Embed Size (px)
Citation preview
Dr Dayanath MishraMD, DM, DNB (NEPHRO)
Chairman, DM Hospitals Pvt Ltd, Thakurpukur, kolkata
Prescription Error – Can it be prevented ?
Medicines can do a lot of good but they also have the potential to cause harm
•Nuclear power
•European railroads
•Scheduled airlines
Less than one death per 100 000 encounters
•Driving•Chemical
manufacturingOne death in less
than 100 000 but more than 1000
encounters
•Bungee jumping
•Mountain climbing
•Health care
More than one death per 1000
encounters
How dangerous is health care?
A prescription ( ) is a health-care program ℞implemented by a physician or other qualified practitioner in the form of instructions that govern the plan of care for an individual patient
Medical Prescription
Prescriptions can help people stay healthy or manage long-term conditions or emergency situations. However, as with other components of healthcare, prescriptions are also subject to error and can lead to unintended harm. Medication errors are one of the most common patient safety issues and prescribing errors are one of the most common types of medication errors.
Medical Prescription
Of a medical practitioner :-
advise and authorize the use of (a medicine or treatment) for someone, especially in writing
Medical Prescription
LEGAL DOCUMENTATION
RECORD SOURCE
MEANS OF COMMUNICATION
THERAPY MODALITY
MEANS OF MEDICAL CONTROL OF THERAPY
MEANS OF CLINICAL TRIAL
Manifest functions of the prescription
There is no global standard for prescriptions and every country has its own regulations.
The most important REQUIREMENT is that the prescription be clear. It should be legible and indicate precisely what should be given
Information on a prescription
Always remember
“to Err is Human!”
Commonly encountered in health care settings. They can lead to inefficient delivery of health care thus jeopardizing patient
care.
Prescription Errors
Failure in the treatment process that leads to, or has the potential to lead to, harm to the patient.
Medication Error
“A clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is an unintentional significant
Reduction in the probability of treatment being timely and effective or
Increase in the risk of harm when compared with generally accepted practice”.
The definition
• 1. Unnecessary drug • 2 Incorrect drug • 3 Duplication • 4 Allergy error • 5 Contraindication error • 6 Interaction error • 7 Dose/strength error • 8 Formulation error • 9 Frequency error • 10 Timing error • 11 Information incomplete • 12 Generic/brand name error • 13 Omission error relating to
failure to prescribe concomitant treatment
• 14 Inadequate documentation in medical records
• 15 Quantity error • 16 Inadequate review• 17 Duration error
Medication Error
A monitoring error occurs when a prescribed medicine is not monitored in the way which would be considered acceptable in routine general practice. It includes the absence of tests being carried out at the frequency listed in the criteria,
Monitoring Error
Monitoring not requested
Requested but not done
Results not available
Results not acted upon
Monitoring Error
Medication errors are one of the most common causes of patient harm and prescribing accounts for
a large proportion of medication errors
Medication Error
Conservatively, at least 1.5 million people per year are harmed by medications.
Many medication mistakes are never reported.
100,000 people die each year as a result of medication errors.
Medication Error Statistics
Prescribing errors
3-20 per 1000 prescriptions
Medication errors
1 per patient per day
Been estimated that drug errors account for 1/5 of all deaths due to
adverse drug events
Reported Incidences
Difficult to estimate due to varying definitions - US/UK
The study involved examination of 6,048 unique prescription items for 1,777 patients
Prescribing or monitoring errors were detected for one in eight patients
Investigating the prevalence and causes of prescribing errorsin general practice (The PRACTICE Study)
The authors found that 39% of 256 residents had one or more prescribing errors, with 8.3% of prescriptions (or intended prescriptions) affected. The most common types of prescribing error were “incomplete information” (37.9%), e.g. no strength or route was specified; ‘‘unnecessary drug’’ (23.5%), ‘‘dose/strength error’’ (14.4%) and ‘‘omission’’ (11.8%).
The PRACTICE Study
Male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed,
Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items.
A wide range of underlying causes of error were identified relating to the prescriber,
The PRACTICE Study
Prescribing
Transcribing
Dispensing
Administering
38%
12% 11%
Medication Errors Reporting Program US
Major Areas for Medication Error
39%
doctors are under a legal duty of care to write clearly,
that is with sufficient legibility to allow for mistakes
by others.
When illegible handwriting results in a breach of that
duty, causing personal injury, then the courts will be prepared to punish the
careless by awarding sufficient damages.
Liability does not end when the prescription leaves the doctor's consulting room.
It may also be a cause of the negligence of others.
Legal obligation to write clearly
Reducing Prescribing Errors
Training personnel to better prepare them for tasks and work conditions is a human factors approach
Education and development
Redesigning equipment and tasks can reduce prescribing errors
Tools
One-to-one education- Prescription error rates decreased from 41% to 24% at the hospital receiving academic detailing and the confidence of junior doctors in writing prescriptions increased.
Group education for trainees
Group education for qualified professionals
Education and development
Most studies suggest computerised tools can reduce prescribing errors
Emerging evidence suggests that to be successful, human factors such as workflow features, tool design and context need to be considered
Computerised Tools
Computerised physician order entry (CPOE)
This is an electronic process for entering instructions about patient treatment
reduce errors related to handwriting or transcription,
E-prescribing
Forcing functions & constraints
Automation & computerization
Standardization & protocol
Checklist & double check system
Rules & policies
Education/ Information
Be more careful, be vigilant
Mosteffective
Leasteffective
Steps to Minimize Medication Error
Use pharmacy system that will not fill any order unless allergy information, patient weight & height are entered
Use computer order entry with dosage checks
Remove dangerous IV drugs (e.g. conc. potassium, hypertonic sodium chloride) from ward stock
Limit choices of available drugs in pharmacy
Limit dosage strengths & concentration for each drug
Mix IVs in the pharmacy
Steps to Minimize Medication Error
Forcing functions & constraints
"The central government has approved to amend Indian Medical Council Regulations, 2002, providing therein that every physician should prescribe drugs with generic names in legible and capital latter and he/she shall ensure that there is a rational prescription and use of drugs"
-JUN 12, 2015
Now doctors have to write prescription in capital letters
Dr. K K Aggarwal of Indian Medical ASSOCIATION (IMA) said this will help decrease prescription errors and it is a cheaper alternative to electronic health records.
"Prescription errors will decrease. It will become uniform. One drug has 10 odd brands. The patients will be now able to know whether the drug is generic or not," Aggarwal told PTI.
"In US alone, 100,000 prescription errors occur every year. India does not have any data on this. This is a cheaper alternative to electronic health records. It will take some time for doctors to get used to it," he said.
JUN 12, 2015
Now doctors have to write prescription in capital letters
Use drug-drug interaction checking system
Use computerized order entry
Use computerized patient information
Use bar-coding on drugs, containers, medication records, patient wristbands
Automated dispensing on patient care unit
Steps to Minimize Medication Error
Automation & computerization (Reduce reliance on memory)
No error –prone abbreviations
Use generic names rather then brand name
Use standard equipment—one kind of pump or syringe
Use protocol for complex medication administration e.g. heparin, chemotherapy
Steps to Minimize Medication Error
Standardization & protocol
Over a period of time, there has been a transition from an era where medical practice and its practitioners were revered to a
time when doubt and fear is expressed and legal suits are pursued by aggrieved patients.
The Changing Scenario
What do I need to prescribe in a safe way?
Patient information
Co-morbid conditions
Drug information
Pharmacology
Pharmacokinetics and pharmacodynamics
Therapeutics
Systems
Policies, guidelines, prescribing aids etc
Think About
ALWAYS write legibly.
ALWAYS space out words and numbers to avoid confusion.
ALWAYS complete medication orders.
AVOID abbreviations.
When in doubt, ask to verify.
Maximize Patient Safety
THE RIGHT PATIENT
THE RIGHT DRUG
THE RIGHT TIME
THE RIGHT DOSE
THE RIGHT ROUTE
Remember the “Five Rights”
Thank you
Prescription Error – It can be prevented…
Acknowledgement :
Technology team DR DMTECH Pvt. Ltd.Staff DM Hospitals Pvt. Ltd.Dr. Reddy’s Lab, Nephrology DivisionAll my patients…
