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Review the Process of Medication Errors by Healthcare Professionals in the Primary Healthcare

Author: Sibu Sen

Summary

A medication error is a therapeutic failure that causes the harm of the patient or has the potential to do like that. Medication errors can happen while selecting the drug for treatment (dosage regimen), prescription errors by the doctors, manufacturing errors during the preparation of formulation (impurities or contaminants, incorrect strength, incorrect or ambiguous packaging), dispensing the formulation (incorrect label, incorrect formulation as well as the drug), while during administration of medication by self or others  (wrong dose, wrong label), and more (failure of alteration therapy if it is required, inaccurate alteration). According to a psychological taxonomy of errors, they can be divided into experience, rule-, action-, and recollection-based errors. Even though pharmaceutical errors might rarely be serious, but they are maybe not sometimes.

Introduction

Medication is a drug substance or active pharmaceutical ingredient along with some excipients present in a formulation [1]. The drug substance should have biological activity. The drug substance along with excipients called a drug product. Generally, the drug product is given to the patients by different routes like oral, iv, im, sc, nasal, rectal, vaginal, etc.

A mistake, such as one made in speech, writing, action, etc., is defined as “anything erroneously done by ignorance or inadvertence.” Failure to carry out a proposed action as planned or the application of the wrong strategy to accomplish a goal [2].

Nowadays, drug usage is a not a simple process and many drug-related inter challenges at each level are there, involving drug manufacturing, pharmacists, doctors, nurses, and patients. So every paramedical person should be actively involved to avoid errors related to the health care system. Medication errors lead to many adverse events, which further cause serious morbidity, continued staying in hospitals, excessive treatments, and sometimes lead to loss of life [3, 4]. Adverse events and medical errors are a predictable truth of health care. For pediatric and geriatric patients they are serious problems [5, 6]. Due to these errors, patients lose their trust in the medication provided by primary health care. Medication errors are most common in Government hospitals due to a lack of proper no of healthcare professionals including doctors, nurses, and pharmacists.

Common Medication Errors and risk factors associated with it

The classification of medication errors—which might be contextual, modal, or psychological—can help us understand how they occur and how to prevent them. Contextual classification takes into account the precise moment, location, substances, and participants [7]. Modal categorization looks at how errors happen, for as by omission, repetition, or substitution. It is preferable to categorize things psychologically since it explains happenings as opposed to just describing them. Its focus on individual rather than systemic sources of errors is a drawback. The following classification of psychological errors is based on Reason’s research on errors in general [8]. Common medication errors include errors in prescribing, dispensing, dispensing mistakes, administration, not proper documentation, medication mistake, drug mistake, prescribing mistakes, administration mistakes, wrong medication, wrong drug, wrong dose, and sometimes errors like the wrong route of administration, wrong dose calculation by physicians, pharmacists and nurses in Government hospitals [9]. Sometimes due to lack of knowledge or proper education of nurses also creates problems in the dispensing of medication. A patient having allergy with certain drug or drugs.

Any aberrant indication/symptom, or pathological lab test, as well as any syndromic blend of these malformations, any unfavorable or unforeseen incidence (such as an accident or an unwanted pregnancy), and any unexpected deterioration in a concurrent illness [10], are all considered adverse events. An adverse drug reaction may occur if a person has a negative event while taking medication (ADR). This is frequently referred to as an “adverse drug event,” although this is a poor term that needs to be avoided. An adverse event remains an adverse event if it cannot be attributed to a drug; if it may be attributed to a drug, it becomes a suspected ADR [8].

Errors due to medication can be different types, skill/memory-based errors, law (rule) based errors and action-based errors. A person is allergic to some specific drug like penicillin sometimes without proper knowledge or forgetting the thing can cause the problem of medication errors. This can cause hypersensitivity reactions to the patients. Diclofenac should be injected in lateral thigh rather than buttock. In the pharmacy retail shop, sometimes due to slip of attention, different drug with same starting letter or pronunciation given to the patient or family member of patient (like diazepam with diltiazem this confusion occurs). This can be overcome by giving them proper knowledge and education as well as training.

Review Process and Preventive Measurements

Review process of health care professionals should be done in a monthly, 6 monthly and yearly process. Proper documentation should be maintained while giving medications to the patients as well as dispensing proper medications. Electronic documentation should be maintained to avoid confusions. Before starting any medications patient allergic history should be checked (the patient is allergic to certain drugs, foods; that should be strictly prohibited to the maintained). Some medication is not given with milk, some should be given before breakfast, some should be given after lunch or dinner. Schedule H drugs should not be given to patients without proper prescription given by doctor or pharmacists. Frequency or timing of the drug should be uniform throughout the treatment period of patient. Before giving any medication to the patient, the nurse should properly check the name of drug is in formulation (strip, vials, ampoules, patch) is matching with the prescription or not. If not report to the pharmacist immediately to avoid the error. In every floor of the hospital, one pharmacist should be there to avoid this medication error happening in the different wards of the hospitals. That documentation of the medicines for the patients should be properly maintained by the nurses and should be checked by a pharmacist in a week or in a daily basis. No of Pharmacists should be increased in the hospitals, so that it will be easy for checking the documentation as well as to avoid medication errors. Sometimes nurses forget the time of medicine. Pharmacists should be act like eagle’s eye in the process of dispensing and administration of the medicines to the patients in the hospitals. Pharmacist should check the dose of the medicines for the geriatric and pediatric patients before administration to them. The patients receiving the chemotherapy, the dose of the chemotherapy should be properly checked by pharmacists. There should be some rules to avoid medication errors in the hospitals. The rules should be strictly followed by all the healthcare professionals. Sometimes the healthcare professionals did a mistake and they did not report the mistake to avoid the loss of their job. They should report the mistakes to the head of that department to avoid errors. Sometimes in the night time, nurses present in the wards of the hospital slept and forgot to give the medicines. There should be CCTV camera installed everywhere in the wards of the hospitals. In operation theatre also trained nurses, doctors should be there to operate the patients. Sterilization of the used things done by the cancer patients should be done in the hospitals. Nurses should check the  expiry date of the medicines before giving to patients.

CONCLUSION

Nowadays medication is very important in routine life. Many patients are taking medicine every day. In primary health care there should be strict protocol and excellent training should be given for paramedical personnel. This will lead to error minimization and the patient’s compliance. Mostly main thing is prescription in which dosage form and time, which makes confusion to pharmacists followed by patients. Nurses in the health care centre should be aware of the medicines and the time at which dose is given. They should be having a thorough knowledge of medicine and pharmacology activity. Even a pharmacist should have communication with the doctor if he doesn’t understand anything related to prescription and its dosing time. Finally, all should have to perform their activity with responsibilities without hesitating anything.

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