medication errors

Etiology

• medication delivery device
• misspellings
• clerical errors
• unintentional discontinuation of medications
• clinician fatigue, overcrowding, staff shortages, improper training, & incorrect information cited as risk factors for medication errors
• stages of medication errors
  • prescribing, transcribing, dispensing, administration, taking, or monitoring
• perpetrators of medication errors
  • clinician, pharmacist, nurse, or patient

Epidemiology

• medication errors can occur at any stage (prescribing, transcribing, dispensing, administering, taking, or monitoring & by any person clinician, pharmacist, nurse, or patient
• 25% of insulin errors lead to patient harm
• insulin is involved in ~ 1/3 of fatal medication errors

Management

• measure & record weight in kilograms only
• standardized delivery devices should be dispensed for home use of liquid medications
• dosing for liquids should always be in milliliters.
• dosing instructions for home use of medications should be based on pictograms
• concentrations of high-risk medications, including drugs used for resuscitation, vasoactive agents, narcotics, & antibiotics should be standardized
• pharmacists should be incorporated as part of the emergency department care team
• prevention strategies include
  • adherence to the 5 rights of safe medication administration
    • administer the right medication, in the right dose, at the right time, by the right route, to the right patient
  • use of barcodes to ensure medications are given to the correct patient
  • minimization of interruptions to allow nurses to administer medications safely
  • use of smart infusion pumps for intravenous treatment
  • use of patient education & revised medication labels to improve patient comprehension of administration instructions
  • preventing medication errors at the dispensing stage
    • capitalizing dissimilar letters (DOPamine & DOBUTamine)
  • preventing medication errors at the prescribing stage
    • adhere to conservative prescribing principles
      • consider alternatives to medication
      • review evidence or guidelines supporting medication use
    • use computerized physician order entry
    • perform medication reconciliation during transitions in care
  • preventing medication errors at the transcribing stag
    • use of computerized order entry helps prevent medication errors due to illegible handwriting

Notes

• medication errors will be reduced by electronic prescribing, but will present new challenges
• pharmacy led intervention can reduce medication errors in primary care
• medications errors common after hospital discharge
  • 50% discordance between hospital discharge medication lists & patients' self-reported medications
• World Health Organization (WHO) has launched campaign to reduce medication errors by 1/2 within the next 5 years
• estimated global cost = $42 billion annually

More general terms

• pharmacology

Additional terms

• medication reconciliation