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MEDICATION ERRORS

According to the European Medicines Agency, “Medication errors” are unintentional errors in the prescribing, dispensing, administration or monitoring of a medicine while under the control of a healthcare professional, patient or consumer. They are the most common single preventable cause of adverse events in medication practice.

Both health workers and patients can make mistakes that result in severe harm, such as ordering, prescribing, dispensingpreparing, administering or consuming the wrong medication or the wrong dose at the wrong time. However, all medication errors are potentially avoidable.

Preventing errors and the harm that results, requires putting systems and procedures in place to ensure the right patient receives the right medication at the right dose via the right route at the right time.

The cost associated with medication errors has been estimated at US$ 42 billion annually or almost 1% of total global health expenditure.

In March 2017 the World Health Organization (WHO) launched a global initiative to reduce severe, avoidable medication-associated errors in all countries by 50% over the next 5 years.

The initiative calls on countries to take early priority action to address these key factors in order to reduce medication errors and harm to patients. It aims to make improvements in each stage of the medication use process including prescribing, dispensing, administering, monitoring and use.

In a multicenter study, Ferner et al, checked systematic medication errors in routine clinical practice. They found that systematic calculation errors occurred in about 5% of cases, and major errors in drawing up in a further 3%, with inadequate mixing in 9%. This indicates that the delivered dose often deviates from the intended dose.

The trend, in the last decade, for improving medication safety in health systems is through innovations in automation technology. As regulatory requirements are increasing and investment in patients’ safety takes high priority, more and more hospitals and pharmacies are searching for computerized solutions to significantly improve the precision and safety of dosages and distribution of medication.

In an article by Chapuis et al, the authors decided to assess the impact of an automated compounding dispensing (ACD) system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. Their conclusion showed that the implementation of an automated compounding dispensing (ACD) system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

  1. https://www.who.int/news-room/detail/29-03-2017-who-launches-global-effort-to-halve-medication-related-errors-in-5-years
  2. https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance/medication-errors
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014610/
  4. https://www.ncbi.nlm.nih.gov/pubmed/20838333

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