Medication Errors

Medication Errors in US Hospitals

These results relied on data voluntary provided to American Hospital Association. It is likely that substantial number of medication errors go undetected or unreported to the hospital medication error reporting system. So, it seems more likely that substantially more patients are harmed each year by medication errors than these figures suggest. As the total medication errors and medication errors that adversely affect patient care outcomes increase, hospital mortality rate, drug cost/occupied bed, length of stay and total cost/occupied bed increase [1].

Medication Error Reporting System

Is ongoing, systematic program for reporting, monitoring and reviewing medication errors in hospitals. Cost associated with a single medication error has been reported to range between $2162 and $2595. In 1999 report, drugs most frequently associated with medication errors were warfarin, insulin, heparin, cefazolin, vancomycin, lorazepam, kcl, meperidine, furosemide, digoxin, famotidine, morphine and theophylline [2].

Identification of Medication Prescribing Errors

All medication orders are reviewed by staff pharmacists and entered into pharmacy computer. Patient-specific information (age, attending service, admitting diagnosis, allergies to medications, medication profile for the present hospitalization...etc) should be routinely available to reviewing pharmacist. A computerized reporting system enables pharmacists to access patient laboratory results. Pharmacy computer system has standard automatic dose range checking, allergy checking, drug interaction checking [3].

Potential Prescribing Problems

• Wrong patient.
• Wrong drug.
• Wrong dose.
• Wrong dosing frequency.
• Drugs were not given.
• Wrong route.
• Wrong dosage form.
• Calculations, decimal points, unit of measure, dose rate expression.
• Inappropriate indication for use.
• Inappropriate combination of drugs.
• Failure to account for patient characteristics in making drug therapy decision.
• Documented allergies to ordered medications [4].

Other Potential Medical Problems

• Designed menus that contain food that is prohibited for patient's condition.
• Unresponsive staff to change I.V. bags before they are empty.
• The risk of having wrong surgery.

What Happens Next

• The medication order (s) in question is either:
• Confirmed as written.
• Clarified.
• Changed.
• Discontinued following the discussion between the pharmacist and the physician.

Confirmed Prescribing Error

• For each confirmed prescribing error, the following data are collected:
• Patient medical record number
• Date
• Time of day order is written
• Prescribing physician
• Attending service
• Medication involved
• Error description
• Pertinent patient-specific characteristics or other factors related to the error [5].

Factors Associated with Increase Medication Errors

• Lack of pharmacy teaching staff.
• Centralized pharmacists.
• Increased number of registered pharmacists / occupied bed.
• Increased number of registered nurses / occupied bed.
• Increased pharmacy administrator staffing / occupied bed.
• Size of hospital (more errors in smaller hospitals).
• Work load (20-25 prescription order / h).
• Insufficient knowledge of patient therapy.
• Lack of awareness of patient conditions.
• Inaccurate calculations and unit or rate expression factors.
• Presence of a drug information service (18%).
• Decentralized pharmacists to patient care areas (45%).
• Pharmacist - provided adverse drug reaction management (13%).
• Pharmacist - provided drug protocol management (38%).

Recommendations for Reducing Pharmacists Errors

• Increasing number of pharmacists by improving education opportunities and produce more graduates.
• Use adequate trained technicians.
• Use robo-druggist (robotics).

• Encourage women pharmacists to come back to work after marriage.
• Shift of 5-year bachelor degree of pharmacy to 6-year doctor of pharmacy degree.
• Pharmacists fill no more than 15 prescriptions / hour.
• Encourage patients to have and use smart card.
• Doctors should type prescriptions directly into pharmacy linked computer (computerized physician order entry).
• Doctors and pharmacists can use a database which can be downloaded from the internet to a hand-held computer that could be carried in rounds.
• Develop preprinted order forms that improve standardization and give guidance for calculating doses.
• Use of bar coding for medications, blood products, devices and patients.
• Use of medication-dispensing machines.
• Use of reliable method to verify patient identity.
• Use of metric system.
• Elimination of abbreviations and acronyms.
• Minimize and eliminating verbal drug orders.
• Provision of up-to-date information at point of care.
• Partnering with patients for safety.
• Work place illumination and organization [7].

What Patient Can Do

• Ask question about his care.
• If he thinks there may be a problem, ask before it is a problem.
• Have his complete medical history in hand.
• Have a paper to record questions about his care and discuss with his doctor.
• Make alliance with his nurse.
• Identify the point provider (primary attending physician).
• Notify staff before he needs them.
• Make sure he is identified.
• Bring along a family member or close friend.
• Know his options.

Conclusions

1. Total elimination of medical errors is probably unrealistic (people care for patients and people make mistakes).
2. Comprehensive error programs are critical steps in the implementation of effective error prevention processes.
3. Improve hospital pharmacy staffing procedures for recruiting and training, decentralize pharmacists and implement clinical pharmacy services can reduce medication errors and improve safety and care of patients.
4. The best organizations have high number of errors detected and documented because that is what they learn from.