct 2016 A student at the School of Pharmacy, Umm Al-Qura University, Al-Taif Road, Mecca 24382, Saudi Arabia Email: f_alhomoud83@yahoo.com ABSTRACT Objective: The increased incidence of prescribing errors has become a major health problem and is a concern for healthcare authorities across the world due to its serious medical consequences for patients. However, very little is known about prescribing errors in Saudi Arabia. Therefore, this review aims to systematically review the studies that have assessed the incidence and prevalence of prescribing errors in Saudi Arabia. Methods: A systematic review of the literature related to prescribing errors among adults in Saudi Arabia was limited by the period from January 2005 up to April 2016, using the following databases: PubMed, Scopus and ISI Web of Science. The search strategy included studies conducted among adults 18 or over; in primary or secondary care in Saudi Arabia; that assessed handwritten prescriptions by junior or senior doctors; and that were published in the English language only. The quality of the included studies was assessed using a 13-item quality assessment tool adopted from two previous studies. Results: Six studies met the inclusion criteria. The overall quality of the included studies was variable. Error rates varied from 7.1% to 94% for prescribing. The median error rate interquartile range (IQR) was as high as 32% (7.1-49%). Duration of the studies ranged from one day to two years. The studies included data on 259,055 prescription orders, with a number of prescription orders assessed in the studies ranging from 1582 to 240,000. The most common types of prescribing errors reported were attributed to incorrect dosage followed by incorrect strength and incorrect duration of treatment. Conclusion: This review suggests the need to improve the prescribing skills and knowledge of prescribers in Saudi Arabia through the introduction of educational and training programmes with the aim of reducing prescribing errors. Keywords: Medication errors, Drug prescriptions, Inappropriate prescribing, Middle East, Saudi Arabia © 2016 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ijpps.2016v8i12.14973 INTRODUCTION Medication errors are common [1], and are a leading cause of patient morbidity and mortality in all healthcare settings [2, 3]. This can cause unnecessary pain and harm to patients and can even lead to death [4, 5]. The Agency for Healthcare Research and Quality (AHRQ) defines a medication error (ME) as “an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication” [6]. In the United States, MEs have been reported to be responsible for 7,000 injuries to patients per year, with a similar incidence and consequences reported in the United Kingdom and worldwide [7, 8]. Although MEs can occur at any stage of the medication use pathway [4], prescribing errors are the most common subtype of MEs in all healthcare settings [9-11]. Evidence from a systematic review that included 65 studies suggested that prescribing errors accounted for 7% of medication orders, 50% of hospital admissions and 2% of inpatients [12]. The percentage of prescribing errors ranged from 29% to 56% of all reported MEs in adults [9, 13]. Many definitions have been used for the term ‘prescribing error’ in previous studies. However, one of the most validated definitions was developed by Dean et al. (2000), as follows: “a prescribing error occurs when, as a result of a prescribing decision or prescription- writing process, there is an unintentional, significant reduction in the probability of treatment being timely and effective; or increase in the risk of harm when compared to generally accepted practice” [14]. It can also be further defined as “a failure in the prescription writing process by a physician that results in a wrong instruction about one or more of the normal features of a prescription” [15]. The “normal features” include the identity of the recipient, the identity of the drug, the formulation, and dose, and the route, timing, frequency and duration of administration [15]. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), which includes 27 national organizations, suggests that MEs are preventable [16]. However, prevention of MEs can be challenging, particularly in inpatient settings where prescription orders are more prone to errors [17]. These errors may result in increased patient care costs due to prolonged length of hospital stay and an increase in the patient mortality rate [18]. MEs have become a universal problem; however, most of the evidence on MEs has been collected from developed countries such as the US and Europe [19], whereas MEs are still under-reported in the developing countries, including Saudi Arabia. Medication errors can cause serious consequences for patients such as adverse drug events (ADEs), which represent a major cause of harm. However, the overall incidence of ADEs and the implications of MEs in Saudi Arabia are still unknown [11]. However, only one study was found in the literature suggested that MEs were a contributory factor to the 26 deaths reported by Aldhawailie et al., study. A study conducted in a large tertiary university teaching hospital in Riyadh, Saudi Arabia, identified 113 (7.1%) prescribing errors out of the total 1582 medication orders assessed [20]. Incorrect drug strength and incorrect drug administration frequency were the two most common types of errors identified during the study [20]. However, no study has systematically assessed the incidence and prevalence of prescribing errors in both primary and secondary care in Saudi Arabia. Furthermore, considering the important International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 8, Issue 12, 2016