Part Three: Medication Errors Can Be Reduced By Better Prescribing Methods

In our first part of this series, we looked at the extent of serious adverse drug reactions (ADRs) in the U.S., and in the second part we considered how those could be reduced by better monitoring of emerging drug-safety issues. In this third part, we will see how the number of serious ADRs resulting from medication errors might be reduced by better prescribing methods.

In July 2006 the National Academy of Sciences’ Institute of Medicine (IOM) issued a report that reminded us just how many people are harmed by medication errors.  Marc Kaufman, of the Washington Post, gave us an idea of the magnitude this problem in his July 21, 2006 article about the IOM report:

At least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications….  Mistakes in giving drugs are so prevalent in hospitals that, on average, a patient will be subjected to a medication error each day he or she occupies a hospital bed….  The report found errors to be not only harmful and widespread, but very costly as well. The extra expense of treating drug-related injuries occurring in hospitals alone was estimated conservatively to be $3.5 billion a year.

The IOM report found that some of the more common medication errors involved:

• doctors writing prescriptions that could interact dangerously with other drugs a patient is taking;
• nurses putting the wrong intravenous drug in an IV drip; and,
• pharmacists dispensing the right pill but at the wrong dosage level.

This July 2006 IOM report, "Preventing Medication Errors", was written for the Centers for Medicare and Medicaid Services.  It had two primary aims, to estimate the incidence of medication errors and to identify the best preventive strategies to prevent and reduce those error.

In the recommendations part of their report, the experts serving on this IOM committee reiterated what many observers had noted previously, that many medication errors could be avoided if there were better prescribing methods by doctors.  Specifically, the report included these four recommendations:

1. All prescriptions should be written electronically by 2010.
2. Doctors should improve communication with patients about how to take drugs safely and about potential risks.
3. Doctors should use electronic decision-support tools to write prescriptions.
4. Doctors should regularly review all medications with patients and other physicians involved in a patient’s care.

The IOM committee members said the extent of the medication errors problem requires immediate action, and noted that at least a quarter of the injuries caused by medication errors could be prevented by taking steps like those recommended in its report.

In the final part of this ADRs in US series we will look at how the failure of some doctors to provide essential prescription drug information to their patients is part of the problem.

(Posted by: Tom Lamb)