Telangana Journal of Psychiatry

EDITORIAL
Year
: 2021  |  Volume : 7  |  Issue : 2  |  Page : 77--78

Prescription errors: How to overcome?


Sai Krishna Puli 
 Editor, TJP, Professor of Psychiatry, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India

Correspondence Address:
Dr. Sai Krishna Puli
Editor, TJP, Professor of Psychiatry, Prathima Institute of Medical Sciences, Karimnagar - 505 001, Telangana
India




How to cite this article:
Puli SK. Prescription errors: How to overcome?.Telangana J Psychiatry 2021;7:77-78


How to cite this URL:
Puli SK. Prescription errors: How to overcome?. Telangana J Psychiatry [serial online] 2021 [cited 2022 Jun 30 ];7:77-78
Available from: https://tjpipstsb.org/text.asp?2021/7/2/77/335645


Full Text



Prescription errors are fairly common in day-to-day practice, especially in mental health establishments. Majority of these errors may result in serious outcome. The incidence and cause of medication error have been studied extensively in in-patient wards. A recent review concluded that it harmed 1%–2% of admitted patients and that prescribing error is the most common type of medication error in this settings.[1]

In a study done by Baker et al. in 1999–2004, there were upto 100,000 preventable deaths in USA.[1] In Canada, 70,000 preventable adverse events occur annually in hospitalized patients. The preventable mortality range was between 9000 and 24,000. Nearly 10% of all patients entering hospitals suffer an adverse event, and a significant number of them die.[2]

A United Kingdom study found that 12% of all primary care patients were affected by prescribing or monitoring error over the course of a year, increasing to 38% in those 75 years and older, and 30% in patients receiving five or more drugs in 12 months period.[3]

A study from Saudi Arabia reported that just under one-fifth of primary care prescriptions contained errors, but only a small minority were serious.[4]

It has been estimated that, in some countries, approximately 6%–7% of hospital admissions appear to be medication-related, with over two-thirds of these considered avoidable and thus, potentially due to errors.[5],[6] Risk of error increases in the elderly due to multiple risk factors and polypharmacy.

The studies report few errors that result in actual serious harm to the patient. Adverse events involving psychotropic a are common. Among these, some may be due to polypharmacy and some may be due to errors in clinical decision making. These are potentially preventable.

Hence, it becomes imperative for the psychiatrist to mitigate the harm.

Such kind of data from middle- and low-income countries is relatively scarce.

 Definition of Medical Error



United States National Coordinating Council for Medication error reporting and prevention defines it as “any predictable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health-care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including prescribing, order communication, product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use.”[7]

Based on the sequence in medication usage, errors can happen during prescribing, transcribing, dispensing, administration, and monitoring.

Considering the type of errors, prescription errors can be due towrong medication, dose, frequency, administration route, and patient.

 Causes of Medication Errors



Health-care professionals-factors associated are lack of therapeutic training, inadequate drug knowledge, and experience, inadequate knowledge of the patient, inadequate perception of risk, overworked or fatigued health-care professionals, physical and emotional health issues, and poor communication between the health-care professional and the patientPatients – Patient characteristics like personality, literacy, and language barriers. The complexity of clinical cases includes multiple health conditions, polypharmacy, and high-risk medicationsWork environment factors are workload, time pressures, distractions and interruptions, lack of standardized protocols and procedures, insufficient resources, and issues with the physical work environment such as lighting, temperature, and ventilationMedicines factors such as the naming of medicines, improper labeling, and packagingTasks – it can be due to repetitive systems for ordering, processing, and authorization, issues in patient monitoring (dependent on practice, patient, other health care settings, and prescriber)Computerized information systems – difficult processes for generating first prescriptions (eg., drug pick list, default dose regimens, and missed alerts). Difficult processes for generating correct repeat prescriptions, lack of accuracy of patient records, and inadequacy design that allows for human error.Primary-secondary care interface – the limited quality of communication with secondary care, little justification of secondary care recommendations.

 Potential Solutions to Reduce Prescription Errors



Flow charts/treatment modules to be made available to all trainees and doctors available in the hospital or instituteSystems approachStrategies involve including clinical pharmacists, computer technology, and educational programs with multifaceted interventionsMultidisciplinary case conferences, education, and clinical decision support systemsMedication review is a process of patient medicines evaluation in order to improve the health outcomes and mitigate the drug-related problemsImproved identification and resolution of medication-related problems; Medication reconciliation is the formal process of establishing and documenting a consistent, definitive list of medicines across transitions of care, and then rectifying any discrepancies.Educating patients self-administration of medication had a positive impact on health outcomesStrengthening the use of electronic tools and computerized provider order entry with decision support. Designed to reduce the alert burden by focusing on clinically relevant warningsInvolve patient and family membersStrengthen workforce capacity and capability to improve safetyFocusing on those who are at higher risk of safety incidents.

References

1Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. CMAJ 2004;170:1678-86.
2Croskerry P. To err is human – And let's not forget it. CMAJ 2010;182:524.
3Avery A, Barber N, Ghaled M, Franklin BD, Armstrong S, Crowe S, et al. Investigating the Prevalence and Causes of Prescribing Errors in General Practice: The PRACtICe Study. London: General Medical Council; 2012.
4Khoja T, Neyaz Y, Qureshi NA, Magzoub MA, Haycox A, Walley T. Medication errors in primary care in Riyadh City, Saudi Arabia. East Mediterr Health J 2011;17:156-9.
5Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ. Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: A prospective study. BMC Clin Pharmacol 2007;7:8.
6Pirmohammed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: Prospective analysis of 18820 patients. BMJ 2004;329:15-9.
7National Cordinating Council for Medication Error Reporting and Prevention. What is a Medication Error? New York, NY: National Coordinating Council for Medication Error Reporting and Prevention; 2015. Available from: http://www.nccmerp.org/about-medication-errors.