Current Health Problem: Medication Errors
Medication use is undoubtedly the most important aspect of patient care worldwide. With the increased and widespread use of medications comes an increased risk of harm. For instance, there are approximately 6800 prescription medications in the United States, not to mention the countless over-the-counter medications (Tariq et al., 2022). This, combined with the numerous herbal medications and health supplements used to treat various conditions, raises the risk of harm to consumers.
As a result, the Medical Product Safety Commission established goals to focus on overall patient treatment improvement and ensuring the appropriate use of medical products (USDHHS, 2020). According to the Medical Product Safety Commission, medical products include drugs, biological products, and medical devices.
Although there is no universally accepted definition, the National Coordinating Council for Medication Error Reporting and Prevention (2021) defines medication errors as a preventable event that may result in inappropriate medication use or patient harm when the medication is in the control of the healthcare provider, patient, or consumer.
The good news, as suggested by the definition, is that medication error is a preventable action, and thus the go-ahead for all stakeholders to work in unison to integrate and coin preventive interventions. This paper aims to describe the context of a medication error, its causes, the populations affected, and why it is essential. A further discussion of the problem’s potential solutions and ethical implications follows.
Description of Medication Errors and Possible Causes
While interventions have been put in place to reduce the occurrence of medication errors, they have yet to be eliminated. The question that the majority would ask is the reason for the perpetual occurrence of medication errors. Before delving into the causes of medication errors, it is critical to understand their classification.
Medication errors can be classified in a variety of ways, including the stage in the sequence of medication use, the type of errors, the severity, and whether the act is the result of omission or commission (WHO, 2018). Medication errors can occur at any stage of the medication use process, including prescription, transcription, dispensing, administration, and monitoring (WHO, 2018). Based on the type, medication errors are classified as wrong dosage, frequency, route, or patient (WHO, 2018).
A further classification includes acts of commission, such as giving the incorrect dosage of a drug, and acts of omission, such as forgetting to administer a drug (WHO, 2018). Regarding severity, medication errors are classified into levels 0 through 6, with level 0 being a non-medication error and level 6 being a fatal error (Gates et al., 2019). These approaches to categorizing medication errors are mutually exclusive, and there is no strong evidence to support a particular classification criterion, particularly in primary care facilities.
Several studies have delved into examining the factors that contribute to medication errors. According to a Commonwealth Fund International Health Policy Survey, 11% of patients experienced medication errors due to the following risk factors: poor coordination of care, multimorbidity and hospitalization, and cost-related barriers to medical services or medicines (Walsh et al., 2018).
In summary, the survey categorized the key factors associated with medication errors into the following categories: healthcare provider-related, patient-related, work environment-related, and computer system-related. According to the survey, healthcare provider-related factors include a lack of therapeutic training, insufficient knowledge of the patient and the drug, fatigue, emotional burden, inadequate perception of the risk, and poor communication with patients (Walsh et al., 2018).
Patient-related risk factors include, but are not limited to, (1) individual characteristics such as literacy and language barriers and (2) clinical issue complexity such as polypharmacy, multimorbidity, and high-risk medications (Walsh et al., 2018). Work environment-related factors include workload and time pressures, distractions, a lack of standardized protocols, insufficient resources, and physical work environment issues such as lighting.
Medication-related factors such as packaging, labeling, and naming of medicines as well as computerized information system issues such as difficult processes, inadequate design, and lack of accuracy of patient records, are all strongly linked to medication errors (Walsh et al., 2018). While all factors contribute to some degree to the risk of a medication error, some have been shown in studies to play a much larger role in medication error causation than others.
Distractions in the workplace are a significant contributor to the vast majority of medication errors. Tariq et al. (2022) attribute over 75% of medication errors to distraction. Physicians are tasked with many tasks, including history taking, physical examination of patients, ordering laboratory tests, and patient education. Amidst all this, they are asked to write drug orders and prescriptions. A lapse in judgment may occur in the rush to write orders and prescriptions, resulting in medication errors (Tariq et al., 2022).
Physicians may scribble drug orders quickly, not paying attention to dosages, frequency, or route, potentially leading to medication errors. Furthermore, while the percentage of contribution is not known, distortions are a common cause of medication errors. The term “distortions” refers to the physicians’ poor penmanship, abbreviations, and misunderstood symbols. Clearly, these contributing factors are largely avoidable with a little forethought and meticulousness.
The Context of Medication Errors, its Significance, and the Population Affected
Medication error is a worldwide issue that affects all levels of care. Due to the morbidity, mortality, and financial implications of medication errors, it is a significant public health issue that must be addressed. It is estimated that 7000-9000 people die each year in the United States as a result of medication errors (Tariq et al., 2022).
Besides the mortality, hundreds of thousands of patients experience but do not report an adverse reaction or a drug complication (Tariq et al., 2022), suggesting that the problem may be more widespread than statistics indicate. In terms of financial implications, the United States spends approximately $40 billion per year to treat patients who have medication error-associated problems (Tariq et al., 2022).
Aside from the monetary cost, medication errors cause significant physical and psychosocial pain, not to mention patient dissatisfaction and growing distrust of healthcare services (Tariq et al., 2022). In other countries, such as the United Kingdom, a study estimated the prevalence of medication errors to be 12% in all primary care patients, with a higher rate of 38% among patients aged 75 and older (Assiri et al., 2018).
A study in Sweden estimated the medication prevalence rate to be 42% nationwide, and in Mexico, it was discovered that 58% of prescriptions contained errors (Assiri et al., 2018). The high prevalence rates and consequences of medication errors provide sufficient impetus for the quest for solutions.
Medication error is an enduring problem for the pediatric and elderly population. Children who have not reached the talking stage are more likely to suffer medication errors due to their inability to communicate whether they are experiencing any medication side effects, if they have an allergy or when they last took the medication (Nkurunziza et al., 2018).
Furthermore, caregivers, often parents, may be anxious about their children’s deteriorating symptoms or, in some cases, lack knowledge of the medication and may administer higher dosages in the hope of achieving a faster clinical remission (Nkurunziza et al., 2018).
In addition, some pediatric drug formulations are sweet, such as Ibuprofen syrup, which has an orange flavor, and risks being consumed in excess, potentially resulting in overdosage. To assess the severity of the problem in the pediatric population, Feyissa et al. (2020) estimate that 41.8% (n=136) of 325 pediatric patients admitted to the pediatric ward and diagnosed with infectious diseases during the data collection period had at least one medication error during their hospital stay.
The elderly are another population group that is at high risk of medication errors. This is due, in part, to the elderly population’s multiple morbidities, which necessitate polypharmacy. Medication errors occur at varying rates among the elderly population. Most studies, however, assign nearly constant factors associated with medication errors in the elderly, such as age ≥65 years, ≥7 days of hospital stay, presence of comorbidity, and polypharmacy (Gebre et al., 2021). While medication errors occur in other populations, the elderly and children account for the vast majority of the cases.
Several studies have explored ways to improve the quality of medication prescription and administration in primary care settings. Educational programs, computer technology, and clinical pharmacists are common strategies used in multifaceted interventions. The education of healthcare providers and patients about medications has been a key area of research in reducing medication errors. Educating a care provider about medications leads to improved adherence to clinical guidelines, which reduces errors (Mieiro et al., 2019).
Similarly, educating patients about their medications and allowing patients to self-administer medications has been proven to be safe and effective in reducing medication errors (Mieiro et al., 2019). The use of automated information systems, such as computerized provider order entry (CPOE) systems, has the potential to reduce medication errors. The CPOE systems include alarm devices that detect incorrect dosages, frequency, and routes, as well as reduce medication errors caused by physicians’ poor penmanship (Mieiro et al., 2019).
Implementation requires an effective information system, hardware, and software, a health informatics group, and the participation of care providers and patients (Mieiro et al., 2019). Clinical pharmacists assist with medication reviews and reconciliation, which entails checking for potential drug-drug interactions, correcting medication discrepancies, and developing interventions that lead to increased identification and resolution of medication-related problems.
People are shifting to technologizing medication processes to reduce medication errors as technology in healthcare becomes more prevalent. However, these interventions are used in tandem because no study has proven that one strategy is superior to others.
Ethical Implications for the Implementation of Potential Solutions
The interventions used to help reduce medication errors must, at the very least, adhere to four ethical principles: autonomy, beneficence, nonmaleficence, and justice. The concepts of autonomy and right to self-determination recognize patients’ rights to make independent decisions and take actions that they deem appropriate. Educating patients about the possibility of medication errors allows them to make informed decisions about seeking treatment if a medication error occurs (McMillan, 2019).
The concept of beneficence and nonmaleficence may cause a conflict for the caregiver when balancing the projected benefits with the patient’s potential risks. Because medications have the potential to cause harm to patients, caregivers should take the necessary precautions to keep patients safe (McMillan, 2019).
While nonmaleficence refers to not harming the patient, it is difficult to completely assure the patient of no harm because all medications have the potential to cause harm to some degree. Justice, on the other hand, refers to treating patients fairly and equally. All patients, regardless of race or other characteristics, receive the best care possible, and if they have a medication-related problem, they are also treated without discrimination.
While medication error is a serious global health concern, it is potentially avoidable. Every country experiences some level of a medication error, which varies depending on the country’s economic situation and the importance placed on health in that country. Effective interventions to prevent medication errors are available worldwide; however, complete elimination has yet to be achieved.
The advancement in technology that has resulted in the revolutionization of healthcare offers great hope for the fight against medication errors. However, it should be noted that a single intervention is rarely sufficient and that multifaceted interventions are frequently required.
Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101. https://doi.org/10.1136/bmjopen-2017-019101
Feyissa, D., Kebede, B., Zewudie, A., & Mamo, Y. (2020). Medication error and its contributing factors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center, southwest Ethiopia: Prospective observational study. Integrated Pharmacy Research & Practice, 9, 147–153. https://doi.org/10.2147/IPRP.S264941
Gates, P. J., Baysari, M. T., Mumford, V., Raban, M. Z., & Westbrook, J. I. (2019). Standardizing the classification of Harm Associated with medication errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Safety: An International Journal of Medical Toxicology and Drug Experience, 42(8), 931–939. https://doi.org/10.1007/s40264-019-00823-4
Gebre, M., Addisu, N., Getahun, A., Workye, J., Gamachu, B., Fekadu, G., Tekle, T., Wakuma, B., Fetensa, G., Mosisa, B., & Bayisa, G. (2021). Medication errors among hospitalized adults in medical wards of Nekemte Specialized Hospital, West Ethiopia: A prospective observational study. Drug, Healthcare and Patient Safety, 13, 221–228. https://doi.org/10.2147/DHPS.S328824
McMillan, J. (2019). Grounded ethical analysis. Journal of Medical Ethics, 45(1), 1–2. https://doi.org/10.1136/medethics-2018-105272
Mieiro, D. B., Oliveira, É. B. C. de, Fonseca, R. E. P. da, Mininel, V. A., Zem-Mascarenhas, S. H., & Machado, R. C. (2019). Strategies to minimize medication errors in emergency units: an integrative review. Revista Brasileira de Enfermagem, 72(suppl 1), 307–314. https://doi.org/10.1590/0034-7167-2017-0658
Nkurunziza, A., Chironda, G., & Mukeshimana, M. (2018). Perceived contributory factors to medication administration errors (MAEs) and barriers to self-reporting among nurses working in pediatric units of selected referral hospitals in Rwanda. International Journal of Research in Medical Sciences, 6(2), 401. https://doi.org/10.18203/2320-6012.ijrms20180276
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2022). Medication dispensing errors and prevention. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519065/
US Department of Health and Human Services. (2020). Medical product safety. Healthypeople.gov. https://www.healthypeople.gov/2020/topics-objectives/topic/medical-product-safety
Walsh, L. J., Anstey, A. J., & Tracey, A. M. (2018). Student perceptions of faculty feedback following medication errors – A descriptive study. Nurse Education in Practice, 33, 10–16. https://doi.org/10.1016/j.nepr.2018.08.017
Assessment 4 Instructions: Analyzing a Current Health Care Problem or Issue
Write a 4-6 page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications.
Assessment topic is — Medication errors
With peer-reviewed articles and references.