Pharmaceutical Press shares the most common types of medication errors
What are medication errors? A medication error is defined as: Any preventable event that causes or leads to inappropriate medication use or patient harm while the medication is under the control of a health professional, patient or consumer.¹
Medication errors occur frequently in health systems around the world, and, according to the World Health Organization (WHO), nearly 50% of preventable harm to patients globally is due to inappropriate use of medicines and other treatments. A quarter of this preventable harm can be severe or even life-threatening.¹,²
Medication errors occur when weak medication systems or human factors affect processes. As a leading cause of avoidable patient harm, a recent study estimated that there are 237 million medication errors in England every year. The majority are thought to have little or no potential for harm but 66 million of these (28%) are potentially significant.³
Fortunately, with greater awareness of the scale of the problem, there is now a focus on ensuring a culture of safety in health systems. With the right education, policies, prescribing tools, and reporting and learning systems, errors can be minimised and patients protected.
What are the most common types of medication errors?
Medication errors can occur at any stage in the medicines use process. Most studies refer to five main types of error, namely those related to prescribing, transcribing, preparation or dispensing, administration, or monitoring. Aronson also noted that errors can occur during the medicine manufacturing process, for example when the packaging is incorrectly labelled or adulterants are introduced.⁵
It is challenging to identify and quantify the most common types of medication errors, as research evidence is limited, and many go unnoticed or unreported. However, the literature suggests that prescribing, administration, and monitoring errors are the most frequent.¹
Administration errors
Administration errors may include using the incorrect route of administration, giving the drug to the wrong patient, or using the wrong dose or administration rate. The worldwide prevalence of these is around 22%, according to a WHO systematic review.¹
Medication errors resulting in claims are likely to represent the tip of the iceberg. Their analysis of medication error claims over a five-year period (April 2015 – March 2020) found that of 487 claims settled with damages paid, 45% related to administration errors. In 27% of these cases, the wrong dose was given, in 18%, the wrong drug was given, and in 15%, the wrong route of administration was used.⁷
Prescribing errors
Prescribing errors account for a high proportion of all medication errors, with the WHO suggesting the error rate may be as high as 53%.¹ These errors can happen at any part of the prescribing process and include irrational, inappropriate or ineffective prescribing, under and over-prescribing, and medicines that are omitted or delayed.⁸
Preventing medication errors
Preventable errors can occur for any number of reasons, from illegible prescriptions, incomplete patient records with regard to information on co-prescribed medications, previous response to therapy, and allergy status, to incorrect drug or dose selection and drugs with similar looking or sounding names. With so many contributing factors, there is no one size fits all solution. Rather, tailored approaches to understanding and mitigating the risks are required. Improved systems can help reduce error rates, such as electronic prescribing and automated dispensing. Reporting all drug errors and near misses, regardless of whether the patient came to harm, and having processes to investigate and analyse the data is crucial. It is only by building the baseline evidence that health systems can better understand how errors occur, and how to prevent them.
“Use of medicines has increased because of increased adherence to disease-based guidance. The increase in use also results, however, in increased hazards, errors, and adverse events associated with medicines, which can be reduced or even prevented by improving the systems and practice of medication,” WHO, Medication Without Harm, 2023.¹
A culture of safety in the health system is necessary to ensure medication safety. With the necessary education, support, and tools, individual health professionals can do much to ensure safe practice.
MedicinesComplete brings regularly updated medicines information, and expert guidance on the use and administration of drugs together in one place, helping health professionals to use medicines safely and avoid medication errors.
Discover how MedicinesComplete supports health professionals in confident decision-making at the point of need here at PharmaceuticalPress.com or meet Matt Orzlowski on the ABHI pavilion at WHX Dubai
SOURCES
1. WHO. (2023). Medication without harm. Available at: https://iris.who.int/bitstream/handle/10665/376212/9789240062764-eng.pdf. Last accessed: 22 April 2024.
2. Panagioti M., Khan K., Keers R.N., Abuzour A., Phipps D., Kontopantelis E., et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: Systematic review and meta-analysis. BMJ. 2019;366:I4185. doi: 10.11136/bmj.I4185.
3. Elliott R.A., Camacho E., Jankovic D., et al. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Quality & Safety 2021;30:96-105. Accessed: 1 June 2024.
4. ECAMET Alliance. (2022). The urgent need to reduce medication errors in hospitals to prevent patient and second victim harm. Available at: https://ecamet.eu/wpcontent/uploads/2022/03/ECAMET-White-Paper-Call-to-Action-March-2022-v2.pdf. Last accessed: 16 April 2024.
5. Aronson, J. K. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM: An International Journal of Medicine, 102(8), 513-521.
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7. NHS Resolution. (2022). Did you know? Insights into medication errors. Available at: https://resolution.nhs.uk/resources/did-you-know-insights-into-medication-errors/. Last accessed: 16 April 2024.
8. Cousins D., Crompton A., Gell J. and Hooley J. (2019). The top ten prescribing errors in practice and how to avoid them. Pharmaceutical Journal. Available at: https://pharmaceutical-journal.com/article/ld/the-top-ten-prescribing-errors-in-practice-and-how-to-avoid-them. Last accessed: 1 June 2024.
9. NHS Resolution. (2022). Did you know? Anti-infective medication errors. Available at: https://resolution.nhs.uk/wp-content/uploads/2022/08/Did-you-know_-Anti-infectivemedication-errors.pdf. Last accessed: 16 April 2024.
10. NHS Resolution. (2022). Did you know? General practice medication errors. Available at: https://resolution.nhs.uk/resources/general-practice-medicationerrors/#:~:text=NHS%20Resolution%20has%20received%20112,April%202015%20to% 20March%202020. Last accessed: 16 April 2024.
11. MHRA and NHS England. Patient Safety Alert. Stage 3: Directive Improving medication error incident reporting and learning. March 2014. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/12/psa-sup-info-med-error.pdf. Last accessed: 2 June 2024.
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14. Hanson, A., & Haddad, L. M. (2022). Nursing rights of medication administration. In StatPearls [Internet]. StatPearls Publishing.
15. Mid Essex Hospital Services NHS Trust. (2018). Medication Error Training Video. Available at: https://www.youtube.com/watch?v=qMuN-MV6Z9Q. Last accessed: 16 May 2024.
16. GMC. (2021). Good practice in prescribing and managing medicines and devices. Available at: https://www.gmc-uk.org/professional-standards/professional-standardsfor-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices. Last accessed: 16 April 2024.
17. RPS. (2021). A competency framework for all prescribers. Available at: https://www.rpharms.com/resources/frameworks/prescribing-competencyframework/competency-framework. Last accessed: 16 April 2024.
