High Prevalence of Medication Errors - Report Example

Running Head: Medication Errors. Medication Errors                 There is a high prevalence of medication errors which result from a number of reasons such as wrong diagnosis, drug selection, prescription, transcription, labeling and packaging-just to mention but a few. A number of solutions such as changes in labeling, packaging and naming have been proposed and implemented, but the problem still persists either due to other unaddressed elements or the inability of these measures to address their designated problem areas effectively. The use of Information Technology as a tool to combat medication errors has been proven as an effective approach to prevent this problem because of its ability to address the challenges from multiple angles. However, its effectiveness is also limited by the fact that IT based solutions are also limited by technological shortcomings and they also fail to address the human element of the problem. As such, the method is found to be effective, but its effectiveness is better realized when it is combined with other non-IT based approaches. Therefore, the use of IT solutions is underscored, but comprehensive effectiveness is only attainable through a combination of approaches. Introduction Incidents of harmful healthcare related events affect eight in every 100 patients according to a study by the World Health Organization (WHO, 2012). The situation is even worse in developing and underdeveloped regions such as Africa and Eastern Mediterranean, where many patients die or suffer preventable disabilities. W. H. O states that these are conservative approximations, which only show a small percentage of the whole problem. The high, life threatening risk associated with improper medical care is evidence that elicits a global solution to address the issue of patient safety, not only in these adversely affected areas, but on a global scale. A large number of harmful healthcare related events result from various types of medical errors. The Institute of Medicine (IOM) categorizes medical errors into various categories including diagnostic errors, treatment errors, prevention errors and others (IOM, 2006). Diagnostic errors include application of outmoded therapy or tests, delayed diagnosis, failure to use results from testing or monitoring sessions and failure to use tests that are indicated. Treatment errors include errors in administration of treatment, errors in conducting tests, operation and procedures as well as errors in dosage or use of drugs. The application of non-indicated care and occurrence of avoidable delays in treatment are also regarded as treatment errors (IOM, 2006). Prevention errors include insufficient follow-up treatment and monitoring as well as the failure to provide prophylactic treatment. Other errors may include equipment and communication failures as well as system failures. A bigger percentage of adverse medical errors are attributed to medication errors. The “National Coordinating Council for Medication Error Reporting and Prevention” (NCCMERP) defines medication error as a preventable occurrence, which may lead to patient harm or improper medication use when the medication process is either in the control of the patient or a healthcare practitioner. These errors result from various factors such as packaging, order communication, prescribing, procedures, transcribing, administration, dispensing, nomenclature, product labeling, compounding and use (IOM, 2006). Problem Statement An estimated 44000 to 98000 people die annually in hospitals because of preventable medical errors (IOM, 2006). According to National Academies Report (2006), medication errors make up a big portion of medical errors, which harm an estimated 1.5 million people annually. Apart from causing preventable deaths and permanent disabilities, medication errors also cost a lot in the undertaking of remedial steps to curb the drug related injuries that they cause. Extra expenses incurred in the treatment of medication-related injuries are estimated to be $ 3.5 billion in a single year, and this approximation does not factor in lost productivity or working hours and wages (National Academies Report, 2006). More often than not most medication errors that are revealed or become evident to the patient or family and friends lead to legal suits, which are also an expensive undertaking for both involved parties. The deaths, disabilities and financial losses resulting from medication errors have become a great concern for the nation and as such various organizations have made a number of initiatives to help curb the problem and raise levels of patient safety as well as confidence of patients in the healthcare system (IOM, 2006). The fact that these errors are still prevalent calls for an initiation of better, additional measures to prevent and reduce the rates of errors experienced Position: The solutions prescribed for medication errors are based on the factors that cause these errors. The IOM report from 2006 showed that errors in medication do not only occur within the medical facilities, but their propagation and occurrence may even begin as early as during the manufacture and packaging and extend into the use period in homes. The report found that 33% of the errors result from packaging, labeling and naming. Similar looking drugs and some that have similar sounding names are likely to be confused (Schlesselman, 2008). However, a large number of the errors occur within the medical processes that take place within medical facilities or rather contribute to the errors that will occur thereafter in the drug use process in homes. The challenges also progress in to the medical processes, where problems arise from wrong diagnosis which leads to equally wrong prescriptions of various medication products. The inaccurate diagnosis may result from lack of proper diagnostic equipments, faulty equipments or a lack of comprehensive historical overview of the patient’s health from the past. In addition patients may have recall bias and an inability to know what medications they are under and for what reasons. As such, doctors may not have all the necessary information to make proper prescriptions (Day et al. 2011). The hand written prescriptions are also known to cause challenges due to ineligibility which results from differing handwritings. As such, the transcribing process may lead to errors. A number or organizations such as the Food and Drug Association (FDA), Institute of Safe Medication Practices (ISMP) and the United States Pharmacopeia (USP) have initiated steps that have recommended proper labeling, naming and packaging that avoid confusion as well as educational programs meant to enhance greater caution in care (Chen & Mazur, 2009). In spite of these initiatives the problem is still persistent. However, there is a budding and promising solution that has already been made available through Information Technology (IT) solutions. The use of IT in maintaining individual pharmacy records (PR) and an e-prescription system with comprehensive details on dosages indicated for various conditions, probable allergies and other medication issues related to polypharmacy would be very essential in ensuring proper medication is attained. There is no single solution to the medication error problem, but the IT solutions offered by e-prescription systems seems to solve most problems that have already been identified as the cause of medication errors. For example, electronically transmitted prescriptions are less likely to have transcribing problems, because they are not hand written. Additionally, the IT-based system would offer a practitioner a chance to make prescriptions while at the same time reviewing the electronic PR record (Pharmacy record) of the patient (Fitzgerald, 2009). This informs the practitioner about other conditions existent in the patient and the kind of medications already being undertaken. During the prescription process the system could also give prompts about potential allergies and contraindications based on the patient’s history fed into the system (Day et al. 2011). This comprehensive view and control of the process is likely to reduce major medication errors, because it provides an overall method of approach in delivering solutions to most problems. The fact that other causes of medication errors such as labeling have been addressed and still the error rates are high implies that there are other problems that need to be addressed through other solutions. The IT provided solution is what I strongly believe can be the solution to the problem. Supporting work: IT-based solutions to medication errors could help prevent errors at various stages including drug selection, dosage setting, and avoidance of transcribing errors and also offer real-time access to medical history records, thus contributing to precision in any treatment, prescription, administration and transcribing process. Computerized decision support systems (CDSS) have been cited as potential IT tools that can help reduce prescription errors that lead to medical errors because of knowledge-based mistakes (Day et al. 2011). This system is meant to help in the drug selection process because it is possible that some errors in medication start with the making of decisions on which alternative drugs to use for different cases. According to Rothschild et al. (2011), 3% of prescriptions that involved new drugs had dispensing errors, and these errors could be corrected through the use of electronic prescribing systems (e-prescription). A study in 2006 assessing the effect of electronic prescribing systems found that the use of computerized prescriber order entry (CPOE), which allowed direct transmission of data on prescription from the physician to the pharmacy significantly, reduced the risk posed by dispensing errors. Dispensing errors in this case were defined as discrepancies between dispensed prescription and the written order (Rothschild et al. 2011). Another study carried out in 2008 and 2010 on the use of bar codes in the delivery of medication is in support of the use of IT based approach to solving medication errors. The bar code medication system was implemented in care homes, where members of the home were given wrist bands that bore information about their prescriptions and the nurses had to use a bar-code-reader prior to any administration process (Nelson, Szczepura & Wild, 2011). The system third area of concern that the IT based solutions can greatly help in, is the provision of a precise medication history. According to Fitzgerald (2009), medication histories are essential in the prevention of prescription errors. The access to an accurate history is also essential in detecting clinical signs change and drug-associated pathology. A good record on this history should contain drug prescriptions done in the distant and recent past as well as any adverse reactions such as allergic or hypersensitive reactions (Fitzgerald, 2009). The integration of such records in the IT system used in prescription and dispensation can greatly help reduce underreporting, which results from non-adherence or recall bias. Errors of omission are prevalent in spite of the structured medication interviews (Dahloff, Poulsen & Glintborg, 2007). In essence IT offers a multiple of solutions that cover wider problem areas associated with medical errors and thus making it one big, potential solution to the problem when combined with all the rest of the measures including educational and legislative measures. Counterargument: In dealing with the medication error problem it is good to be cognizant of the fact that IT approaches may offer efficient solutions in this case, but their total effectiveness is not guaranteed unless they are combined with other approaches to reduce medication errors. Additionally, most errors are human and perhaps the best approaches should entail addressing the human insufficiency which is behind the problem rather than jumping straight to the IT solutions. If only practitioners learned how to minimize these problems, there would probably be no need of computerized system. Additionally, IT-based systems are not fail-proof and they too have technical failures that are characteristic of the field of IT (Rothschild et al. 2012). The effectiveness of using computer systems also relies on how humans are well able to handle them in application. As such, it all boils down to improving human participation and ability, which should be placed first. Conclusion In conclusion, medication errors are prevalent all over the globe and these arise due to a number of challenges within the medical practice such as improper diagnosis, packaging, labeling, dispensation, administration, use, compounding and transcription. A number of measures have been taken to combat the problem including appropriate labeling, packaging and training of practitioners on how to exercise more caution, but the problem still persists. Recently developed IT systems that assist in decision-making, medical history access and transfer of orders for transcribing have proven to be very effective and as such led to the proposition of IT-based solution as the best option in preventing medication errors among other approaches. In spite of their effectiveness, the inherent IT challenges and the fact that most errors are human-based also suggests that the search for the solution should not only concentrate on IT solutions, but review human interventions such as educational programs to improve overall practice. References Chen, S. & Mazur, M. L. (2009). An empirical study for medication delivery improvement based on healthcare professionals’ perceptions of medication delivery system. Health Care Management Science 12 (1): 56–66 Dalhoff, P. K. Poulsen, E. H. & Glintborg, B. (2007). The use of nationwide on-line prescription records improves the drug history in hospitalized patients. British Journal of Clinical Pharmacology, 65 (2): 265–269 Day, O. R. Braithwaite, J. Westbrook, J. & Baysari, T. M. (2011). The Role of Computerized Decision Support in Reducing Errors in Selecting Medicines for Prescription: Drug Safety Journal; 34 (4): 289.298 Fitzgerald, J. R. (2009). Medication errors: the importance of an accurate drug history. British Journal of Clinical Pharmacology, 67 (6): 671–675 Institute of Medicine (IOM) (2006). To err is human: building a safer health system. Retrieved on April 27th 2012 from http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf National Academies (2006). Medication errors, Evidence of unsafe care, retrieved on April 27th 2012 from http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623 Nelson, S. Szczepura, A. & Wild, D. (2011).New barcode checks help reduce drug round errors in care homes, Nursing Management, 18 (5): 26-30 Rothschild, M. J. Bates, W. D. Seger, L. D. Keohane, A. C. Seger, C. A. & Moniz, T. T. (2011). Addition of electronic prescription transmission to computerized prescriber order entry: Effect on dispensing errors in community pharmacies; American Journal of Health-System Pharmacy, 68 (2): 158-163 Schlesselman, S. L. (2008). 10 Strategies to Reduce Medication Errors; Pharmacy Times, retrieved on April 28th 2012 from https://secure.pharmacytimes.com/lessons/200809-01.asp U. S. Food and Drug Administration (2012). Medication errors, retrieved on April 27th 2012 http://www.fda.gov/drugs/drugsafety/medicationerrors/default.htm World Health Organization (WHO) (2012). Patient safety: Evidence of unsafe care, retrieved on April 27th 2012 http://www.who.int/patientsafety/en/ Read More