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Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration



To assess and evaluate patient safety incidents and in particular, medication errors, during a large multi-center pre-hospital trial of emergency therapy (PARAMEDIC2), in order to inform and improve future pre-hospital medicines trials.


The PARAMEDIC2 trial was undertaken across five NHS Ambulance Services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out -of-hospital cardiac arrest unresponsive to initial resuscitation were randomly assigned to 1 mg intravenous adrenaline or matching placebo. Records were reviewed to identify trial medication errors involving documentation and/or clinical protocol errors occurring in trial participants. Causes of medication errors, including root cause analysis where available, were reviewed to identify patterns and themes contributing to these errors.


Eight thousand sixteen patients were enrolled, of whom 4902 received trial medication. A total of 331 patient safety incidents was reported, involving 295 patients, representing an overall rate of 3.6% of these, 166 (50.2%) were documentation errors while 165 (49.8%) were clinical protocol/medication errors. An overall rate of 0–4.5% was reported across all five ambulance services, with a mean of 2.0%. These errors had no impact on patient care or the trial and were all resolved


The overall medication error rate of 1.8% primarily consisted of administration of open-label adrenaline and confusion with trial medication packs. A similar number of patients had documentation errors. This study is the first to provide data on patient safety incidents relating to medication errors encountered during a pre-hospital trial of emergency medication administration and will provide supporting data for planning future trials in this area.

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We thank all those involved in the original PARAMEDIC2 trial from which this data was extracted. In particular, we thank London Ambulance Service NHS Trust, North East Ambulance Service NHS Trust, South Central Ambulance Service NHS Trust, Welsh Ambulance Service NHS Trust, West Midlands Ambulance Service NHS Trust, members of the Trial Steering Committee and Data Monitoring Committee and the University of Warwick Clinical Trials Unit.


The original PARAMEDIC2 trial from which this data is extracted was funded the National Institute for Health Research Health Technology Assessment Programme (12/127/126).

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All authors contributed to the design and implementation of the research, and to the analysis and interpretation of the results. EE and CD led the writing of the manuscript with input from all authors. The trial statisticians (RL, SG) collated and analysed the trial data.

Corresponding author

Correspondence to Gavin D. Perkins.

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All authors report the grant from National Institute for Health Research related to the PARAMEDIC2 study. All authors declare no other COI.

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England, E., Deakin, C.D., Nolan, J.P. et al. Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration. Eur J Clin Pharmacol 76, 1355–1362 (2020).

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  • Drug errors
  • Medication errors
  • Clinical trial
  • Drug administration