Medication Errors and Drug-Related Problems

Medication Error

• Medication errors are errors or mistakes in the medication use process (prescribing, dispensing, administering of drugs) that may result in negative outcomes.
• Difference between drug-related problems and medication errors:
  • Drug-related problems (DRPs) are problems in medication use that can occur even when best medication practices are applied.
  • Examples of DRPs: side effects, potential upset stomach associated with non-steroidal anti-inflammatory drugs.

Classification of Medication Errors

• Prescribing errors:
  • Occur when prescriptions have an incorrect drug selection, dose, dosage form, quantity, route, concentration, rate of administration, or instructions for use of a drug product.
  • Include illegible prescriptions or medication orders that lead to errors that reach the patient.
• Dispensing errors:
  • Mistakes made during the dispensing process where a patient receives the wrong drug, the correct drug for the wrong patient, or wrong dose.
• Administration errors:
  • Occur when patients are administered something other than that prescribed for the patient – the wrong dose, omitted dose, additional dose, wrong administration time, incorrect handling of drugs during administration, or wrong infusion rate.
• Drug Preparation Error:
  • Drug product incorrectly formulated or manipulated before dispensing or administration.
• Route of Administration Error:
  • Wrong route of administration of the correct drug.
• Administration Technique Error:
  • Inappropriate procedure or improper technique in the administration of a drug other than wrong route.
• Deteriorated Drug Error:
  • Dispensing or administration of a drug that has expired or for which the physical or chemical dosage-form integrity has been compromised.
• Monitoring Error:
  • Failure to review a prescribed regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.

Factors Contributing to Medication Errors

• Hospital Administration Related Factors:
  • Inadequate policies regarding safe use of medication.
  • Inadequate policies governing reporting of incidents in the institution.
  • Inadequate policies concerning performance of tasks for supportive personnel.
• Personnel Related Factors:
  • Lack of hospital pharmacist.
  • Lack of administration nurse.
  • Overburdened personnel.
• Technique Related Factors:
  • Use of non-professional personnel in areas requiring professional judgment.
  • Inadequate labeling of drugs and allied items for nursing station.
• Facility Related Factors:
  • Inadequate storage and equipment facilities.
  • Inadequate drug station on patient care areas.

Preventing Medication Errors

• Institute of Medicine recommendations:
  • Involve patients in the medication use process.
  • Provide consumer-oriented medication resources to support patient self-management.
  • Ensure healthcare providers have access to patient information and decision-support tools.
  • Improve medication labeling and communication methods.
  • Encourage healthcare payers and oversight organizations to promote good medication use practices.

Corrective Measures

• Administration-Related Measures:
  • Formulate policies regarding safe use of medication.
  • Implement a comprehensive policy on incident detection and reporting system for each drug accident in the hospital.
• Lack of Personnel:
  • Hire a pharmacist to oversee pharmaceutical services.
  • Share pharmacists between two or more small hospitals.
  • Combine responsibilities such as procurement and administration.
  • Purchase pharmaceutical services from community pharmacies.
  • Use consultant pharmacists.
  • Use supportive personnel for tasks such as taking telephone orders, weighing or measuring ingredients, and affixing labels.
• Inadequate Labeling of Drugs:
  • Affix labels with necessary information (strength, identification, route of administration, warnings, and cautions).
  • Use color coding, label position indicators, and auxiliary labels.
• Inadequate Drug Stations on Patient Care Areas:
  • Provide medication cabinets or rooms for preparation and storage of medications.
  • Ensure medication rooms are designed for observation, quiet, and security, with features such as divided shelves, safe storage, and secure narcotics storage.

Learn about the differences between medication errors and drug-related problems, and how they can impact patient outcomes. Understand the medication use process and how to prevent errors.