Medication or drug mistakes occur with alarming frequency. Several years ago, actor Dennis Quaid’s newborn twin boys faced a serious medical emergency when they were given an adult dose of the blood thinner, heparin. The error occurred due to a mix up. The adult dose had a dark cap whereas the infant dose had a light blue cap. The dosing nurse made the mix up and administered the adult dose to the infants who nearly died. Fortunately, the hospital’s drug mistake was discovered quickly and the twins suffered no major medical issues.
This example is just one of literally thousands. In fact, according to the U.S. FDA, there are roughly 1.25 million medication errors each year. Source: 2004 Final Rule, FDA Bar Code Label Requirements for Human Drug Products. There are three scenarios when a medication or drug mistake may occur:
- hospital medication mistake,
- doctor prescription mistake, and
- pharmacy mistake.
Hospital Medication/Drug Errors
In general, most medication or drug mistakes occur in an inpatient setting, i.e., hospitals, long-term care facilities, etc. According to a 2002 study of medication mistakes published in the Archives of Internal Medicine, “Medication Errors Observed in 36 Healthcare Facilities,” 1 out of every 5 medication doses administered in hospitals involves an error. In hospital settings, the two most common mistakes involve dispensing medicine at the wrong time (almost half of all incidents) and omitting a dose (roughly a third of all incidents).
Doctor Prescription Mistakes
In 2008, researchers at the University of California School of Pharmacy and Pharmaceutical Science studied prescription errors in a family care or primary care setting. The study, “Medication Errors Reported by US Family Physicians and Their Office Staff,” was published in Quality and Safety in Health Care.
With respect to the cause of family/primary care setting drug mistakes, the study revealed the following:
- 70% involved errors in prescription,
- 10% involved errors in administering medicine,
- 10% involved documentation errors,
- 7% involved dispensing errors, and
- 3% involved monitoring errors.
Nearly 60% of the medication mistakes in the study actually reached patients. Of these cases:
- 35% did not require any follow-up,
- 8% required medical monitoring,
- 13% required medical intervention, and
- 3% resulted in hospitalization.
Pharmacy Drug Mistakes
Drug mistakes also occur when a drug store pharmacist makes an error. A drug store pharmacist may mix up prescriptions for customers with similar names. For example, prescriptions for two patients with the name “Michael Smith” may be mixed up. In addition, pharmacists can also make dosing errors, such as dispensing the wrong drug or the wrong dose.
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