M4

• Medication errors are a major problem
• USA: $17 billion – $37 billion is lost annually due to medication errors resulting in loss of income, disability and healthcare expenses
• At least 400,000 adverse drug events in hospitals are preventable
• Medication errors are not fully preventable
• Causes more deaths in a year than

  • Breast cancer
  • AIDS
  • Vehicular accidents
• Medication safety


  Totality of medication use to the patient
• Medication safety


  Core of health system pharmacy practice
• Over 7000 preventable deaths occur each year due to medication errors
• Aim 1: Safety


  • Medications should be as safe for patients in health care facilities as in their homes
• Aim 2: Effectiveness


  • Evidence and science behind health care should be applied and serve as the standard in the delivery of care
• Aim 3: Patient-centeredness


  • System of care should revolve around the patient
  • Respect patient preferences and put the patient in control
• Aim 4: Timeliness


  • Patients should experience no delays or waiting in receiving care and service
• Aim 5: Efficiency


  • Care and service should be efficient
  • Waste should be eliminated from the system
• Aim 6: Equitable


  • Unequal treatment and disparities in care should be eliminated
• Medication misadventures


  Preventable hazards or incidents associated with indicated drug therapy resulting to harm
• Causes of medication misadventures

  • Medication errors
  • Adverse drug reactions
  • Adverse drug events
• Adverse drug reactions (ADR)

  Drug related problem that consists of an unexpected, unintended, undesired or excessive responses to a drug that requires medical response or resulting in negative outcome at normal doses during normal use
• Adverse drug events (ADE)

  • ADRs that result in an injury that is either preventable or not preventable due to the use or lack of intended use of a drug
  • May be drug related or not
• ADR is not always a result of medication error
• Allergic reaction


  • Result of immunologic sensitivity to drugs
  • Due to hypersensitivity
• Allergic reactions


  • Rash, hives, anaphylaxis
• Idiosyncratic reaction


  • Reaction to a medication that is unpredictable and unprogrammed
  • Unique to a particular person
• Allergic reactions and idiosyncratic reactions are considered as adverse drug reactions, not side effects
• Side effects


  • Expected and predictable reactions
  • Require monitoring or adjustment in patient management
• Side effects


  • Antihistamine, anxiolytics, anticonvulsants
  • Antibiotics
  • Antidepressants
• Medication errors


  Any preventable event that may cause or lead to inappropriate medication use or patient harm
• Medication errors are mistakes that occur in the medication use process
• Healthcare personnel are not infallible
• Stages where medication errors can occur

  • Prescribing
  • Dispensing
  • Administration
  • Monitoring
• Causes of medication errors

  • Lack of patient information
  • Lack of drug information
  • Lack of communication related to medication
  • Inadequate drug labeling, packaging
  • Lack of medication delivery device
  • Environmental factors
  • Inadequate staff competency and education
  • Lack of patient education
• Prescribing error


  Inappropriate or incorrect drug selection
• Causes of prescribing errors

  • Lack of knowledge
• Dispensing error


  Incorrect drug issued, either as wrong drug, wrong strength, or wrong dosage form
• Causes of dispensing errors

  Lack of knowledge
• Administration error


  Caused by healthcare personnel
• Types of administration errors

  • Omission error/skipped dose
  • Wrong time error
  • Unauthorized drug error
  • Improper drug error
  • Wrong dosage form error
  • Wrong drug-preparation
  • Wrong administration-technique error
• Omission error


  Failure to administer an ordered dose to a patient before the next scheduled dose
• Wrong time error


  Administration of medication outside a predefined time interval from its scheduled administration time
• Unauthorized drug error


  Administration to the patient of medication not authorized by a legitimate prescriber for the patient
• Improper dose error


  Administration to the patient of a dose that is greater than or less than the amount ordered by the prescriber