You've made a prescribing error. Now what?
Key Takeaways
Medication errors are a common source of patient injury, with prescription mistakes accounting for about 50% of them. Pharmacists and nurses catch up to 70% of medication errors.
A culture of blame exists in medicine, and repercussions of medication errors involve fines, licensure, and litigation.
Strategies to avoid medication errors should be followed, and medication errors should be reported.
With the vast array of medications available and the increasing responsibilities placed on physicians, it’s not surprising that medication errors happen.
When they do occur, they should, of course, be reported immediately. But there are strategies physicians can employ to avoid them.
Nature of medication errors
Medication errors can happen at any step during patient care. Common errors occur with prescribing, ordering, transcribing, documenting, dispensing, administering, and monitoring.
According to an article published in StatPearls, between 7,000 and 9,000 people die of medication errors in the United States each year. Cumulative costs of medication errors total more than $40 billion each year.[]
Monetary costs aside, medication errors can cause health challenges for patients. The psychological and physical costs can be great, and those who experience medication errors may lose trust in physicians, as well as in the healthcare system as a whole.
The StatPearls authors found that most medication errors occur at the prescribing/ordering stage and account for almost 50% of errors made. These errors can include writing the wrong medication, route, dose, or frequency. Pharmacists and nurses typically catch between 30% and 70% of these errors.
Placing blame
No physician deliberately commits a medication error. Ideally, the healthcare community should recognize that healthcare workers and healthcare systems play important roles in managing them.
“The focus should be on identifying the error-prone aspects of the medication use continuum with the goal of improving system safety and reliability through remedial action,” wrote the Association of Managed Care Pharmacy (AMCP).[]
"Neither committing nor reporting an error should become the basis for disciplinary or punitive action by an employer."
— AMCP
"Every error should be examined to determine what elements in the system allowed it to happen,” the AMCP continued. "In this way, those who manage health systems can learn from error and determine what corrections are needed to prevent similar errors in the future."
The reality, however, is that when errors are discovered, censure can result. Repercussions include formal punishment including fines, license suspension, or license revocation. Moreover, physicians can lose the respect of their colleagues, “which may be even more devastating than a professional reprimand,” according to the AMCP.
Medication errors can lead to litigation.
Winning a settlement revolves around the prosecution proving an error occurred and demonstrating resulting injuries. The physician’s actions should reflect the standard of care, or what any other reasonable professional would have done in the same situation.[]
What to do when an error is made
The AAMC recommended full transparency in cases of medication errors, and promotes a model of openness that includes the following:[]
Full explanations to the patient and family
Early reporting and assessment of resulting negative outcomes
Apologies and compensation from the hospital (when relevant)
Emotional support for clinicians involved in the mistake
“While the open approach may feel counterintuitive to administrators, physicians, and malpractice attorneys, studies and anecdotal accounts suggest transparency and accountability policies can save hospitals, patients, and families years of grueling litigation that typically ends in settlement,” the AAMC wrote.
Avoiding medication errors
There are various steps that can be taken to avoid prescription errors.
The first step is to approach every prescription very carefully. Here are some other tips:
Use electronic prescriptions to avoid issues with handwriting legibility.
Avoid the use of abbreviations, which can be misinterpreted (eg, QD vs QID). Be precise with dosages, and use metric units.
Specify the duration of treatment—not just the number of pills to be dispensed.
Consider factors such as age, liver function, and kidney function. Remember that patients with impaired liver and kidney function usually require smaller doses.
Be clear with instructions (and add supplemental ones) as necessary. For instance, potential drug-drug interactions should be noted.
Carefully counsel patients on prescription medications and include contact phone numbers on the script.
Watch for potentially dangerous medications and note drug indications on scripts. This can help pharmacists counsel patients, as well.
What this means for you
No physician wants to make a medication error, but they happen. Although such errors can result in various professional and financial repercussions, they still must be reported. Avoid errors by keeping factors such as age, liver function, kidney function, drug-drug interactions, and more in mind when prescribing.