People go to doctors for a variety of reasons, ranging from a mild fever or cough to severe life-threatening cases. Regardless of the reason for the visit, patients rightfully expect their doctors to treat them appropriately and with the utmost care. The doctors are held to a high standard of precision and attentiveness when it comes to treating patients, as even a minor slip from a doctor can lead to life-threatening situations.
At the end of almost every doctor’s visit, a doctor either will refer a patient to a different department, or to a procedure, or the doctor might prescribe a therapeutic drug to their patients. This may be the last step of the visit but is a very crucial step and any mistake or negligence during this step can have dire consequences for the patients and the doctor.
What is a medication error?
Any error made during the medication use process, from the medication being prescribed by the doctor to the distribution of it by the pharmacist and the consumption of it by the patient, is referred to as a medication error. The Institute of Medicine has estimated that the medication errors resulted in 1 out of 131 outpatient deaths and 1 out of 854 inpatient deaths. Furthermore, the Food and Drug Administration (FDA) receives upwards of 100,000 reports of medication errors from the US alone.
Checkpoints at which medication errors occur
Millions of drugs are sold every year in the US, both over the counter medications and prescription-only medications. To acquire a drug, there are certain steps the patients need to go through and a medication error can occur at any of the steps, which are listed below:
Typically, the mistakes are made in the first step during the ordering and prescribing period by the doctors themselves.
Types of Medication Errors
Medication errors can be due to several reasons, resulting in various consequences, and based on this information, they can be of different types, as mentioned below:
- Wrong time
- Unauthorized drug
- Improper dosage
- Wrong dose prescription/wrong dose preparation
- Administration errors including the incorrect route of administration, wrong patient, extra dose, or wrong rate
- Monitoring error such as not documenting allergies, drug interactions, the effect of the drug on liver and kidney function
- Compliance error such as not following protocol or rules established for dispensing and prescribing medication
Causes of medication errors
Medication errors may arise due to many reasons and some of them are listed below:
- Distractions: Approximately 75% of medication errors are due to a distracted doctor. Doctors are responsible for many things in the hospital which occupy their mind at all times. On a busy day, while worrying about other responsibilities, they are more likely to make a mistake in prescribing drugs. They may either forget about drug interactions or allergies and prescribe the wrong drug, they may prescribe the wrong medication to the wrong patient, or they may prescribe the wrong dosage.
- Distortions (Poor handwriting and writing): Another major cause of medication errors is the bad handwriting stereotypically, but accurately associated with doctors and the use of illegible short forms and abbreviations. Sometimes, this results in errors because each system in the hospital is too busy to double-check and the pharmacist may give whatever he understands of the abbreviation or handwriting. This can result in serious medication errors.
- Negligence of the healthcare staff including the doctors, nurses, and pharmacists.
Mistakes made specifically by the doctors
Prescription of the right drug at the right dosage for the right disease is extremely important for both, saving lives and preventing lawsuits. More often than not, the wrong drug might be prescribed or the wrong dosage may be written.
Sometimes, a doctor may not pay attention to the patient’s personal history and prescribe a drug for their chief complaint. Now, since they prescribed a drug and listened to the chief complaint, it doesn’t mean that the doctor did the job correctly. By not paying attention to the personal history, the doctor completely missed out on the crucial information on which drugs they are using and what conditions the patient already suffers from.
The medication that the doctor has prescribed might result in drug interaction with a drug already prescribed to the patient. This drug interaction may result in adverse effects worsening the patient’s conditions, rather than improving it.
For example, prescription of certain beta-blockers, a drug for the treatment of hypertension when a patient is already taking Selective Serotonin Reuptake Inhibitors (SSRI), a commonly prescribed anti-depressant, may result in drug interactions, causing severe symptoms.
Drug reactions don’t always result in adverse reactions but can sometimes result in a reduced reaction of the prescribed drug, hence slowing down the therapeutic process. Regardless of the effect, drug interactions are a serious issue in the medical community and doctors should be considerate of it.
Drug interaction is especially to be considered when treating patients with multiple morbidities coexisting at the same time. Negligence of the doctor in taking proper history may cost the patient their life and the doctor their medical license.
The most common medication error is an error in the appropriate dosage. Most of the reports received show that a wrong dosage was prescribed to the patient, which may be too high or too low. This can either result in a slowing of the therapeutic response to the drug or result in toxic levels of the drug in the body causing organ dysfunction.
Furthermore, a doctor might make a mistake in prescribing the drug’s administration route, decreasing the efficiency of the drug by multiple folds. It can not only reduce the capabilities of the drug, it might cause adverse effects that will result in an overall worsened condition of the patients.
As mentioned above, the use of certain abbreviations that are not understandable to the rest of healthcare staff except the doctor may result in wrong drugs being distributed, especially drugs that are spelled like the right drug. Or the dosage may be mixed up, the common error being the abbreviation of micrograms to Ug by the doctor which is read as Units by the pharmacist, resulting in a very high dosage of the drug being distributed.
There are several other mistakes that can be made by the pharmacist and by the nursing staff, however, the doctors are the ones who suffer the consequences of a medication error. If the handwriting of the doctor was illegible and the pharmacist gave the patient the wrong drug, the blame is still on the doctor. If the nurses do not check the mistake by the doctor or the pharmacist and administer the wrong drug or wrong dosage, the blame is still on the doctor and the illegible handwriting.
Medication errors can result in lawsuits against the hospital and the doctor that can cost the hospital millions and the doctors their medical license. In fact, many law firms have a special department dedicated to medication errors and they help affected patients or their families sue the hospital and the doctor.
These malpractice claims or lawsuits can be very costly and can be avoided completely if the doctors become more careful and attentive in clinics, and use computerized prescription forms to remove the illegible handwriting aspect from the problem. Furthermore, better communication between doctors can prevent drug interactions and allergies, and better communication between the patients and the doctors can reduce the medication errors incidence significantly.
However, doctors alone are not to be blamed for medication errors even though they are the ones who suffer from legal consequences. Hospital administration overworking the healthcare staff and overbooking of a doctor by the admin resulting in only a few minutes with each patient is equally responsible in the making of a negligent and distracted doctor.
There is no one single step to reducing medication errors, in fact, the entire healthcare staff and administration need to work together to reduce these errors, by hiring more staff, reducing the numerous responsibilities of one single doctor, and better communication. Communication is key.