HOW WE CAN PREVENT MEDICAL ERROR AND PATIENT HARM

HOW WE CAN PREVENT MEDICAL ERROR AND PATIENT HARM

By Aisha Sanusi

Medical errors are preventable human errors resulting from medical care which could be harmful to the patient. A medication error is defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer,” according to the National Coordinating Council for Medication Error Reporting and Prevention.

In Nigeria, a national survey of 2,386 health professionals conducted by Kehinde et al, reported a prevalence of selfreported medication errors of 47%. A medication of 47% is quite high, thus putting a lot of patients at risk. The World Health Organization (WHO) estimates

that medical errors are one of the top ten causes of death and disability worldwide, particularly in low and middle-income countries (LMICs) where 134 million healthcare-associated adverse events occur contributing to 2.6 million 4 deaths annually.

To discuss the causes of a medication error, it would be best to go via the perspective of its classification. Medical errors can be classified according to Jeffery K as Mistakes that can be divided into (i) knowledge-based errors and (ii) rule-based errors. Failures of skill can be divided into (iii) actionbased errors (‘slips’, including technical errors) and (iv) memory-based errors (‘lapses’). Prevention of medication errors is important because such errors leading to patient harm are avoidable. Preventive measures can be put in place based on the classification of errors.

Knowledge-based error is an error committed based on the limitation of knowledge by the health professional or physician. The world of medicine is revolving, research is going on daily thus new inventions, understanding of ailments, and scope of treatment. This error could also be based on specific knowledge of the patient such as allergy. All health professional must broaden their knowledge often, read more books, and attend symposiums and conferences. Physicians should take time to take the correct medical history of their patients to enhance treatment for patients.

Rule-based errors are error that occurs from applying a bad rule or wrong rule for treatment. Computerized decision-support systems can train prescribers to make fewer errors.

The action-based error can be further categorized as prescribing, dispensing, or administration error of a drug. Prescribing errors are made when the incorrect drug selection for a patient occurs. These errors can include the dose, quantity, indication, or prescribing of a contraindicated drug. Prescribing errors can be prevented by the use of eligible handwriting, and the appropriate use of abbreviations and decimals. Electronic prescribing may help to reduce the risk of prescribing errors resulting from illegible handwriting, although it can in turn lead to further problems such as incorrect drug selection. Computerized physician order entry systems eliminate the need for transcription of orders by nursing staff and interpretation of orders by pharmacy staff and have been shown to have a significant effect on reducing medication errors.

Dispensing error occurs from receiving the prescription in the pharmacy to supplying the medication. Preventing dispensing errors would be by ensuring a safe dispensing procedure, Separating drugs with a similar name or appearance, Keeping interruptions in the dispensing procedure to a minimum, maintaining the workload of the pharmacist at a safe and manageable level, and introducing safe systematic procedures for dispensing medicines in the pharmacy.

Administration error of drugs occurs when there is a deviation between the drugs received by the patient and that intended by the physician. Drug administration errors largely involve errors of omission where the drug is not administered for a variety of reasons. Other types of drug administration errors include incorrect administration techniques and the administration of incorrect or expired preparations. These errors can be prevented by carefully checking the patient’s identity, dosage calculations should be checked independently by another healthcare professional before the drug is administered, ensuring that the prescription drug and patient are in the same place so that they may be checked against one another, certify that the medication is given at the correct time and minimizing interruptions during drug rounds.

Memory-based error is when the right medication or form of therapy is forgotten. Memorybased errors are the most difficult to prevent. They are best tackled by putting in place systems that detect such errors and allow remedial actions. Checklists and computerized systems can help.

It is important to also take note of errors that could be made due to the mental or emotional state of health care professionals. Health professionals are also human, thus they have personal issues too which could affect their professional life. Health professionals should learn to manage their emotions while at work, seek help when needed and also take breaks when needed.

In addition, consumers and patients should take their health as the utmost priority.

They should ask questions, take time to understand the instructions given to them, use color codes, shapes, or sizes to differentiate medication, read labels of drugs prescribed, and store drugs in their original container.

A non-punitive approach should be adopted to improve the rate of reporting medication errors, allowing further investigation of these important causes of preventable patient harm. It would make healthcare professionals more cautious and alert when attending to patients.