Overview: What Is Medication Errors in Pharmacy Practice
A dispensing error is a deviation from a written prescription that occurs during the dispensing process, wherein a patient receives a medicine that is different, in terms of formula, strength, or dosage, from the prescription received by the pharmacy. This may include dispensing a medicine with inferior quality, mixing up patient orders and sending patients home with the wrong drugs, delivering the wrong drug or the incorrect strength or dosage of the prescribed drug, confusing medicine with similar-sounding names, as well as the inability to educate the patient on the correct way to take the medicine, a failure to adjust the medication to reflect changes in the patient’s condition, miscalculating a compound formula, or not screening for drug interactions or contraindications.
Medical errors are common in pharmacies, and may even lead to severe consequences, ranging from illness to death. In fact, dispensing errors account for approximately 21% of all medication errors and may cost millions in professional liability insurance coverage. However, the good news is that most medicine errors in pharmacy are preventable if stringent quality control policies are put in place.
The goal of every pharmacy should be to implement procedures to prevent medical errors, such as to verify prescriptions if they seem dubious, as well as to conduct a drug utilization review to take into account any medications a patient may be taking, and consider any known allergies, possible drug reactions, or medical conditions before prescribing a medicine. The goal should be to dispense the right dose of the right medication to the right patient, at the right time.
Types of Medication Errors in the Pharmacy?
One of the most common medication errors is the act of commission, which includes a pharmacy dispensing an incorrect drug, an inaccurate dosage, or strength, or overlooking possible drug interactions or known allergens or contraindications, resulting in adverse reactions. Not to mention, patients sometimes receive expired medication or even medicine that had been incorrectly compounded. It also happens sometimes that discrepancy exists between the information listed on the prescription and the actual drug label.
Drugs with similar looking names account for one-third of medication errors, especially when prescriptions are handwritten. This type of error occurs due to an innate tendency to interpret information according to one’s preconceptions, instead of processing anything new. This type of medication error is common where non-standard decimals, abbreviations, and acronyms are associated.
One other type of medicine error happens when pharmacists who are boggled down due to heavy workloads inadvertently select the wrong containers. For instance, instead of scanning three different bottles of drugs before loading into an automated dispensing machine, a busy pharmacist may accidently scan one bottle thrice. It also happens sometimes that pharmacists may mix up a patient’s prescription with another customer, and send that patient home with the wrong medicines.
Last but not the least, the error of omission happens when a pharmacist fails to comprehend the information on the label or educate the patient about the correct way to take a medicine or warn them about potential side effects. For instance, the absorbency of some medicines depends on the time at which the drug is taken, or whether it is ingested with or before/after meals. Not adhering to scheduled timings can reduce the efficacy of a drug.
What Are The Examples Of Medication Errors In The Pharmacy?
We have witnessed numerous cases where patient safety was threatened due to medication errors in pharmacy. For instance, a 71-year-old woman was prescribed amlodipine (Norvasc), metoprolol, and doxazosin for her various medical conditions. However, it was only after the woman returned to the ER a few months down the lane, complaining of extreme fatigue, a shuffling gait, and a loss of personality, that it was revealed that the outpatient pharmacy had accidentally handed her antipsychotic Navane, instead of Norvasc. This error related to similar-sounding drug names could have been life-threatening had a medical reconciliation not revealed the error in time.
In another case, a patient was rushed to the ER with inexplicable abdominal bleeding. The reports revealed an unusually high INR, although EMR records indicated that the patient had never received anticoagulant therapy. Digging deep into the matter, a selection error at the pharmacy was identified as the main culprit. The pharmacy had inaccurately dispensed 5mg Coumadin instead of 5mg Coversyl as prescribed by her physician. The cytotoxic drug resulted in a miscarriage since the girl was pregnant.
In another case, an elderly patient with a history of cardiac arrhythmia was prescribed a 150mg prescription of Rhthmol, in a follow-up visit. He received his medications from the clinical pharmacy but called his physician a fortnight later, complaining of extreme nausea, rapid heartbeat and excessive sweating. As it turned out, the pharmacy had misconstrued the physician’s handwriting and handed him Synthroid (levothyroxine) 150 mcg, instead of Rythmol 150 mg.
What Are Some Ways To Prevent Or Solve These Errors?
Call the Physician for Clarification
Mostly owing to the notoriously illegible handwriting of physicians, pharmacists tend to second guess vague prescriptions according to what they think is written. If a prescription is illegible or unclear, it falls upon the pharmacist to call up the prescriber for further clarification instead of assuming what is written. Additionally, all verbal prescriptions should be documented and double-checked with the prescriber to ensure accuracy. Especially prescriptions involving zeros, decimal points, and abbreviations are most vulnerable to dispensing errors. For example, 6U of insulin could be construed as 60 units. Thankfully, E-prescriptions reduce errors in pharmacy since these prescriptions are in a digital format and sent directly from the prescriber to the pharmacy.
Reduce the workload of Pharmacy staff
Lack of pharmaceutical staff or increased workload of pharmacists further increase the likelihood of medicine errors. When you look at the highly sensitive nature of work that pharmacists do, it becomes all the more important to allow your staff to de-stress and take regular breaks to relax.
Provide patient counseling
Involving patients in their healthcare journey is a critical part of ensuring compliance. Informing patients on how to properly take the medication or warning them about possible side effects can prevent a lot of medical errors. Instead of silently handing out medicines to patients, allow them to ask questions regarding their prescription, so that verifications can be performed. As a pharmacist, you can go the mile extra by opening containers and showing patients their prescriptions so that they can identify if their medicines are exactly how they should look like.
Pharmacists should educate patients on the purpose of the medicine, the correct strength, and dosage of the prescribed drug, including the correct duration, frequency, and route of administration, as well as any side effects and possible drug and food interactions. Furthermore, patients should be informed of the right storage conditions, the method of applying for a refill, as well as any other information pertinent to the drug. Patients should also know what therapeutic outcomes to expect, what to do in case of a missed dose or even an overdose, and when to contact a physician.
Evaluate medication appropriateness
In order to dispense the right medicine to the right patients, pharmacies should assess medication appropriateness and resulting patient safety, in light of age, medical history, weight, any known conditions and allergies, as well as the ethnicity of patients. Patient history may result in a change in prescription or symptom monitoring to prevent any adverse side effects.
Misheard requests and communications
Verbal medicine orders are sometimes unavoidable, especially during emergency procedures or while seeking Telehealth services. However, these verbal requests are often misinterpreted, especially when similar-sounding drug names or drugs with complex naming are involved. For instance, a verbal order for Antithrombin can be misconstrued as thrombin by the pharmacy. The policy for double-checking verbal orders is to repeat back the drug information back to the prescriber, including the correct name, spelling, dosage, and frequency.
Double-check all prescriptions
Counterchecking and involving multiple people in the verification process can prevent the occurrence of most medical errors. For instance, pharmacists should ideally compare the written prescription with the medicine being shown in the system and the printed label, and even open up bottles to show to patients to reduce medical errors.
Review Patient’s EHR Records
Analyzing each patient’s past medical records before dispensing medicine helps to gauge the appropriateness of drug therapy, look out for any possible drug interactions or past histories of allergies, check the prescribed drug against previously known medications, ensure compliance, and avoid duplication.
The use of standard machine-readable codes can significantly reduce the occurrence of medical errors in pharmacies. The barcode reader machine helps ensure that the right dose of the right medication is being administered. The scannable barcode, printed on the label of each medicine, reveals the drug formula, dosage form and route, strength, expiration date, and even information regarding correct storage. This also eliminates the possibility of patients receiving expired products.
How to Prevent Medication Errors In Pharmacy Using IT Software?
E-prescriptions allow physicians and healthcare staff to enter prescriptions directly into the EHR integrated electronic prescription records, and directly transmit the prescription to the pharmacy management software of their chosen pharmacy, in order to avoid the chances of any misinterpretation or human error. In contrast to hand-written prescriptions, e-prescriptions follow a digital format to input correct strength and dosage, as well as the correct schedule and method of administration.
E-prescriptions contain all the data needed to fill, label, and even dispense a prescription, as per law. This data helps pharmacists prevent adverse drug interactions and even make sure that a patient is not receiving duplicate therapy. Due to integration with EHR, E-prescriptions allow seamless communication between pharmacists and physicians, reducing both verbal miscommunication and workflow interruptions associated with clarifying prescriptions and help to improve care through a process of total patient management. Especially when poor handwriting and prescription filing errors take 7000 lives each year, real-time, bi-directional collaboration becomes all the more important. Folio3 Custom medical software development company designs E-prescription platforms that take care of most medical errors.
Another benefit of E-prescriptions is that several medications are available in multiple forms, strengths, and doses. Manually writing these details could result in slip-ups or mistakes. E-Prescribing software comes with drop-down menus that make it easy for prescribers to simply fill out all the fields with accurate, computer-provided details. Many E-Prescribing software is even outfitted with decision support to help pharmacists if a particular drug is appropriate for a patient. Folio3 EHR/EMR integration allows pharmacies to cross-check the patient’s prescriptions with their current insurance coverage or any other program where the patient may be eligible for benefits.
E-prescriptions also make it easier to ensure the safe use of opioids and other controlled drugs. Integration with EHR ensures that pharmacists track medicine data across multiple pharmacies and decrease the chances of over-prescription. For instance, an E-prescription platform would alert the pharmacist if the drug dose exceeds recommended guidelines or if the pharmacist is dispensing higher than the above dose.
What are the errors that a pharmacist should avoid while dispensing drugs?
A pharmacist should make sure that the right drug is being administered to the right patient at the right time. As such, pharmacists should ensure the correct formula, dosage, and strength of a prescribed medicine is being given to the patient. Also, pharmacists should avoid working in a hassle, as they may mix up prescription orders and send patients home with the wrong medicine. Pharmacists also need to look out for any possible drug interactions or past histories of allergies, check the prescribed drug against previously known medications, ensure compliance, and avoid duplication.
What are medication errors in community pharmacies?
Some of the most common medication errors in community pharmacies relate to outdated prescriptions, patients always in a hurry, illegible handwriting of the prescriber, pharmacist failing to identify drug interactions or contraindications, and drugs with similar-looking and confusing packaging getting mixed up.
What are medication errors in the clinical pharmacy?
Lack of information on the prescription misconstrued information due to illegible writing or foreign medicine names, and transcribing/typing errors are known to be the most common errors in clinical pharmacies.