CONTACT: Richard Puff, Albany Medical Center, 518-262-3421
Embargoed: 4 p.m. (EST) Tuesday, January, 21, 1997
ALBANY, N.Y., January 21, 1997 -- A study conducted by Albany Medical Center researchers which quantifies the most common causes of medication prescribing errors can help physicians and pharmacists to significantly prevent adverse drug events and reduce the risk to hospital patients.
The study in the Jan. 22 edition of the Journal of the American Medical Association involved a review of medication prescription problems recognized and corrected by Albany Medical Center pharmacists. The ability to detect and correct the prescribing errors prevented injury and adverse drug effects to patients.
"Understanding the causes of these errors can assist all hospitals in establishing more effective error prevention strategies and by focusing efforts on the factors identified in this study, the risk to patients from prescribing errors can be reduced," said Timothy Lesar, Pharm.D., director of the Albany Medical Center pharmacy and the lead author of the study. "Our findings suggest that initiatives designed to prevent, detect and avert problems associated with prescribing errors can eliminate a large proportion of medication prescribing problems."
The study found that the most common causes of prescribing errors were the failure of physicians to take into account a patient's status or disease which could affect selection of the optimum drug or drug dose; a lack of knowledge or appreciation of drug therapy issues; the miscalculation of medication doses; the prescription of an inappropriate form of medication; and confusing medication prescribing nomenclature.
The study was co-authored by Laurie Briceland, Pharm.D., associate professor at the Albany College of Pharmacy, and Daniel Stein, M.D., associate professor of medicine, pharmacology and neuroscience at Albany Medical College.
The authors reviewed 696 prescribing problems detected at the Albany Medical Center which could have had the potential for serious adverse patient effects but which were averted by the vigilance of the Medical Center's pharmacy staff. The authors then evaluated each prescribing problem to determine the cause of the error.
"The most common cause of these prescribing problems was the doctor's failure to take into account the current status of the patient when prescribing medications. For example, a patient with reduced kidney function would need less of a medication than normal because the medication remains in their bodies longer," Dr. Lesar explained. "The patients weight and age also would have a bearing on this."
Dr. Lesar also noted that it is becoming increasingly difficult for doctors to maintain a current knowledge base about all medications. Indeed, the federal Food & Drug Administration in 1996 approved a record 53 new drugs compared to 28 in 1995. The previous high number for new drug approvals was 30 in 1995 and 1991.
"With all the new drugs being approved, it is becoming more and more difficult for doctors to maintain adequate knowledge on all the drugs available to patients," Lesar said.
Dr. Stein added that a strong message physicians should receive from the study is the need for increased interaction between doctors and pharmacists to prevent medication errors.
"Doctors should use the expertise of their pharmacists," Dr. Stein said. "The integration of pharmacists on medical teams and in patient care units also would be an effective method of promoting appropriate medication use. Additionally, hospitals must commit the necessary resources to support a fully staffed pharmacy operation."
The researchers cited the value of pharmacists in detecting prescription errors and preventing adverse drug events which could be harmful to patients.
"Redirecting pharmacists from traditional drug preparation and dispensing to providing more direct patient care and consultations, as has been done at Albany Medical Center, is one of the key system changes which can reduce the risk of adverse drug events," the authors noted.
Dr. Lesar also suggested that patients can help prevent medication errors while in the hospital.
"Patients must communicate with their physicians and report all medications that they are taking and fully reveal their health status. They also should be encouraged to ask questions about the medications that are prescribed for them and keep an open line of communication between themselves and their care givers," Dr. Lesar said.
More than one in six errors were the result of a miscalculation of medication doses, wrong decimal point placement, incorrect unit measurement or concentration, or an incorrect medication administration rate. Calculation mistakes were particularly common in pediatric patients. Suggested methods to reduce these problems include a double check of all calculations by another person, increasing the use of standardized drug preparations and dosing and using computer technology.
Finally, the names of medications and other drug nomenclature used to identify dosage formulations by manufacturers is often confusing and increases the risk for errors. Manufacturers of these products should carefully consider nomenclature used in the brand names of prescription medications, the study warned.
The most common types of prescribing errors were overdosing (41.8 percent), underdosing (16.5 percent), medications to which the patient was allergic (12.9 percent) and inappropriate dosage forms (11.6 percent).
The most common medications involved in prescribing errors were antibiotics (39.7 percent), cardiovascular agents (17.5 percent), gastrointestinal agents (7.8 percent), and non-narcotic analgesics and fever medications (6.6 percent).
-- 30 --
RSS