David W. Bates|Sarah P Slight
Medication Errors: What Is Their Impact?
Harvard University|Brigham and Women's Hospital|Durham University|Brigham and Women's Hospital
loss loved one devastating knowledge death could prevented makes harder still medication errors result severe patient injury death preventable although errors minor huge spectrumand fatal january 4 2001 englishman wayne jowett injected dose cytotoxic drug vincristine intrathecally rather intravenously mistake never occur1dyer c government introduce safer administration cancer drugs fatal errorbmj 2001 322 1013crossref pubmed google scholar experienced leg paralysis respiratory failure transferred intensive care unit failed recover mechanical ventilator switched month later inquest 18yearolds death coroner told 14 patients died left paralyzed result mistake previous 15 years united kingdom alone1dyer c government introduce safer administration cancer drugs fatal errorbmj 2001 322 1013crossref pubmed google scholar specific prevention strategies place eg bar coding forcing function would allow vincristine injected intrathecal catheter would likely occurred fortunately medication errors catastrophic big problem best prevented issue mayo clinic proceedings 2 articles address domain wittich et al2wittich cm burkle cm lanier wl medication errors overview cliniciansmayo clin proc 2014 89 11161125abstract full text full text pdf pubmed scopus 104 google scholar discuss questions providers may medication errors reviewing evidence mixon et al3mixon myers ap leak cl et alcharacteristics associated postdischarge medication errorsmayo clin proc 2014 89 10421051google scholar present study frequency medication errors hospital discharge clearly vulnerable time wittich et al2wittich cm burkle cm lanier wl medication errors overview cliniciansmayo clin proc 2014 89 11161125abstract full text full text pdf pubmed scopus 104 google scholar note medication errors common type frequency vary substantially setting much frequent intensive care units example patients receive average 25 medications per day4cullen dj sweitzer bj bates dw burdick e edmondson leape preventable adverse drug events hospitalized patients comparative study intensive care general care unitscrit care med 1997 25 12891297crossref pubmed scopus 483 google scholar much less problem areas obstetrics medications generally avoided medication errors result harm called adverse drug event ade ades associated medication errors preventable previous studies hospitalized patients reported medication error rates 48 535jimenez munioz ab muino miguez rodriguez perez mp escribano md duran garcia sanjurjo saez medication error prevalenceint j health care qual assur 2010 23 328338crossref pubmed scopus 26 google scholar 6bates dw boyle dl vander vliet mb schneider j leape l relationship medication errors adverse drug eventsj gen intern med 1995 10 199205crossref pubmed scopus 728 google scholar errors occur stage medication use process eg ordering dispensing administering monitoring although medication errors result patient injury likely occur prescribing 56 administering 34 stages hospital setting commonly intercepted former stage 48 latter 0 respect administration errors typically one nurse person administering drug patient detect predict error7bates dw cullen dj laird n et alade prevention study groupincidence adverse drug events potential adverse drug events implications preventionjama 1995 274 2934crossref pubmed scopus 2759 google scholar although many studies hospitalized patients outpatients clear medication errors problem groups many medications consumed outside hospital one study gurwitz et al8gurwitz jh field ts harrold lr et alincidence preventability adverse drug events among older persons ambulatory settingjama 2003 289 11071116crossref pubmed scopus 1368 google scholar assessed incidence preventability ades older patients ambulatory care setting found errors occurred prescribing n246 584 monitoring n256 608 stages prescribingstage errors included wrong drugwrong therapeutic choice n114 271 wrong dose n101 240 whereas 2 common errors occurred monitoring stage failure act available information relating laboratory results n154 366 inadequate laboratory monitoring drug therapies n152 361 many preventable ades related errors patient adherence n89 211 including continuing take medication despite recognized adverse effects drug interactions known patient taking another persons medication contrast hospital setting responsibilities medication administration monitoring outside hospital usually extended patient family member many degrees freedom introducing error setting hospital discharge another vulnerable time introducing medication errors study medical patients discharged hospital forster et al9forster aj murff hj peterson jf gandhi tk bates dw incidence severity adverse events affecting patients discharge hospitalann intern med 2003 138 161167crossref pubmed scopus 1338 google scholar found 19 ades immediate postdischarge period 6 experienced serious ade article mixon et al3mixon myers ap leak cl et alcharacteristics associated postdischarge medication errorsmayo clin proc 2014 89 10421051google scholar published issue mayo clinic proceedings examines area detail ie assess frequency medication errors association patient medicationrelated factors postdischarge medication errors particular focus patient literacy numeracy study conducted patients cardiovascular disorders group often many medications changed hospital admission especially incident event authors compared preadmission medication lists patients recently hospitalized cardiovascular disease discharge medication lists classified discordant medication either error omission patient taking medication discharge list error commission patient taking medication discharge list half hospitalized patients studied least 1 unintentional discrepancy 2 lists patients lower numeracy health literacy high levels depression also associated high odds errors commission although study assess clinical outcomes ades studies found exposure inpatients antidepressant drugs odds ratio 33 cardiovascular drugs 24 independent correlates preventable severe ades respectively10bates dw miller eb cullen dj et alade prevention study grouppatient risk factors adverse drug events hospitalized patientsarch intern med 1999 159 25532560crossref pubmed scopus 293 google scholar ambulatory care setting cardiovascular drugs among frequently used prescription drug classes study population frequently implicated agents preventable ades n103 245 contrast antidepressant sedativehypnotic drugs used 10 study population implicated far fewer preventable ades n15 36 n6 14 respectively thus prevalence use medicines source population may reflect frequency ades cases perhaps interesting findings study mixon et al3mixon myers ap leak cl et alcharacteristics associated postdischarge medication errorsmayo clin proc 2014 89 10421051google scholar explorations literacy numeracy lower numeracy associated misunderstandings regarding dose frequency associated discordant medication misunderstanding indication general health care systems could better understanding health care literacy numeracy patients implementing interventions tailored specific needs patients health care provider factors also contribute medication errors examined underlying causes prescribing monitoring errors primary care practices found variety health care provider factors may contributed errors11slight sp howard r ghaleb barber n franklin bd avery aj causes prescribing errors english general practices qualitative studybr j gen pract 2013 63 e713e720crossref pubmed scopus 62 google scholar including prescribers therapeutic training drug knowledge experience knowledge patient perception risk high workloads time pressures interruptions daytoday activities physicians nurses also known patient safety concerns particularly regarding medication administration errors westbrook et al12westbrook ji woods rob mi dunsmuir wt day ro association interruptions increased risk severity medication administration errorsarch intern med 2010 170 683690crossref pubmed scopus 498 google scholar observed interruptions occurring 50 nurses medication administrations interruption associated 121 increase procedural failures 127 increase clinical errors respect prevention effective strategies depend clinical setting hospitalized patients implementation computerized physician order entry cpoe linked clinical decision support single effective errorprevention strategy providing physicians dosing suggestions assisting calculations monitoring checking harmful drugallergy drugdrug drugdisease interactions13bates dw gawande aa patient safety improving safety information technologyn engl j med 2003 348 25262534crossref pubmed scopus 1097 google scholar 14bates dw leape cullen dj et aleffect computerized physician order entry team intervention prevention serious medication errorsjama 1998 280 13111316crossref pubmed scopus 1657 google scholar 15slight sp seger dl nanji kc et alare heeding warning signs examining providers overrides computerized drugdrug interaction alerts primary careplos one 2013 8 e85071crossref pubmed scopus 63 google scholar appropriately implemented cpoe systems help improve communication among health care professionals patients shamliyan et al16shamliyan ta duval du j kane rl doctor ordered review evidence impact computerized physician order entry system medication errorshealth serv res 2008 43 3253pubmed google scholar found use cpoe systems associated 66 reduction medication errors adults 034 similar effect found children cpoe systems also contributed statistically significant p05 reduction number ades 5 studies17wolfstadt ji gurwitz jh field ts et althe effect computerized physician order entry clinical decision support rates adverse drug events systematic reviewj gen intern med 2008 23 451458crossref pubmed scopus 240 google scholar bar coding also large effect inpatient medication safety18poon eg keohane ca yoon cs et aleffect barcode technology safety medication administrationn engl j med 2010 362 16981707crossref pubmed scopus 420 google scholar ambulatory care setting less clear strategies important improving safety although computerized prescribing undoubtedly one clear though immediate postdischarge period particularly hazardous preventable patient harm one simple approach pharmacists call patients hospital discharge reported decrease ade rates19schnipper jl kirwin jl cotugno mc et alrole pharmacist counseling preventing adverse drug events hospitalizationarch intern med 2006 166 565571crossref pubmed scopus 598 google scholar tools prevent postdischarge harm still developed yet routine use organizations one example partners postdischarge medication reconciliation tool20schnipper jl liang cl hamann c et aldevelopment tool within electronic medical record facilitate medication reconciliation hospital dischargej med inform assoc 2011 18 309313crossref pubmed scopus 46 google scholar designed make easier primary care providers compare contrast preadmission postdischarge medication regimens displaying identical medications next highlighting changes made primary care providers presented active reminder discharged patients whose medications reconciled full approaches tailored meet patients specific needs including issues literacy numeracy elevated risk specific issues likely helpful future medications beneficial aggregate also cause substantial harm many adeprevention strategies already developed although maturely applied inpatient setting outpatients providers need understand leverage prevention approaches make medicationrelated care deliver safer setting achieve optimal benefit take advantage lessons avoid repeating mistakes past happened wayne jowett preceded medication errors overview cliniciansmayo clinic proceedingsvol 89issue 8previewmedication error important cause patient morbidity mortality yet confusing underappreciated concept article provides review practicing physicians focuses medication error 1 terminology definitions 2 incidence 3 risk factors 4 avoidance strategies 5 disclosure legal consequences medication error error occurs point medication use process estimated institute medicine medication errors cause 1 131 outpatient 1 854 inpatient deaths fulltext pdf characteristics associated postdischarge medication errorsmayo clinic proceedingsvol 89issue 8previewto examine association patient medicationrelated factors postdischarge medication errors fulltext pdf