To err is human. However, when it comes to medications, errors in prescribing, transcription and administration can prove very costly by compromising patient safety and increasing healthcare expenditure. Outsourcing medical transcription to an expert can ensure accurate entry of orders into the EHR. But medication errors can occur in various other areas of the medication-use system, such as when prescribing drugs, when preparing or dispensing drugs, or when the drug is administered or taken by a patient.
The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.”
According to an article published on www.mdlinx.com in February, 2020, the risks of adverse drug events are high in the U.S. as there are more than 10,000 prescription drugs on the market and about one-third of all American adults take five or more medications daily. What’s worrying is that most prescription errors are preventable.
Types of Medication Errors
Common prescribing errors, medicines and situations that can cause severe harm to patients and even death and include:
- Use of the wrong medication, strength or dose – Incorrect medication, dosage strength or dosage form may be given to the patient. Wrong strength or dose can occur due to incorrect use of decimals while writing the dose of a drug. For e.g., confusion can occur and lead to incorrect medication administration in the following case: the medication order reads Administer M Sulphate 2g IV now and every 6 hours. Confusion can arise as to whether M Sulphate refers to magnesium sulfate (MgSO4) or Morhine sulfate (MSO4).
- Mistakes due to same-sounding or look-alike drugs – Misreading medication names that look similar or sound similar is a common error. Unintended interchange of drugs can occur when medicines are prescribed verbally. For example, the FDA reported several instances of confusion between two drugs with similarity in names: Farxiga (dapagliflozin), a drug that lowers blood glucose levels in type 2 diabetes, and Fetzima (levomilnacipran), an antidepressant (www.mdlinx.com).
- Administration of medications by the wrong route – Such errors include intravenous administration of enteral formulas, giving oral medications intravenously, mix-up of epidural and intravenous lines, and using intravenous medications orally.
- Miscalculations when administering drugs intravenously – Intravenous medications are especially risky due to their greater complexity. Studies have shown that intravenous medication errors in the U.S. have a significantly higher rate of associated deaths than other medication errors. A 2015 study published in the British Medical Journal (BMJ) found that a large proportion of IV administration errors occur because of knowledge and/or skill deficiencies, and that these errors reduce in the first few years of clinical experience.
- Errors in ordering and transcription – Common ordering errors include omission, orders that are incomplete and lack clarity, wrong drug, wrong time, wrong dose, wrong dosage form, patient allergy errors, and wrong patient. Transcribing errors occur when mistakes are made while manually transcribing orders into written records and those that are electronically transcribed into the EHR. Causes of transcription errors include incomplete or illegible prescriber orders, incomplete or illegible nurse handwriting, use of error-prone abbreviations, improper defaults in the EHR, and lack of familiarity with drug names, doses, or frequencies (www.ashp.org).
- Omitted or delayed prescriptions for medicines – Delays and omissions in medication administration have been identified as being a major patient safety issue. Delayed medication refers to medication prescription or administration more than two hours after the time the dose is due. This can vary based on the condition being treated. An omitted dose can refer to failure to prescribe a drug in a timely manner or not administering a dose before the next dose is due. For once only doses, omitted dose refers to failure to administer dose within 2 hours of the time it is due. Omitted or delayed prescriptions can prolong patient recovery times and lengthen admission.
Best Practices to Avoid Medication Errors
The U.S. Food and Drug Administration (FDA) receives more than 100,000 U.S. reports each year associated with a suspected medication error. Following certain good practices can help minimize the risk of avoidable medication errors.
- Clarity in dose instructions – To prevent confusion, doses should explicitly and routinely be prescribed.
- Review medicine procedures – This can help identify critical medicines where timeliness and continuity of administration is important. Electronic prescribing and dispensing systems should be configured to support identification of critical medications.
- Proper communication – Prescribers should communicate to other healthcare professionals, the patient and caregivers about an urgent prescription that requires dispensing and administration.
- Understand drug interactions – Pharmacists and healthcare professionals need to recognize and be aware about the drug interactions can cause significant patient harm
- Explaining potential interactions to patients – Adverse interactions can also arise due to patient error. Patient should be educated about therapeutic requirements, which can help prevent injury or poor outcomes.
- Ensure medicines reconciliation – Effective medicines reconciliation is crucial when patients are admitted and discharged from hospital
Organizations should develop and implement specific strategies to address medication errors and prevent patient harm. Areas to focus include high-risk populations, high-risk processes, high-alert medications, and easily confused drug names medication (www.ashp.org). Transcription errors can be prevented by outsourcing EHR-related documentation task to a reliable medical transcription company. Established service providers have trained and experienced medical transcriptionists who can maximize the use of computerized prescriber order entry and ensure medication safety.