Study highlights extent of medication errors in hospitals
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7516.534-a (Published 08 September 2005) Cite this as: BMJ 2005;331:534All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
A recent report highlighted that medication errors on admission
affected up to 67% of patients and were potentially harmful to patients
(1). As many of the medicines that a patient takes during their hospital
admission are a continuation of existing treatment, getting the medication
right on admission is important if we are to reduce risk of errors.
Although clinical pharmacy review has been shown to highlight and
correct medication related error(2)the retrospective nature of
prescription review leads to significant delays in the correction of
errors (3), allowing erroneous drug treatment to be administered to
patients. In a multi-centre study Pharmacists reviewed 791 (71.85%) out
of 1170 medical patients admitted to 7 hospitals in England and Wales over
a five-day period. A total of 464 interventions were made in 298 (37.67%)
patients, 391 (83.75%) of which were accepted by the relevant medical
staff, 1 was rejected and 72 (16%) were unresolved at the time of
reporting. The most common intervention (41.4%) was to add a drug that
had inadvertently been omitted from the prescription.
Examples of errors identified include:
• Digoxin 1mg prescribed instead of doxazosin 1mg
• Patient with acute coronary syndrome prescribed sumatriptan
• Thyroxine 250mcg prescribed instead of 25mcg
• 4 incidents of antibiotics being prescribed for patients with
documented allergy
• Azathioprine prescribed in error
• Examples of omitted drugs include – 3 cases of anticonvulsants, 2
cases of regular cardiac medication and 3 cases of insulin or oral
hypoglycaemics.
There is a significant potential for ‘errors’ in prescribing on
admission to hospital, most commonly omission of current medicines. The
fact that the interventions were accepted and prescriptions amended
suggests these were inadvertent omissions. This is consistent with other
reported findings (4).
References
1. Spurgeon D. Study highlights extent of medication errors in
hospitals BMJ 2005;331:534
2. Hawkey CJ, Hodgson S, Norman A, Daneshmend TK, Garner ST. Effect
of reactive pharmacy intervention on the quality of hospital prescribing.
Br Med J 1990; 300: 986-990
3. Farrar KT, Stoddart MJ, Slee AL. Clinical pharmacy and reactive
prescription review – time for a change? Pharm J 1998; 260: 759-61
4. Nester TM, Hale LS. Effectiveness of a pharmacist-acquired
medication history in promoting patient safety. Am J Health-Syst Pharm.
2002; 59: 2221-2225
Competing interests:
None declared
Competing interests: No competing interests
Study highlights extent of medication errors in hospitals: A pharmacist’s involvement in Medical Admissions
In a recent BMJ news article (1) the results of a systematic review
of medication errors that occurred around hospital admission were reported
and suggested a role for pharmacists in obtaining an accurate medication
history. Subsequent correspondence (2) has highlighted current practice is
to confirm retrospectively medication histories.
At Queen's Medical Centre, Nottingham, UK we audited the quality and
efficiency of a pharmacist taking a medication history and writing the in-
patient medication record and compared this with the traditional system of
records being written by doctors.
A baseline audit was undertaken to determine the accuracy of
medication records written by doctors. Patients (n=175) taking 1035
medications were eligible for inclusion during the study period. As a
follow up to this audit patients (n=125) taking 773 medications were seen
by the Emergency Department pharmacist prior to admission who documented a
medication history and wrote the medication record. The admitting doctor
signed the medication record prior to medication being administered.
Doctors made errors with 44% of medications whilst the pharmacist
only made errors with 2% (p<0.0001). The pharmacist unintentionally
omitted significantly fewer medications than the doctors (p<0.0001) and
always completed the allergy status of the patient. Other differences
between the doctors and the pharmacist included incorrect dose (7.8% v
0.4%); incorrect frequency (7.3% v 0.6%) and illegible prescriptions (7.4%
v 0%).
Approximately 50% of the errors made by doctors were deemed to be
clinically significant. The classes of medication most frequently
implicated in errors were cardiovascular medications (e.g. nitrates, beta-
blockers, digoxin, furosemide), similar to previous studies (1,3).
Pharmacists obtaining medication histories and writing in-patient
medication records in the Emergency Department improved the quality of
prescribing on admission and may reduce medication errors.
References
1 Spurgeon D. Study highlights extent of medication errors in
hospitals BMJ 2005; 331:534
2 A Slee et al. Medication errors on admission to UK hospitals.
http://bmj.bmjjournals.com/cgi/eletters/331/7516/534-a (accessed on 28th
September 2005)
3 E McCrudden et al. Review of pharmacist-conducted medication
histories at three teaching hospitals. Aust J Hosp Pharm 1995; 25: 261-3
Competing interests:
None declared
Competing interests: No competing interests