Naveed Saleh, MDLinx, February 13, 2020

With over 10,000 prescription drugs on the market and about one-third of all American adults receiving more than five medications daily, there is an excess of room for potential adverse drug events. According to the Agency for Healthcare Research and Quality, annually, adverse drug events make an approximate 700,000 emergency department visits and 100,000 hospitalizations. Disconcertingly, most reviewed are preventable.

It’s known to everyone that electronic health records (EHRs) are time-consuming, and might once in a while feel that doctors are spending valuable time filling out documents while they can be seeing another patient. However, it’s essential to not forget that EHRs have helped alleviate preventable errors. Although no method is fail-safe, following several good practices and safety strategies can help lower the risk of preventable errors.

Here’s a closer analysis at some examples of preventable medication errors and strategies to prevent them.

Examples of medication mix-ups

All of the following examples of medication mix-ups have literally happened with various degrees of frequency:

Confusing name pairs: The matter of look-alike and sound-alike (LASA) medication errors turns into graver as further drugs hit the market. The health consequences can range from no harm to death. A physician’s poor calligraphy or a pharmacist’s inability to read a prescription can result in LASA medication errors. Confusion may occur owing to similarities in the spelling and sound between two brand names (eg, Keppra and Kaletra), between two generic names (eg, midodrine and minoxidil), or between a brand and a generic name (eg, Hespan and heparin). For example, the FDA has indicated several cases of mix-ups between Farxiga (dapagliflozin), a drug that reduces blood glucose levels in type 2 diabetes, and Fetzima (levomilnacipran), an antidepressant. Additionally, both drugs were authorised within 6 months of each other, which can further lead to conflation.

Ambiguous course dosing: To prevent any confusion, doses should expressly and routinely be prescribed using the “dose/kg/day for a set amount of days” format. Also, dosing by telephone order—even when repeated back-should be avoided.

Drug-drug interactions: With a growing number of drugs presented each year, adverse drug-drug interactions have become a promptly rising problem. However physicians are often cautioned to potential drug-drug interactions, the absolute number of drugs out there can make it complicated to remember all of them. Therefore, it’s an excellent idea for physicians to reference EHR clinical decision support tools-or a resource like Micromedex-to screen drugs for eventually harmful interactions.

Explaining potential interactions to patients: Adverse interactions can also occur owing to patient error. A patient may misinterpret or be ignorant of several therapeutic requirements, which may result in injury or poor outcomes. To reduce preventable medication errors, physicians should cautiously discuss all therapeutic instructions and requirements with their patients. 

The Institute for Safe Medication Practices (ISMP) promotes healthcare professionals to notify medication errors whenever confronted via the ISMP National Medication Errors Reporting Program (ISMP MERP), which is a confidential service.

Safety strategies

Strategies to prevent medication mix-ups can be posted at every step of the prescription pathway.

In terms of prescription, it’s a good idea to prescribe cautiously to avoid unnecessary medications. Moreover, medications should always be reconciled when care is upgraded.

Additionally, computerized supplier order entry systems should be coupled with clinical decision support systems to avoid errors at the medication ordering and dispensing stages. Essentially, handwritten prescriptions should be avoided whenever possible.

During dispensing, ensure supervision by a clinical pharmacist. Moreover, tall-man lettering, wherein distinguishing letters in LASA drug names are capitalized, is recommended. One pneumonic that helps with dispensing is the 5 Rs: Right medication, Right dose, Right time, Right route, and Right patient. Importantly, automated dispensing cabinets should be used for high-risk medications.

With administration, it’s important to restrict any interruption to allow nurses to safely give medications. Smart infusion pumps should be used for intravenous infusions. Moreover, multi-compartment medication devices can be advantageous in cases of polypharmacy. Finally, patient education is clutch, with robust and comprehensible advice distributed.