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Rising number of unintentional medication errors in nonhealthcare facilities a potential safety threat

Roshini Claire Anthony
26 Jul 2017

The number of unintentional medication errors in nonhealthcare facilities is rising and poses a significant safety threat, according to findings of a US-based retrospective study.

Between 2000 and 2012, 67,603 unintentional medication errors occurring outside healthcare facilities and resulting in serious outcomes were reported to US Poison Control Centers, amounting to an average 1.73 incidences per 100,000 population, 93.3 percent of which occurred at the patient’s residence (n=63,063). [Clin Toxicol (Phila) 2017;doi:10.1080/15563650.2017.1337908]

The rate of serious medication errors per 100,000 US residents increased by 100 percent with an average 1.09 in 2000 to 2.28 in 2012 (p<0.001); number of exposures increased from 3,065 to 6,855 between 2000 and 2012 (123.7 percent increase).

The frequency and rate of errors increased among all age groups except children aged <6 years where the rate increased from 1.68 to 2.02 per 100,000 population between 2000 and 2005 and then decreased to 1.67 in 2012.

“This is ... associated primarily with a decrease in the number of medication errors resulting from the use of cough and cold preparations ... [partly] attributed to the Food and Drug Administration’s 2007 recommendation that such medications not be administered to young children,” said the researchers.

In the overall population, most medication errors were due to incorrect dosage (19.8 percent), and use or administration of the wrong medication or of the medication twice (18.4 and 15.7 percent, respectively).

In contrast, among children aged <6 years, incorrect dose (22.2 percent), healthcare provider iatrogenic error (12.1 percent), and tenfold dosing error (10.9 percent) were the main medication errors, while use or administration of the medication twice (18.8 percent), of another person’s medication (18.8 percent), or of the wrong medication (18 percent) were the most common errors among children aged 6–12 years.

“[P]arents and caregivers have the additional responsibility of managing others’ medications,” said lead author Dr Nichole Hodges from Nationwide Children’s Hospital, Columbus, Ohio, US, who recommended that parents maintain a written log of medications dispensed in order to minimize error.

While incidence of death due to unintentional medication errors was low (0.6 percent, n=414), with a majority of errors resulting in moderate effect (prolonged, pronounced, or systemic non-life-threatening or non-disability- or disfigurement-causing symptoms; 93.5 percent), one-third of errors (33.2 percent) resulted in hospitalization, with 17.4 percent of patients admitted to critical or intensive care units.

Cardiovascular drugs (20.6 percent), analgesics (12 percent), hormones and hormone antagonists (11 percent), sedatives, hypnotics, or antipsychotics (9.6 percent), and antidepressants (8.6 percent) were the medications most associated with unintentional errors, with analgesics and cardiovascular drugs the most frequent sources of errors leading to death (35.7 and 30.2 percent, respectively).

“Most nonhealthcare facility medication errors are preventable ... and additional efforts are needed to prevent these errors,” said the researchers.

“There is room for improvement in product packaging and labelling. Dosing instructions could be made clearer, especially for patients and caregivers with limited literacy or numeracy,” said Henry Spiller, co-author and director of the Central Ohio Poison Center, Nationwide Children’s Hospital.

 

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