MEDSAFE (Medication Error Decrease through System Adaptation, Feedback, and Education): A Quality Improvement Initiative to Enhance Medication Safety in the Emergency Department

Abstract Medication errors are a common and preventable source of harm in Emergency Departments where fast-paced workflows, high patient volumes, and frequent interruptions increase vulnerability to system failures. Following the implementation of a new electronic health record system, medication error rates remained unchanged at 6.8 per 10,000 ED attendances. This initiative was launched to reduce medication errors. ED medication-related incident reports from August 2022 to July 2023 were analysed to establish baseline data. Improper dosing and failures of positive patient identification (PPID) caused 52% of errors. An interprofessional team designed two interventions: 1. Pre-hospital medication screening and triage-administered medications, supported by OurPractice Advisory (OPA) prompting Medication Administration Record review; and 2. A strengthened PPID training framework incorporating a senior-led buddy system, observational audits and simulation-based training. Interventions were refined using Plan-Do-Study-Act cycles. Primary outcome was monthly medication error rate per 10,000 ED attendances; process measures included OPA compliance and PPID audit performance. Over two years, overall medication error rates decreased by 47% to 3.6 errors per 10,000 ED attendances, with reduced variation on statistical process control charts. Days between improper dosing errors improved from 10.8 to 43.8, with a sustained peak of 276 days. Days between PPID-related errors improved from 16.5 to 57.7 days, with no errors recorded for more than six months from April 2025. OPA compliance remained above 90%. PPID audit compliance exceeded 98%. Targeted EHR optimisation combined with experiential, behaviour-focussed training resulted in substantial and sustained reductions in dosing and patient-identification errors in a high-volume ED. MEDSAFE demonstrates that integrating system design enhancements with human-centred training can yield meaningful improvements in medication safety and may be adapted for other acute care settings.