MEDICATION PRESCRIBING ERROR: A SOURCE OF CONCERN
Sadia Zafar, Faaiza Qazi, Nusrat Bano, Rabia Sheikh
Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan. Faculty of Pharmacy, Ziauddin College of Pharmacy, Ziauddin University, Karachi, Pakistan. Nigehban Compounding Pharmacy, Karachi, Pakistan
Keywords: Medication error, Prescribing guidelines, Protocol.
Abstract

Background: There are different types of medication errors which are experienced by the pharmacists in hospital settings. In Pakistan number of attending Pharmacist per bed is low and is a major cause of fatal and life threatening events. Aim: The aim of present retrospective study was to assess the extent and type of medication error in inpatient medical charts. Method: The physician’s orders were analyzed by the clinical pharmacists in hospital setting during 2007-2008 in different wards. Various types of prescription errors had been reported and expressed in percentages. Result:Out of 450 medical treatment charts, 381 medication errors were found in 350 charts. The highest rate of error was the wrong dose (25%) prescribed by physicians.Infrequent errors were lack of dosage frequency, protocol for treatment, dosage form and continuation of antibiotic after prescribed treatment days. However, most frequently occurring serious errors were wrong dosing frequency (17%) and no dose adjustment according to creatinine clearance (12.8%).3.41% errors were related to directions for use of medicines. Conclusion:Our study has demonstrated large number of prescription errors and high proportion of themwere of serious nature therefore careful counter checking of medical charts is suggested.

Article Information

Identifiers and Pagination:
Year:2015
Volume:7
First Page:
Last Page:
Publisher Id:19204159.7:1.2015
Article History:
Received:November 3, 2015
Accepted:November 10,2015
Collection year:2014
First Published:January 1, 2015

INTRODUCTION

Medication error is the most frequently occurring incidence in the healthcare system.[1]These errors occasionally causes any emergency conditions, life threatening incidences or affects patients’ quality of life.[2,3]General practitioners commonly do not follow the prescription guidelines.[4]These prescribing, dispensing or administering errors are avoidable,[5] various approaches have been suggested to control these medication errors which emphasizes on the collaborative approach to ensure proper contribution by each healthcare personnel involved in healthcare system.[6]Pharmacists actively play their roles in hospital settings especially during wards rounds.[7] Hospital pharmacy is the area which fulfills their urge to impart their skill and knowledge at the fullest. Their command on pros and cons of particular drug action provide them opportunity to serve the patient in true sense .[8] A large no. of data is available which shows that pharmacist as a custodian of drugs save the lives of patients. Pharmacists serves as a bridge between doctor and patient, therefore pharmacists counter checks the discrepancies contributed by doctors and nurses[9]Whether it may be an inpatient medical chart or outpatient prescription there are numerous chances of type A,B,C,D  errors.[10,11] To avoid these errors a lot  of researches and reviews have established various approaches to control these medication errors especially  emphasizes on the collaborative approach that is the steps to ensure proper contribution by each healthcare personnel involved in healthcare system [6] especially the inclusion of clinical pharmacist in wards round with doctors. It also highlights the importance on taking advantage of recent advances, interventions and technologies [3]

Every pharmacist faces hindrances and noncooperation from other healthcare providers[11,12]therefore the benefits from pharmacists’ skill are not being fully utilized in Pakistan.[13] However, no one can deny the fact that scrutiny of medication order by pharmacist during clinical rounds and at the time of dispensing can largely minimize the chances of undesirable events[7,14]

1. The aim of present retrospective study is to identify the areas where the chain of collaborative approach among doctors, nurses and pharmacist breakdown and results in adverse events causing reversible or irreversible harm to the patient.

2. To analyze the extent and type of medication errors in inpatient medical charts which are observed by the clinical pharmacists in hospital setting

METHODOLOGY

The current study has been conducted from Jan2007 – Jan 2008, in different wards (GIT, CW, MICU, CCU)of renowned tertiary care hospital of Karachi. The mode of ordering medicines to patients was based on hand written instructions by doctors on patients medical history file. The nurses than put down the order in prescription for pharmacist to dispense in wards. The clinical pharmacist also participated in clinical rounds along with the physicians and reviewed patient history, laboratory reports as well as physicians orders during this period and reported medication errors identified by them. Total 450 medical treatment charts have beenchecked, analyzed and different types of medication errors were studied and expressed in percentages.

RESULT

In our present stud we have observed different types of medication errors. Prescribing wrong dose (28%) was the most common medication error followed by the wrong dosage frequency (19%) .It was found that practitioners did not state the strength of preparation in 16% of prescriptions among all which was followed by either wrong strength (15%) and no dose adjustment according to creatinine clearance (14%).

Table 1: Medication errors observed during clinical wards rounds

DISCUSSION:

Bandresetal studied low level of prescription errors however they found incomplete prescriptions were in high frequency.[15]Ajemigbitseetalfound that lack of attention on part of docters was the most errors in prescriptions.[16] Merino etal observed high frequency of prescription error at prescription and administration stage.[17] Our findings were further substantiated by the outcomes observed by Alshaikhetal that is 17% of total prescriptions were unclear due to poor hand writing.[18]

Abbasinazarietal showed that highest error rate was found in prescriptions having 27 % wrong frequency, 9.5% forgot to discontinu.[19] In one of studies conducted by Alsulamietal it was observed that most common tpe of prescribing error were incorrect dose, wrong frequency and strength.[20] Many previous studies have reported prevalence of dispensing, administering and transcribing errors.[21,22]

Insufficient data availability related to medication error as well as non implementation of prescribing rules have potentiated the need for adopting necessary measures to ensure patient safety.[23]

Karthikeyan andLalitha in his studies indicated administration errors (28.35%) were most frequently occurring error.[24]Gouyonetal observed high frequency of dosing error in his studies.[25]

CONCLUSION:

Since pharmacists serves as a bridge between doctor and patient therefore pharmacists can play vital role in avoiding discrepancies contributed by doctors and nurses. Most of the prescription errors occurs during ordering and transcribing and these initial errors could be effectively inhibited by inclusion and active participation of Pharmacists, because being expert they can provide valuable advises in careful dispensing as well as administration of drug.

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19.    19.Abbasinazari M, HajhosseinTalasaz A, Eshraghi A, Sahraei Z.(2013) Detection and management of medication errors in internal wards of a teachinghospital by clinical pharmacists. Acta Med Iran;51:482-6.

20.    Alsulami Z, Conroy S, Choonara I.(2013)  Medication errors in the Middle East countries: a systematic review of the literature.Eur J Clin Pharmacol.;69:995-1008.

21.    Mansouri A, Ahmadvand A, Hadjibabaie M, Kargar M, Javadi M, Gholami ,(2013)  Types and severity of medication errors in Iran; a review of the current literature. Daru, ;21:49.

22.    Avery AJ, Ghaleb M, Barber N, Dean Franklin B, Armstrong SJ, Serumaga B, Dhillon  S, FreyerA, Howard R, Talabi O, Mehta RL,(2013) The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review. Br J Gen Pract.;63:e543-53.

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Editor in Chief
Prof. Dr. Cornelia M. Keck (Philipps-Universität Marburg)
Marburg, Germany

Bibliography

Welcome to the research group of Prof. Dr. Cornelia M. Keck in Marburg. Cornelia M. Keck is a pharmacist and obtained her PhD in 2006 from the Freie Universität (FU) in Berlin. In 2009 she was appointed as Adjunct Professor for Pharmaceutical and Nutritional Nanotechnology at the University Putra Malaysia (UPM) and in 2011 she obtained her Venia legendi (Habilitation) at the Freie Universität Berlin and was appointed as a Professor for Pharmacology and Pharmaceutics at the University of Applied Sciences Kaiserslautern. Since 2016 she is Professor of Pharmaceutics and Biopharmaceutics at the Philipps-Universität Marburg. Her field of research is the development and characterization of innovative nanocarriers for improved delivery of poorly soluble actives for healthcare and cosmetics. Prof. Keck is executive board member of the German Association of Nanotechnology (Deutscher Verband Nanotechnologie), Vize-chairman of the unit „Dermocosmetics“ at the German Society of Dermopharmacy, active member in many pharmaceutical societies and member of the BfR Committee for Cosmetics at the Federal Institute for Risk Assessment (BfR).

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Abbreviation: J App Pharm
doi: http://dx.doi.org/10.21065/19204159
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