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What is the national medication error rate? What standards are available for benchmarking?

What is the national medication error rate? What standards are available for benchmarking?

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  • Estimating the prevalence of medication errors is difficult due to the varying definitions and classification systems employed. Rates can vary depending on the denominator used (e.g., patient, prescription or a specific medication). These issues are reflected in the widely varying error prevalence rates reported in different parts of the world. For example, a United Kingdom study found that 12% of all primary care patients may be affected by a 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 during a 12-month period. Overall, 5% of prescriptions had prescribing errors. A Swedish study found a medication error rate of 42%. However, two-thirds were related to a failure to state the purpose of the treatment on prescriptions and only 1% of errors resulted in an incorrect dose. A study from Saudi Arabia reported that just under one-fifth of primary care prescriptions contained errors, but only a small minority were considered serious. Another study in Mexico observed that 58% of prescriptions contained errors, with dosage regimen accounting for most cases (27.6%). These examples are provided to show that medication errors are a global issue.

Standards or Recommendations available for benchmarking Medication errors

Recommendations on Prescription or Medication Order Writing

1. All prescriptions must be legible and in plain language. Prescribers, whenever possible, should adopt a direct, computerised, order entry system, recognising the need for care in product selection from any list.

2. To guard against decimal point errors, a zero should always precede expressions of less than one, and a terminal zero should never be used (e.g., Correct=0.5g … not .5g or 0.50g).

3. Abbreviations for names of medicines (e.g. HCTZ for hydrochlorothiazide), Latin abbreviations in directions for use (e.g. b.i.d. for twice daily) and Roman numerals should be avoided.

4. Prescriptions should always include directions for use.

5. Prescription orders should include a brief notation of purpose (e.g., for cough).

6. Prescribers should include the name, the age (preferably by stating date of birth) and, when appropriate, the weight of the patient.

7. The prescription should include the name of the medicine, the dosage form, and the strength or concentration in the metric system, except for therapies that use standard units such as insulin, vitamins, etc.

Recommendations on Naming, Labelling and Packaging

. 1. The packaging and labelling of prescribed medicines should be designed with a view to minimising errors in selection and use.

2. Machine-readable coding (e.g. bar coding) should be employed on labelling of all medicines.

3. Expiry dates should be in plain language, not coded and should be clearly indicated.

4. The batch number should be plainly indicated.

Recommendations on Dispensing and Administration of Medicines

1. Pharmacists should use only properly labelled and stored medicinal products and labels should be read several times during the dispensing process or computer technology should be used to check the selection.

2. Pharmacists and other health care professionals involved in administering medicines should read the label when selecting or preparing the medicine, immediately prior to administering the medicine and when discarding the container or returning it to its storage location.

3. Pharmacists and other health care professionals should report, in confidence, actual and potential medication errors to the appropriate reporting programmes, details of which should be readily available to all health care professionals, for the purpose of securing improvements in the process.

4. Health care professionals should share error-related experiences, case studies, etc., with their colleagues through newsletters, journals, bulletin boards, and the Internet.

5. Where calculations are necessary in the administration and/or dispensing of medicines, a doublecheck system should be incorporated.

6. Pharmacists should have written standard operating procedures for the dispensing and administration of medicines.

7. Pharmacists providing medicines should ensure that the patient or the person caring for the patient understands how the medicine should be used to ensure maximum therapeutic benefit and to avoid untoward effect or error in use of the medicine.

8. When national systems require repackaging of medicinal products, policies and procedures should be designed to minimise errors and as many as possible of the requirements in this document relating to labelling should be observed.

Recommendations to Organisations that Provide Health Care Organisations that provide health care (e.g. hospitals, community pharmacies, nursing homes, etc.) should establish systems to report, analyse, and prevent medication errors.

1. An environment which focuses on improvement of the process involving the use of medicines and systems for internal reporting of actual and potential errors which include strategies to encourage reporting.

2. Systematic approaches within the organisation to identify and evaluate actual and potential causes of errors.

3. Processes for taking appropriate action to prevent future errors through improving both systems and individual performance.

4. Education and training programmes for pharmacists and other health care professionals, technical support personnel, patients and those providing care for patients that address methods for reducing and preventing medication errors

Note:The National Coordinating Council for Medication Error Reporting and Prevention(NCC MERP) is an independent body for reporting and prevention of medication errors.


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