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.

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.

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.

Even when errors are not harmful or severe, they can drive the cost of care up, and the quality of care down. Health professionals do their best to protect patients from harm due to medicines but human factors, such as fatigue and insufficient staffing levels, can play a part. Medication errors that lead to patient harm can negatively impact the mental health of health professionals, and their ability to do their job.

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.

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.

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.

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.

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%.

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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.

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.

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.

The “5 Rights” of medication safety can help health professionals who administer drugs to avoid errors.

Best practice dictates that health professionals carry out the following checks before giving a medication:

1. Right patient: Check the patient’s name using two identifiers and the patient to identify themself if they are able.
2. Right drug: Check the medication label against what has been prescribed.
3. Right dose: Confirm the dose using current references, such as local protocols or British National Formulary (BNF). If necessary, recalculate the dose and have a colleague check it.
4. Right route: Check the appropriateness of the route that has been prescribed and confirm with the patient if they are able to take the medicine that way.
5. Right time: Check the frequency of the prescribed medication and confirm when the last dose was given.

Other strategies for avoiding administration errors include:

• Following medication reconciliation procedures.
• Double or triple checking procedures.
• Having a colleague read the prescription back.
• Using name alert systems, which alert health professionals to patients with similar names.
• Always placing a zero before decimal points to avoid confusion at the point of administration.
• Learning the institution’s medication administration policies, regulations, and guidelines.
• Documenting the date, time, route, and dosage of the drug.

Both the General Medical Council (GMC, 2021) and the Royal Pharmaceutical Society (RPS Competency Framework, 2021) stipulate that health professionals should make use of all available evidence-based resources to keep their knowledge and skills up to date.

Such resources include those published by the Medicines and Healthcare products Regulatory Agency (MHRA), the National Institute for Health and Care Excellence (NICE), BNF, and BNF for Children, all of which are essential for practice.

MedicinesComplete

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.