Pitfalls In Prescribing: How to Minimize Drug Therapy Risks

Recent headlines in the nation's newspapers haveriveted public attention on medication errors--aproblem that has long plagued the medical community.¹ Prescribing mistakes are common, andthey exact a costly toll: the US Institute of Medicineestimates that 98,000 Americans die each year becauseof a failure in the drug treatment process.² Estimatessuggest up to 5% of all inpatients will experiencesome type of medication error.^3,4More people die each year of drug errors than fromcar accidents, AIDS, breast cancer, or workplace accidents.²A medication error is a "failure in the drug treatmentprocess (ie, prescribing, interpreting, dispensing,and administering) that leads to--or has the potential tolead to--harm."⁵ Many factors contribute to the prescribingerrors that occur every day--both in and out of thehospital.1 They include:

• Similar drug names. More than 10,000 trade andgeneric names exist for currently available drugs. Numerousreports describe problems that ensued after a soundalikedrug was inadvertently prescribed.
• Lack of drug knowledge. Lesar and colleagues⁶ recentlyfound that 12.1% of errors were related to a prescriptionwritten for a patient with a known allergy to the prescribedmedication class.
• Errors in calculating dosage. The Lesar study alsofound that dosing mistakes were among the most commontype of medication error.⁶
• Wrong spot for the decimal. A stray mark from a penor a misplaced decimal on a prescription can lead to tragicconsequences.
• Wrong dosage form. Various formulations of the samemedication have different bioavailabilities and pharmacokineticpatterns. Thus, a prescription for the wrong form of amedication can lead to marked discrepancies in its effect.
• Wrong dosing frequency. Mistakes are made when aprescriber is unfamiliar with the dosing regimen.
• Confusing abbreviations. Clinicians' handwriting is oftenchallenging to read.⁷ Medication errors occur when poorlywritten, ambiguous, or unfamiliar abbreviations are incorrectlyinterpreted.
• Drug interactions. Interactions can potentiate the therapeuticand pharmacologic properties of a medication andcan lead to toxicity; they can also nullify any beneficialeffects of the added drug.
• Disease states. Prescribers often forget to adjust dosagesfor patients with renal, hepatic, or cardiac impairment.
• Incomplete patient history. Lack of a current medicationhistory can open the door to a serious drug interaction--or to the omission of a needed medication.

How to minimize the risk of a medication error? Theanswer to that vital question is the focus of a new feature,"Pitfalls In Prescribing," which begins on page 337. Eachmonth (in a few short pages), I will choose a commonlyprescribed drug (this month the spotlight is on warfarin),and will share key information with supporting literatureto help you use that agent safely. I will emphasize druginteractions, adverse effects, and appropriate dosageadjustments for decreased renal or liver function.It is my sincere hope that the details and strategiesunveiled in this series will help your patient attain the beneficialeffects the medications were designed to provide.

References:

REFERENCES:

1.

Finch CK, Self TH. 10 Common prescribing errors: how to avoid them.Consultant. 2001;41:766-771.

2.

Kohn L, Corrigan J, Donaldson M, eds, for the Committee on Quality ofHealth Care in America, Institute of Medicine. To Err Is Human: Building a SaferHealth System. Washington, DC: National Academy Press; 2000.

3.

Ferner RE, Aronson JK. Medication errors, worse than a crime. Lancet. 2000;355:947-948.

4.

Bond CA, Raehl CL, Franke T. Medication errors in United States hospitals.Pharmacotherapy. 2001;21:1023-1036.

5.

Ferner RE, Aronson JK. Errors in prescribing, preparing, and giving medicines:definition, classification, and prevention. In: Aronson JK, ed. Side Effects ofDrugs Annual, 22. Amsterdam: Elsevier Science; 1999.

6.

Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing.JAMA. 1997;277:312-317.

7.

A study of physicians’ handwriting as a time waster. JAMA. 1979;242:2429-2430.