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How to ward off medication errors: Experts' perspectives

Pearl Toh
18 Jan 2020
 

Almost three-quarters of adverse events (AEs) related to medication errors in over-the-counter (OTC) cough and cold medications (CCMs) for paediatrics required evaluation by healthcare facility and majority of the cases were due to dosing errors, a surveillance study has found, highlighting the need for interventions to mitigate medication errors. 

With the advent of the digital age, the potential of new technologies can be harnessed to help detect medication errors and allow for medication reconciliation at transition points such as at hospital admission, as shown in a separate study.

When asked on how medication errors can be prevented in the primary care setting, Dr Serene Wee from Parkway Shenton, Singapore, who was not affiliated with the studies, responded: “What we do is a two-people verification and check of medications. In polyclinic, there are pharmacy technicians to cross check.” 

“We also have drug information option available on [clinic management software system] to check drug dosages, indications [and other drug information],” she added.

Dosing errors most common

In the national surveillance study, 513 paediatric cases with a significant AE related to OTC CCM identified were due to medication errors. Almost all cases (93.2 percent) were due to the wrong dose of medication administered. Of these, dose volume error constituted 86.6 percent of the dosing error, while 19.2 percent involved dose frequency error. [Acad Pediatr 2019;doi:10.1016/j.acap.2019.09.006]

Although no deaths were reported from the medication errors, nearly three-quarters (74.3 percent) of the cases needed to be evaluated at healthcare facility, and 24.6 percent were admitted.

“Continued standardization of measuring devices, concentrations, and units of measure along with consumer education are needed to further decrease medication errors from CCMs,” the researchers suggested.

Diphenhydramine (30.2 percent) and dextromethorphan (50.9 percent) were the most common ingredients responsible for most medication errors, regardless of formulations used. They also accounted for most of the medication errors requiring evaluation at healthcare facility (29.1 percent and 52.0 percent, respectively).  

“While identifying the root cause of medication errors may help target interventions to improve safe use, nearly a third of medication error cases involved children <4 years old for whom CCM use is not recommended,” said the researchers.

Almost half of the medication errors (45.8 percent) involved children aged 2 to <6 years.

“The child is growing. Their weights are moving targets. Sometimes parents may underdose the child by giving the same volume months ago,” commented Associate Professor Andrea Kwa, assistant director of Health Services Related Research Unit at Department of Pharmacy, Singapore General Hospital, Singapore, who was unrelated to the study.

“The key is to empower the parents how to dose, what to use these medications for, and the knowledge of what is available in the local market,” she stressed.

Labelling, counselling, education

Many errors come about from not knowing what had been given was actually similar type of medications, and this arises because of leftover medications from previous visits to pharmacies and clinics, according to Kwa.

In such cases, counselling and detailed labelling can help keep medication errors at bay, be it in the setting of OTC pharmacies, primary care, or hospitals, she said. Patients should be counselled on what other drugs they receive and how to identify drugs with similar active ingredients locally and online.

“I will add on and explain the following details, teaching the parents how to apply should [the child] need the same medication many months down the road,” said Kwa, alluding to keeping details such as the patient’s weight by the date recorded, the appropriate dose by weight (mg per kg), and the associated dose (in volume) in the label.

“Further education to healthcare providers on the recommended safe use of these medications in young children, in addition to understanding caregiver awareness of labelled warnings and reasons why they continue to use CCMs despite these warnings may lead to additional improvements in safety,” the researchers added.

Also, modern technology can promote medication adherence and avoid dosing medication errors —especially in cases involving multiple caregivers — by improving communication between different parties and avoid repeat dosing, the researchers pointed out.

Electronic tool for medication reconciliation

A separate study showed that an electronic pharmaceutical record (EPR) of past medications used by a patient can help detect prescription errors and allow for medication reconciliation at hospital admission. [Presse Med 2019;48:999-1000]

“In our study, EPR has proved to be an essential tool to detect prescription errors. Indeed, it has enabled to detect them, frequently more than other sources of information [such as] patient's interview [and] contact with community pharmacy,” said the researchers.

Of the 70 prescription errors detected, drug omission was the most common types of errors (65.7 percent), followed by discrepant dose (27.1 percent) and discrepant frequency (2.9 percent).

When the researchers looked into the information sources used to detect these errors, most of them were detected based on EPR (77.1 percent), followed by patient’s interview (64.3 percent), contact with community pharmacy (42.9 percent), and previous drug prescriptions (41.4 percent).

In fact, six prescription errors (8.6 percent) would not have been detected if not for the source of information from EPR. 

“The EPR represents therefore a very interesting source of information, especially for patients for which limited information is available about their personal treatment,” said the researchers. “It has the advantage to list self-medications, which could interact with the current treatment. It also allows a better coordination between healthcare facilities and community.”

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