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TRAINING & EDUCATION
Changing the medication culture
Dipak Duggal, MRPharms, MBA, director global solutions & marketing at BD (Becton, Dickinson and Company) Dispensing Hospital International, shares his unique insights into solutions to reduce medication errors.
A recent report has highlighted the strikingly high incidences of medication errors in the NHS; researchers from the Universities of York, Manchester and Sheffield report that an estimated 712 deaths result from avoidable adverse drug reactions (ADR) every year. ADRs could, however, be a contributory factor to up to 22,303 deaths a year, they report.1 In addition to the loss of human lives, the cost to the health system is enormous and estimated to amount to around £1.6 billion per annum; this is a staggeringly high amount of which leading commentators and the Government have taken notice, with Health and Social Care Secretary Jeremy Hunt recently declaring that new patient safety measures will be put in place.2 Although automation and e-prescribing
are certainly ways to help reduce the incidence of this type of error, Mr Hunt also calls out the ‘teamwork and communication’ involved in getting it right, an important combination that many would argue is critical to ensuring patient safety across the board.3
Critical stages: dispensing, prescription and administration
At BD we’ve been campaigning to bring the right level of attention to patient safety across a variety of adverse events including medication errors. In fact, studies show that 18.7%-56% of all adverse events among hospitalised patients result from preventable medication errors.4 Typically medication errors take place at the prescription, dispensing and administration stages. We’ll now touch upon how these instances can be reduced in each process.
Administration
A number of studies show that medication errors are particularly likely to be linked to IV infusion, not surprising given that 90% of hospital patients receive medication via the IV route,5
making this a key process to
focus on for improvement. IV administration is also identified as a frequent contributor to medication errors and injuries that result from them.6
In fact, IV errors represent more than Dipak Duggal, MRPharms, MBA.
half of the adverse events due to medication among hospitalised patients;7
the risk of an
IV error is therefore more than doubled compared to that with no IV medication use.8 Most MEs occur during the prescription and administration phase,9
errors are also the hardest to intercept.10 Dispensing
Dispensing stage errors are also frequent and under-reported, meaning their incidences could indeed be much higher than we think. The dispensing error rate detected in prospective observational studies is between 0.79% and 33.5%, while retrospective studies of incident reports suggest that the rate of dispensing errors was actually reported as being between 0.0147% and 0.13%. Typically these errors are due to human error such as confusing look-alikes/sound- alikes in medication, high pharmacy workloads, low staff numbers, staff inexperience, and rushing to complete tasks.11 When it comes to preparation errors, in a recent UK study, incorrect product labelling was identified in 43% of doses, the wrong diluent was used in 1% of cases in UK and at least one deviation from proper aseptic technique was observed among 100% of cases.12
In addition to this, 13%
of preparations failed to meet the 10% acceptable tolerance threshold and dose variations ranging from -64.9% to 94.2% were recorded.13
Most MEs occur during the prescription and administration phase, but administration errors are also the hardest to intercept.
JUNE 2018 Prescription
Prescription errors, though less frequent, are under increased scrutiny with e-prescribing solutions providing a helpful tool. Automated and standardised physician planning solutions – such as e-prescription systems – can be
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