Medication Errors in Hospitals

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					Medication Errors
Drug misadventuring includes:
A. medication errors.
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 ,
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
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,
B- Evaluate total patient status, history
Drug history, Medical history
Patient social history
Smoking, alcohol drinking
C- Complete drug order.
Patient name
Generic name
Trade name
Dosage form
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
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
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
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
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
- Level 6: Error occurred → patient death.

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