It is estimated that there are as many as 1.5 million preventable adverse drug events that occur in the U.S. annually with 530,000 of these events occurring in the Medicare-age group alone. The Institute of Medicine estimates that as many as 44,000 to 98,000 people die from medical error each year. Of these preventable deaths, one-third are from medication errors.

This problem is the focus of research for many groups in order to reduce this risk in all health care settings. This article will describe common causes and ways that we as health care consumers can reduce our own individual risk of taking the wrong medication or dosage, or suffering from adverse drug reactions.

Common causes for medication errors

Dispensing and education on the use of a medication involve a number of people (physician, office nurse and personnel, pharmacist, patient or his/her family, etc.). In the hospital setting, the physician’s orders are transmitted by clerical staff to the pharmacy, filled by pharmacy staff, and then dispensed by medical personnel to the patient, making for multiple opportunities for errors to be made. [See sidebar on page 18 for a detailed list of common sources of error.]

Ways to improve medication safety

As a health care consumer, you have a responsibility to know why and how you need to take any medication prescribed by a physician or clinic. All new medications, or even getting a refill for a long-standing drug, should prompt you to ask the doctor or staff member to go over potential side effects and emergency procedures. Also report to your doctor any over-the-counter medications, or vitamin or food supplements you are taking. Ask for and read medication information that is included with the dispensed medication by the pharmacy.

If you have problems reading a prescription bottle or have difficulty in opening the lid, ask the pharmacist for assistance. Always check the bottle(s) and the appearance of your pills before you leave the pharmacy in order to make sure that you are receiving the right medication.

Hospitals and physicians are very aware of the problem of medication errors. Many institutions and most doctors’ offices are converting to electronic medical record systems that require the physician or nurse to enter orders and data by computer. These programs also include the capability of electronic transmission of medication names and doses directly to the pharmacy. There are a number of pharmacy software programs that will automatically screen for potential adverse reactions or inappropriate dosing. In many hospitals, there is a barcode system that will match the medication to the right patient. This decreases errors due to poor handwriting or mixing up drugs. It is estimated that using these systems in the hospital and in outpatient settings will reduce errors by over 80% when fully implemented nationwide.

Some potential causes of medication errors or experiencing adverse reactions:

1. The wrong prescription is given to the wrong patient (can happen in a busy office)

2. Allergies or past problems with taking a specific or class of medication not communicated to the physician

3. Taking over-the-counter medication or food supplements and not sharing this with the doctor or nurse

4. Certain medical conditions such as cardiac problems, hypertension, cancer, diabetes, kidney or liver disease are associated with the need for multiple medications. The greater the number of prescribed medications, the higher the risk of adverse drug reactions.

5. Poor handwriting and the use of abbreviations on the script

6. Dosage or instructions for taking the medication are inappropriate for the age, weight, kidney or liver function of the individual. How a medication is prescribed will vary with the presence of chronic health problems, weight and age. Also pediatric dosing is very different from adults, even if it is the same medication.

7. Medications are inappropriately prescribed for pregnant women. Many medications cannot be prescribed to pregnant women due to adverse effects for the mother and/or fetus. If unsure, it is always best to get a pregnancy test before taking medication.

8. Unclear instructions given by office or hospital staff. Instructions should be clear and easy to understand, including warnings about potential side effects. Often the patient or his/her family lacks adequate reading or language skills to understand these written or verbal instructions.

9. For some older patients, problems with hearing or eyesight will increase risk of medication errors. Also, because of the common use of generic drugs, the coloring and shape of the medication will be different from brand names and can change from month to month depending on where the pharmacy purchases its medication. It is easy to confuse pills.

10. Insufficient training. Drug devises such as syringes, glucose meters, or home-administered I.V. medication all require a great deal of training for properly administering a drug.

11. Improper measurements. Liquid medications need to be taken using the proper measuring devise available in pharmacies. The use of household spoons can under or overdose the person.