In this week’s post we discuss an article published earlier this year in The Pharmaceutical Journal, focusing on the top ten prescribing errors and how pharmacists can help reduce them. These errors are often avoidable and can be very costly, both financially and from a patient outcome standpoint. Do you know what the top ten are? Are you working with a consultant pharmacist to help reduce your risk and improve patient safety?
It has been noted that in general practice, the rate of prescribing errors per order approaches five percent. This number jumps to nearly nine percent in acute care hospitals. Although many errors lead to no harm, or low to moderate harm, some errors result in significant patient harm and in some cases, death. Here is a list of the top ten errors and what you can do to minimize the risk to your patients:
1. Prescriptions for medicines were omitted or delayed: This is often a system failure in continuity of care. What can you do? Ensure proper communication with other healthcare professionals, the patient and caregivers. Additionally, make sure your organization has in place a process for medication reconciliation when patients are admitted and discharged.
2. Anticoagulants: Warfarin and heparin were traditionally involved in these errors. The introduction of Direct Oral Anticoagulants has increased treatment options, but also the number of potential errors. What can you do? Develop a policy and procedure to address the management of anticoagulants perioperatively. It is imperative that patients receive education on when to stop and then resume anticoagulant therapy, what to expect in terms of possible side effects and when to call their doctor.
3. Opioid analgesics: Improper use of opioids can lead to tolerance, dependence and even overdose. What can you do? Obtain a thorough history to determine if the patient is currently using opioids. Double check appropriate dosing for opioid naïve patients and review dosing equivalence when changing from one opioid to another.
4. Insulin: With the number of available insulins and insulin combinations growing, the potential for error continues to escalate. What can you do? Use electronic prescribing when possible and cross reference with available information to confirm identity.
5. Nonsteroidal anti-inflammatory drugs: These medications lead to many adverse drug events including bleeding, heart attack, stroke and kidney injury. What can you do? Avoid using these drugs in higher risk populations, such as the elderly, when possible. Use the lowest dosage for the shortest possible time and if prolonged use is needed, consider gastroprotection. Alternatives could include acetaminophen or topical therapy.
6. Drugs that require regular blood test monitoring: There are many drugs that require routine blood tests; this includes angiotensin-converting enzyme inhibitors, clozapine, digoxin, gentamicin, lithium, loop diuretics and mirtazapine. Lack of monitoring can lead to adverse drug events and patient harm. What can you do? Set up monitoring when the medication is first started and educate patients on the frequency and importance of monitoring.
7. Known allergy to medicine, including antibiotics: Patient harm often occurs when they are exposed to medications to which they are allergic. These allergies are often known and documented. What can you do? Document all patient allergies and clarify the specific reaction to each one. Additionally, check allergy status before initiating any new medication.
8. Drug interactions: Drug interactions may reduce the effectiveness of a medication or they could worsen an adverse drug event. What can you do? Use an electronic system that provides prescriber alerts and rely on a knowledgeable pharmacist as one of your valuable resources.
9. Loading doses: Loading doses often require calculations that are error prone. What can you do? Good communication is essential especially when there is a transfer of care. Providers should encourage open dialogue and always question dosages that seem higher than normal.
10. Oxygen: Oxygen should be considered a medication and treated accordingly. Using inappropriate concentrations of oxygen can lead to patient harm. What can you do? Ensure that an order is written for the specific patient and the order includes a target saturation.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.
