___________________________________________ Medical Errors and the United States Healthcare System
The incidence of medication errors is an issue of contention. Because definitions of medication errors can differ, many medica- tion errors must be self-reported to be recorded, and data suggest a significant percentage of medication errors are not reported [19]. In addition, there is no central agency or institution respon- sible for collecting reports of medication errors, so no one knows how many medication errors actually occur. A medication error is defined as “any preventable event that my cause or lead to inappropriate medication use or patient harm while the mediation is in the control of the healthcare professional, patient, or consumer.”[19] Medication errors are the most common type of medical error. About 1.3 million people are injured annually in the United States following such errors [34]. The incidence of medication errors varies according to patient population and clinical setting. Children and the elderly are more likely to be harmed by medication errors than other segments of the population; children are more susceptible to harm from dosing errors due to their small size, while older individuals tend to take more medications, increasing their potential for medical error and adverse drug interactions. Polypharmacy is not uncommon is patients older than 62 years [35]. Medication errors are more likely to occur in fast-paced, stressful environments such as intensive care units, where errors are more likely to be more severe and cause harm [36]. Data from the FDA show that the most common error involving medications was related to the administration of an improper dose of medicine, accounting for 41% of fatal medication errors. Administering the wrong drug and using the wrong route of administration each accounted for 16% of the errors [34]. Some drugs that are frequent causes of medication errors are commonly used (e.g., insulin and antibiotics). Others are suffi- ciently potent and there is little room for therapeutic error and substantial potential for harm from seemingly small mistakes (e.g., the cardiovascular drug nitroprusside, heparin, warfarin, insulin, or colchicine). Another set of drugs are common causes of medication errors because they can be easily confused (e.g., Percocet ® [acetamino- phen and oxycodone] confused with Vicodin ® [acetaminophen and hydrocodone]). The Institute of for Safe Medication Practices (ISMP) identified some specific medications classified as high-risk, meaning that they are associated with a heightened risk of causing significant patient harm when used inappropriately [37]:
• Ephinephrine subcutaneous. • Epoprostenol (Flolan) IV. • Insulin U-500 (All forms of insulin are considered high-risk. Insulin U-500 has been singled out for special emphasis to bring attention to the need for distinct strategies to prevent the types of errors that occur with this concentrated form of insulin). • Magnesium sulfate injection. • Methotrexate, oral, nononcologic use. • Opium tincture. • Oxytocin, IV. • Nitroprusside sodium for injection. • Potassium chloride for injection concentrate. • Potassium phosphates injection. • Promethazine, IV. • Vasopressin, IV or intraosseous. In an effort to identify root causes, a great deal of attention focused on why medication errors occur. Among a variety of reasons or these mistakes are poor staffing, unskilled/new nurses, stress, personal error, and distraction. These data suggest the most common medication errors are related to an improper dose of medication, administering the wrong dose of medication or the wrong drug, or administering medication via the wrong route [34]. The FDA has also commented on common causes of medica- tion errors as follows: poor communication; ambiguities in product names, directions for use, medical abbreviations, or writing; poor procedures or techniques; patient misuse because of poor understanding of the directions for use of the product; job stress; lack of knowledge or training; similar labeling or packaging [38]. The following list describes the most common causes of medi- cation errors according to specific definitions:[37] • An action-based medication error is defined as the performance of an unintended. Examples of action-based medication errors would include selecting the wrong medication or administering an incorrect dose. • A rule-based medication error occurs because the provider did not follow proper rules or procedures for medication administration. • A memory-based medication error occurs when a provider forgets to perform a task or forgets important information about the patient. The provider may forget to give a dose of a medication, that the medication has been discontinued, or that the patient is allergic to the medication.
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