Pharmaceutical Review (Scientific Reporter). There are million of medication error happened around the world every year. Many of these mistakes are potentially avoidable. Our scientific research reported provided us a review report as under,
Key Terms Omission error Root Cause Analysis (RCA) are Unauthorized drug error, Wrong administration technique error, Wrong dosage form error and Wrong time error. However the major Types of Medication Errors are as under,
Prescribing Errors; Omission Errors; Wrong Time Errors; Unauthorized Drug Errors; Improper Dose Errors; Wrong Dosage Form Errors; Wrong Drug Preparation Errors; Wrong Administration Technique Errors; Deteriorated Drug Errors; Monitoring Errors; Compliance Errors.
Prescribing Errors; Prescription error occurred/ happened in specific patient’s:
Drug; dose; dosage form; route of administration; length of therapy; number of doses; administration; drug concentration; inadequate or incorrect instructions for use; illegible handwriting;
Wrong Time Errors Standardized administration times: Acceptable interval surrounding scheduled time; Medications administered outside this window; considered wrong time errors; Occasionally unavoidable; patient is away care area for test; medication is not available at time it is due.
Unauthorized Drug Errors: Administration of medication to patient without proper authorization by prescriber; Administration of medication outside established guidelines; Medication for patient given to another patient; Nurse gives medication without prescriber order; Patients “share” prescriptions; Refilling prescription that has no refills remaining; Protocols may allow flexibility-not unauthorized;
Improper Dose Errors Dose that is greater or less than prescribed dose: Can occur when additional dose is administered; delay in documenting dose; absence of documentation; Inaccurate measurement of oral liquid; Exclusions from this error type; topical applications; variances that occur from apothecary to metric conversions.
Wrong Dosage Form Errors: Doses administered as different form than ordered; Depends on state laws & facility guidelines; Dosage form changes may be acceptable; Accommodate particular patient needs; Often acceptable.
Wrong Drug Preparation Errors: Reconstituting oral suspension with incorrect volume; Using bacteriostatic saline instead of sterile water to reconstitute lyophilized powder for injection; Not activating an ADD-Vantage® IV admixture bag.
Wrong Admin Technique Errors: Examples:
- Subcutaneous injection that is given too deep
- Intravenous (iv) drug is allowed to infuse via gravity instead of using an iv pump
- Instilling eye drops in wrong eye
Deteriorated Drug Errors: Monitoring expiration dates is very important; Drugs used past their expiration date; may have lost potency; may be less effective or ineffective; Refrigerated drugs stored at room temperature may decompose & lose efficacy; Monitoring Errors Inadequate drug therapy review Examples:
- Ordering serum drug levels but not reviewing them
- Not responding to level outside of therapeutic range
- Not ordering drug levels when required
- Prescribing antihypertensive agent & then failing to check blood pressure
- Errors that cannot be placed into category examples:
- Medication dispensed without adequate patient education
Determination of the incidence: Few studies provide complete evaluation of errors; Different methods used to detect errors; Various definitions of errors; Large volumes of medications dispensed;
Small percentage of errors can result in large number of medication errors: Annual # of prescriptions ~ 3.54 billion; Small % of 3.54 billion is still large number; Medication Errors are as under,
- Errors occurring earlier in medication use process more likely to be detected & corrected than those occurring later in process
- Many studies varying results:
- error rates outpatient pharmacies reported ~12%
- in hospitals ~1 error per patient per day
- hospitals & skilled nursing facilities:
- 19% of all doses were not administered correctly
- 43% of errors were due to wrong time of administration
Review of Institute of Medicine: ~ 1.5 million people are harmed by medications each year; Up to 400,000 of adverse events considered preventable; Medication error studies report different error rates; How studies were performed; various techniques & definitions used; scope of study; Errors which are corrected before medications reach patient might not be accounted for necessary action.
Review of Medication Error Reporting: Medication error rates based on incident reports; Errors not always reported: Lack of knowledge to identify errors; Lack of time to document errors; Afraid of negative consequences.
Impact of Medication Errors: Outcomes; Range from no effect to long-term disability or death; Significance; Type of medication error; Health status of patient; Pharmacologic classification of drug involved; Route of drug administration, Timing of drug administration; Cost to health care system; Damage to patient’s trust in care providers; Impact on Patient: Personal and Financial Implications; Health status of patients; Magnitude of overdose; Damage as result of omission; Financial implications; Prolong hospital stays & increase health care expenses; Estimated to cost billions of dollars annually; Additional medical management; Legal fees & out-of-court settlements; Never Events-not reimbursed by Medicaid.
Loss of Trust Loss of faith in medical community: From either experience or knowledge of event; May choose to; Switch pharmacies or physicians; Hesitate to seek medical help; Seek nonconventional treatments from outside medical community.
Causes of Medication Errors: Calculation errors; Improper use of zeros & decimal points; Inappropriate use of abbreviations; Careless prescribing; Illegible handwriting; Missing information; Drug product characteristics; Compounding /drug preparation errors; Prescription labeling; Work environment & personnel issues; Deficiencies in medication use systems. Errors Committed by and population at risk: Prescribers; Pharmacists; Technicians; Nurses; Pediatric population at risk; Adult formulations be diluted/manipulated for peds; Personnel with multiple years of experience are just as likely to make mathematical errors as inexperienced.