Reducing prescription errors

Experts have shown that medication errors are common. One study found that around 237 million medication errors occur at some point in the medication process in England every year.

Fortunately most of these errors (72%) cause minimal harm to patients and only a very small proportion (2%) cause severe harm. Nevertheless, that means that around one quarter of medication errors cause moderate harm, potentially leading to emergency hospital care.

Errors can happen in any setting including at home, in the GP surgery, in hospital or in residential care. The frequency of errors does vary across settings. Although error rates are lowest in primary care, it deals with so much medication that it is responsible for 38.4% of all errors. By contrast, care homes deal with much fewer patients but have much higher error rates per patient resulting in a high proportion of all errors (41.7%). 19.9% of errors relate to hospital care.

Mistakes can also occur at any stage although they are most likely to occur when a drug is prescribed (21.3%) or given/taken by a patient (54.4%) Prescription errors include:

• Prescribing 21.3%
• Transition (discharge from hospital) 1.4%
• Dispensing 15.9%
• Administration 54.4%
• Monitoring 7%

Administration related errors include:

• Giving medication to the wrong patient
• Giving the wrong medicine
• Giving the wrong dose
• Giving medicine the wrong way
• Failing to give the medicine at the right time or not at all
• Giving medicine to someone who is likely to be allergic or hypersensitive to it

Some medicines are especially dangerous if they are misused or used in error. Common medicines on the “high risk” list include:

• Warfarin and other anticoagulants
• Blood pressure lowering medicines
• Antiplatelet medicines including clopidogrel and common painkillers such as ibuprofen or diclofenac
• Paracetamol
• Medicines used to treat diabetes
• Some antibiotics
• Anticholinergic medicines in elderly and frail patients
• Morphine and other opioid based medicines
• Benzodiazepines such as temazepam or diazepam
• Lithium
• Clozapine

Common medication errors in General Practice settings

The most common medication errors relating to GP prescribed medicines relate to:

• Blood thinners and/or anticoagulants
• Antibiotics
• Anticonvulsants – those used to treat pain or seizures
• Opioids such as morphine

Errors can occur during transition whenever medication is reviewed, transcribed and deliberately or unintentionally changed. Medication can change deliberately when a new drug is started, when the dose of a drug is changed or when an existing medication is discontinued. These can occur unintentionally if there is an error in transcribing the drug name, dose or frequency.

Every time a patient moves to a different health care setting there is a high risk of introducing a medication or prescription error. Whether it’s being admitted to hospital, to a different ward, to a day unit, consulting with a hospital specialist or primary care clinician or being discharged home or somewhere else, each transition and interaction has the potential to introduce a mistake.

Unanticipated harms can occur if a new drug is prescribed, or the dosage is changed, without being fully aware of the patients current or previous medication record, the patient’s health state, or any drug related allergies or sensitivities.

Nowadays people take all sorts of food or vitamin supplements, painkillers, and herbal remedies to improve their health. It is important to know that these are a form of medicine and can carry the same dangers as prescribed medicines.

They can also interact with prescribed medicines and shape how safe or effective they are.

For your parent(s) and relevant clinicians to minimise any avoidable harm make sure you:

• pass on accurate information about:
  • current and ongoing medication regimes – including any over the counter treatments or supplements etc
  • any health issues which could affect medication safety e.g. kidney disease, liver disease, etc
  • any known allergies or sensitivities to medicines
  • any previous medicine related problems
• Check that new and old information is transcribed accurately and completely – especially when care is being passed between services such from hospital to home or other care setting
• Clarify any changes to a medication regime so that everyone concerned fully understands exactly what the new regime entails, including when and how to take the new medicine safely
• Ask about the safety of all prescribed medicines but especially any regimes concerning”high risk” medication listed in this article

If you are involved in giving someone their medication or supervising them taking it, then make sure you check the name and dose of each item and make sure that it is not on the list of known allergies or sensitivities. You will also find other ways of helping with medication in this article about polypharmacy in our Carenting Guides.