Medication Errors Drug misadventuring includes: A. medication errors. B. ADRS Definition of medication errors They are preventable events that may lead to inappropriate medication use or patient harm Consequences of medication errors 1. They compromise patient confidence in health care system, - 2. increase health care costs and may result in serious mortality. - Types of medication errors 1. Prescribing error It is an error of physicians It results from a. incorrect diagnosis b. Improper drug selection (indication, contraindication, allergy) 2. Dispensing error It is a pharmacist or nursing staff errors a. Wrong dosage form error Dispensing oral dosage form for patients having dysphagia b. Wrong drug preparation errors c. Wrong administration technique errors d. Deterioration errors (expiry date errors) e. Monitoring errors prior to dispensing the prescription to investigate DI , CI 3. Omission error (compliance) It is due to patient errors such as It may be intentional or non intentiaonal compliance errors Such errors may be due to : a. Wrong time error Administration of drug at time outside the predefined by the physcian b. Improper dose error Administration of the drug at dose more or less than that prescribed Recommendation for preventing medication errors 1. Organization &department recomendation A. Policies that ensure adequate personnel selection who involved in medication ordering, dispensing, preparation B. Sufficient personnel. C. Suitable work environment. D. Lines of authority & areas of responsibility. -The pharmacy director must ensure that all drugs used are of high quality & integrity. E- The use of patient's home medication should be avoided, F- All discontinued drugs should be returned to the pharmacy immediately. G- Computerized pharmacy system. H- Standard drug administration times, drug conc → to minimize the dosage calculations by The staff. I- Standard abbreviations. J- Educational programs to discuss medication errors. 2. Recommendations for prescribers or physicians A- Continued education through literature review and consultation with other pharmacists, physicians…. B- Evaluate total patient status, history Drug history, Medical history Patient social history Allergies Smoking, alcohol drinking C- Complete drug order. Patient name Generic name Trade name Dosage form Dose Frequency of administration Prescriber name d. Use clear instructions - Not use: taken as directed - Use: "daily" instead of "q.d" - Exact dose strength (500 mg instead of 1 tab) - Standard generic name (hydrochlorothiazide not HCTZ) - Spell out the words ("units"instead of "u") - Avoid use decimals, use leading zero before a decimal (0.5 mL), while terminal zero should never be used (5.0 mL) - Verbal orders used in narrow situations. - Print or type medication orders (to avoid poor handwriting) 3. Recommendations for pharmacists A- Continuing education through literatures, seminars, clinical skills events, consultations with other Health Care Team …... B- Be available as a source of drug information for patients, physicians, nurses, all members of Health Care Team ... C- Be familiar with medication ordering system , inventory control, distribution of drugs. D- Never assume or guess the confusing medication orders. Contacting prescriber prior to despensing such confusing orders E. When preparing drugs Pharmacist should maintain orderliness in the work area, performs one procedure at time with few interruptions. F- Before dispensing medication make sure of use the original copy. G- Use auxiliary labels (shake well, ext. use... H- Ensure that medications are delivered in time & storage procedures are followed 4. Recommendations to nurses A- Review patient medication orders before administration the 1st dose. B - All doses administered at scheduled times. C- If no standard drug conc. → calculation checked with 2nd individual. D- No borrowing medication from one patient to another one. E- In case of large № of dosage units or volume to a single patient→ verify the medication order. F- Talk with patient or caregivers to ascertain that they understand the use of the medications and the precautions 5. Recommendations for patients & caregivers: A- Inform the health care providers about all symptoms, allergies, and current medication use. B- Take the medication as directed (compliance). C- Feel free to ask questions about any drug or procedures. D- Learn the name of drugs, dosage strengths and schedules. 6. Recommendations for pharmaceutical manufacturers: A- Avoid look-alike or sound-alike trademarked names. B- Avoid similar packaging and labeling. C - Avoid lettered or numbered prefixes or suffixes in trademarked names. D- Use highlighted instructions on labels E -Any changes in the product formulation or dosage form→ communicate with health care providers. F-The prominent items on the label should be information concerned safety of the drug (name, strength) Monitoring medication errors A- Quality improvement programs. B- Identification of medication errors, I. documentation and studying their causes II. develop system that minimize their recurrence. III. Identification of medication errors risk factors These risk factors include - Work shift. - Inexperienced, inadequate trained stuff. - ↑ № of medication per patient. - Staff work load. - Improper drug storage. - Verbal orders. - Poor handwriting. - Confusing drug nomenclature, packaging or labeling. - Lack of effective policies & procedures. Managing medication errors: - Corrective and supportive therapy. - For clinically significant errors → fact gathering. - Reports of clinical significant error, reviewed by the supervisor and department head of the area. - Periodical review of errors reports to determine causes and develop actions to prevent recurrence. Classification of medication errors: I* Simple classification: - Clinically significant. (potential error) - Minor. II* Hartwing, Denger & Schneider classification - Level 0: Non-medication error (potential error). Error is detected and corrected before drug administration - Level 1: Error occurred, didn't result in patient harm. - Level 2: Error occurred → ↑ patient monitoring (no change in VS, no patient harm). - Level 3: Error occurred → ↑ ↑ patient monitoring with change in VS, but no patient harm. - Level 4: Error occurred → treatment with other drug and ↑ length of stay under observation. - Level 5: Error occurred → permanent patient harm as loss of vision - Level 6: Error occurred → patient death.