The main aim of public health is to ensure patient safety. It is as a result of this fact that numerous precautions and measures have been put in place to ensure that the overall health of the public is guaranteed. Despite the efforts that have been put in place to ensure that this goal is realized, the society still faces various health challenges. One of the health challenges that contemporary societies are facing come from medication errors. As asserted by Grissinger (2013), medication errors are considered as being one of the most common medical errors in the contemporary world.
In the United States, for instance, approximately 1.5 million people are harmed by this predicament which result in the spending of approximately $3.5 billion directly or indirectly to put the resultant effects under control and a further $77 billion is spend on morbidity and mortality costs (PST, 2015). The Academy of Managed Care Pharmacy (AMCP) recognizes medication errors as a major public health issue and has put a lot of effort in terms of research and funding to reduce its occurrence in the field of medicine. Despite the efforts of the AMCP and other bodies engaged in this campaign, the instances and effects of medication errors are still felt all around the globe. This paper will this expound on this issue by defining medication errors, exploring the factors that lead to their occurrence, critically analyzing the procedures and steps that are followed in an event of a medication error, and the recommendations that can be put in place to control and reduce its occurrence in medical practice.
Medication Errors
PST (2015) defined medication errors as errors that might come about at any stage from the drug prescription process by a clinician to the receipt of medication by a patient. On the other hand, preventable adverse drug events only occur when a patient actually receives and uses a prescription drug resulting harm. It is critical to note that most preventable adverse drug events are preventable if proper measures are put in place. In some instances, a patient might not be harmed by a drug that has been wrongfully administered, either through early interception or by the lack of reaction by their bodies. Such errors are referred to as potential adverse drug events. There are those patients who are harmed after consuming drugs that had been wrongfully administered to them, but this administration could have been mitigated. Such errors are referred to as ameliorable adverse drug events. Finally, there are events whereby a patient is harmed by a drug that was correctly prescribed and administered. Such errors are referred to as unpreventable adverse drug events, more commonly known as side effects.
One of the highest risk medications that is currently used in medicine is anticoagulant heparin. The administration of this drug is considered as being risky due to the fact that it dosage highly relies on the patient’s weight as well as consistent monitoring and testing of their blood clotting ability (PST, 2015). If the administered dose is too high, the patient stands a high chance of bleeding extensively. If the dose is inadequate on the other hand, the patient might experience clotting complications. Therefore, is a clinician prescribes heparin whose dosage is either too high or inadequate, this case will be treated as a medical error. If these errors are detected before the drug is administered to the patient, it will be considered as an ameliorable adverse drug event. However, if the patient fails to suffer from harm whatsoever, this case will be considered as a potential adverse drug effect. At this point, it is critical to note that medical errors can occur in either pharmaceutical setting where drug prescriptions are administered by qualified medical personnel or in ambulatory setting where patients administer drugs by themselves.
Causes of Medical Errors
In practice, the process of prescribing a drug to a patient is generally complex in nature. However, as pointed out earlier in this paper, medication error can occur at any given stage from the time a prescription is given to the point where the patient receives the actual drug. According to AMCP (2010), medication errors can arise as a result of the following factors:
- Incorrect diagnosis.
- Error during prescription.
- Error in the calculation of dosages.
- Poor drug distribution and handling practices.
- Administration of incorrect drugs.
- Poor communication.
- Lack of proper education.
- Drug device related problems.
Of the listed factors above, the most leading cause of medication errors is considered to be errors during prescription of the actual drug. Medication errors as a result of poor drug prescription have caused harm to millions of patients and in some adverse instances, this error has resulted in fatalities. In the USA, for instance, fatalities as a result of poor prescription of drugs were approximated to be around 198,000 (AMCP, 2010). By the year 2000, this figure had increased to 218,000 causing the economy to lose approximately $177 billion annually on mortality related costs (AMCP, 2010).
As put by Peters (2007), preventable medication errors occur due to inappropriate application of the systems that have been put in place to regulate the drug prescription and ordering process. Illegible handwritten prescriptions are one of the leading causes of preventable medical errors. In such an event, it is usually difficult, and at times impossible to determine the legitimacy of a given prescription. Errors may also arise due to the lack of critical information such as co-prescribed medicine, the response of the patient to previous dosages of the same drug, patient’s medical records and the possibility of allergic reactions to specific medication.
Such information is critical, as it will determine whether or not a patient should be administered a specific drug, the dosage to be administered, and the level of monitoring that should be put in place. Such considerations also eliminate the possibility of an incorrect drug or dosage being prescribed. Confusion also arises when drugs with similar names are prescribed orally. This confusion also extends when dispensing drugs that have names that look more or less alike while dealing with handwritten prescriptions. Finally, lack of proper drug documentation and utilization reviews can lead physicians to wrongly prescribe drugs especially during the sampling process.
Dispensing errors are also common causes of medical errors, especially in pharmaceutical settings. These errors arise as a result of omission or commission by medical personnel. Commission errors arise in events where medical personnel prescribe the wrong drug, dosage, or input an incorrect entry in the computer during the process of dispensing drugs. On the other hand, omission errors arise as a result of failure to counsel a patient, to conduct extensive tests and background checks (medical history) and so on. These errors result in the admission of an incorrect dosage (form or strength), an incorrect drug, or failure to determine the interactions and adverse effects that a specific drug might have on a patient.
Errors also do occur as a result of improper drug administration. These errors can arise either from the acts of a healthcare provider or a patient. In most cases, drug administration errors do come about as a result of miscommunication (AMCP, 2010). On one end, it is a common practice for patients not to take into consideration the information that is being conveyed to them while receiving oral or handwritten prescriptions for drugs. This can highly be attributed to the fact that they are unaware of the effects and repercussions that incorrect drug administration might have to them.
In such instances, medication errors do occur due to the miscommunication on the name of the drug, its appearance, the reasons behind the prescription of the drug, the quantity and frequency that the drug is to be consumed, the best time to take the drug, the duration of which the drug is to be taken and the common effects the drug might have on them, especially considering its consumption with food, substances and other drugs. Furthermore, over-the-counter medication also pose a huge threat of medication errors due to the fact that most patients do not take their time to read the information and instructions on these drugs. It is also difficult for healthcare providers to determine whether patients take over-the-counter drugs and if so, it is difficult to identify the ones that have been consumed.
Response to Medication Errors
At this juncture, it is critical to point out that healthcare providers do not deliberately commit medication errors in the course of their practice. These individuals are highly trained and possess the knowledge and skill that is required to ensure professional execution of their roles, especially with regards to drug prescription and administration (AMCP, 2010). It is perhaps as a result of this fact that when medication errors occurs, healthcare providers are usually the ones who get blamed for the incident, despite the fact that they might not in any way have been involved in the commission of the error. Normally, the such professionals tend to receive formal punishment from respective bodies and might include acts like the imposition of fines and suspension or revocation of their practicing licenses. In most cases, the accused professionals tend to lose respect from their fellow practitioners; an act that might have adverse impacts on them as compared to any form of punishment that might be directed towards them.
However, from a critical point of view, punishment might not be the best approach towards minimizing medication errors despite the fact that it is critical in ensuring professional standards and ethics are adhered to. It is much more important to determine system weaknesses that might have resulted in the actual commission of the error (AMCP, 2010). Therefore, a thorough investigation of the drug use and delivery system that is in place is important to identify and rectify system weaknesses as a means of preventing future incidences from occurring. The success of this approach highly relies on the efforts put by healthcare professionals with regards to monitoring, identification, and evaluation of medical errors. At the same time, it is important to ensure that an environment that is not punitive, threatening, and is confidential is present in a medical setting to encourage medical professionals not only to prevent medication errors from occurring but also in reporting these instances to ensure that corrective measures are put in place to prevent such incidences from occurring in future.
The responsibility of reporting medication errors lies on every individuals including healthcare providers as well as patients (AMCP, 2010; PST, 2015). There are specific organizations that these reports should be sent to. In the USA, for instance, the Institute of Safe Medication Practices as well as the Food and Drug Administration are examples of institutions that handle medication error reports. However, it is critical to point out that successful medical error reporting systems should ensure the confidentiality of the information reported and the individual or institution that reported the error. This is due to the negative attitude that healthcare providers and pharmaceutical companies have towards mandatory reporting laws and regulations, especially if the reports are made public (AMCP, 2010). Such systems are considered punitive and tend to result in lawsuits, revocation of licenses, loss of professional respect and trust among medical practitioners, hence not significantly improving the presence of medication errors.
In Abu Dhabi, the Health Authority Abu Dhabi (HAAD) has the mandate to control and investigate medication errors. Through its directives, HAAD has made it mandatory for all health professionals to have the responsibility of detecting, reporting, evaluating, and preventing medication errors in Abu Dhabi (HAAD, 2011). Furthermore, the HAAD has developed specific policies and measures that need to be adopted by all healthcare providers within Abu Dhabi that aim at promoting continuous quality improvement in healthcare service delivery. For instance, the HAAD has developed the medication error severity system that facilitates better management and follow up activities in an event where a medication error is detected.
Consistent with the literature covered earlier, most errors in Abu Dhabi arise in the process writing prescription of specific drugs, administration of drugs by pharmacists, preparation of the dosage of drugs at nursing stations, and administration of the drugs by patients (HAAD, 2011). Therefore, the Medical Error Severity system clearly classifies the types of medication errors, the impacts and urgency of different types of means and the procedures that are to be followed in reporting them. Furthermore, this system also makes it mandatory for every healthcare organization to develop specific medication error policies through their Pharmacy and Therapeutic Committees (PTC). The reports from respective PTCs should then be submitted to the HAAD Pharmacovigilance center for critical analysis to determine the causes of medical errors and appropriate means that can be put in place to prevent such occurrences in future.
Prevention of Medical Errors
Patient education is considered as one of the most effective approaches of preventing medication errors. As asserted by AMCP (2010), most medication error incidences arise from ambulatory cases. Therefore, the provision of patient education empowers them to actively participate in their healthcare management, thus minimizing the risk of medication errors. Education in this regard should mainly focus on understanding of medication nomenclature, importance of reading and understanding a medication prescription sheet, proper use of drugs and discourage medication sharing, the importance of reading and understanding medication instruction, taking into consideration their expiry date, proper means of storing and disposing medication, and most importantly ensuring that medication is kept out of reach of children. The importance of patient education came as a realization of the important role that they play in the medication error prevention systems by ensuring they are informed about the names of different medications, their proper administration in accordance to the dosage provided and other safety measures. Patients act as the final check in this system, hence their empowerment is key in reducing the occurrence of medication errors.
Prior authorization programs are also influential in the provision of high quality and cost effective drug prescription benefits. Prior authorization programs aim at ensuring patient safety is realized through the appropriate use of medication. Using medical evidence, this program can control the approved and unapproved of specific drugs in accordance to a specific health plan preventing adverse outcomes in highly contraindicated patient populations (AMCP, 2010). For instance, there are medications whose use are disapproved for pregnant patients as a means of preventing children born with birth defects. On a separate incident, this program can be used to prevent the administration of specific types of drugs such as antibiotics for a prolonged period of time to certain types of patients in a bid to avoid the occurrence of adverse outcomes.
Given the fact that we are living in an era of high technological advancement, electronic technology also plays a significant role in the reduction of medication errors. For instance, bar coding can be used to ensure that the right medication is prescribed and administered to the right patient in the right dosage given the intended usage. Electronic Prescription Record (EPR) is a tool that is used to ensure that contains data that is required to fill, dispense, and submit payment for prescriptions. This tool is important has it enabled healthcare providers, pharmacists in particular to ensure that the correct drug is prescribed with regards to the intended use of patients, their medical history, the current and past drugs they have been administered. This tool is further used to avoid negative drug interaction and duplication. This tool is also effective in minimizing errors that arise as a result of miscommunication.
Internal quality control processes are also important in reducing the occurrence of medication errors by controlling and regulating drug dispensing practices. The changes that are brought about by these new processes provide effective and efficient workflow evaluation analyses and enhance the overall process of detecting, reporting, evaluating and prevention of medication errors. To realize the set goals, these processes provide additional safety checks, additional instructions on prescription texts, and a messaging portal during the drug dispensing process, drug utilization reviews, and quality evaluation procedures. These checks not only control and regulate the drug dispensing process, but also ensure that standard practices are met, hence preventing medication errors.
Conclusion
Medication errors are common in the healthcare service delivery system and have adverse effects on the health of patients. These errors arise as a result of errors of omission or commission by healthcare providers and the patients themselves. Additionally, these errors can also arise as a result of drug dispensing system failures. It is as a result of this fact that effective and efficient systems need to be put in place to ensure that medication errors are detected, reported, evaluated and prevented early enough. At the same time, patient education is a critical empowerment approach of minimizing the risks associated with medication errors especially with regards to ambulatory cases. These considerations will not only enhance the overall quality of healthcare service provision, but will also reduce the occurrence of medication errors.
References
AMCP (2010). Medication errors. Web.
Grissinger, M. (2013). The role of managed care pharmacy in reducing medication errors. Journal of Managed Care Pharmacy 9(1), 62-65.
HAAD (2011). Reporting medication errors. Web.
Peters, M. (2007). Identifying and preventing medication errors. New York City: National Academies Press.
PST (2015). Medication errors. Web.