Medication errors drug dispensation

A number of factors are believed to increase the risk of drug-related problems in the elderly, including suboptimal prescribing (e.g., overuse of medications or polypharmacy, inappropriate use, and underuse), medication errors (both dispensing and administration problems), and patient medication nonadherence (both intentional and unintentional). The following subsections address suboptimal prescribing and medication nonadherence, the most common problems. 

The traditional system of providing patient care— wherein physicians initiate drug therapy, pharmacists dispense medications, and nurses administer medica-tion.s—is often run in a disjointed fashion. This results in potentially avoidable adverse drug events that contribute to poor patient outcomes and increased medical costs. Efforts aimed at modifying the current processes of care to enhance efficiency of workflow, improve patient outcomes, and reduce medication errors arc needed. 

Drug dispensing/distribution is one of the m.ain clinical activities of Spanish hospital pharmacists. Many studies have shown that the unit-dose distribution system has reduced drug errors, and it is one of the main contributions of the hospital pharmacy to patient care. Pharmacist participation in medical rounds and presence at the time of prescription can result in even better patient care and a prompter detection of treatment failures. - " Such clinical pharmacy activity is being conducted with some groups of patients in some Spanish hospitals - and is becoming more frequent. 

FIGURE A—1 The prescription. The prescription must be carefully prepared to identify the patient and the medication to be dispensed, as well as the manner in which the drug is to be administered. Accuracy and legibility are essential. Use of abbreviations, particularly Latin, is discouraged, as it leads to dispensing errors. Inclusion of the purpose of the medication in the subscription (e.g., control of blood pressure") can prevent errors in dispensing. For example, the use of losartan for the treatment of hypertension may require 100 mg/day (1.4 mg/kg per day), whereas treat-... 

The variation in the error rates was probably due to the differences in the definitions of medication errors, the methodologies used and the settings. For example, the error rate in a neonatal intensive care unit is much higher than that in a general paediatric ward. Furthermore, the systems of prescribing, dispensing and drug administration vary... 

Eontan J E, Maneglier V, Nguyen V X, Loirat C, Brion E (2003). Medication errors in hospitals computerized unit dose drug dispensing system versus ward stock distribution system. Pharmacy World and Science 25 112-117. 

As a rule, medicines used in bigger amounts in hospitals are commercially supplied by industry, smaller amounts and ad hoc orders by wholesalers, see Chap. 36. Some tasks delegated to the hospital pharmacist may be fulfilled by centralised services for allied partners due to economic or effectiveness reasons. The frame for this duty has to be flexible enough to attain a fast track distribution within the institution and thus a fast dispensing of medicines to the patient. Thus, not only drug supply, but also the medication process and consequently the prevention of medications errors, which are multidisciplinary processes within patient care, are to be considered as integral parts of the mandate [4]. 

Automated dispensing devices create several situations that can easily result in errors. While these machines are routinely restocked, the wrong drug still can be placed into the wrong bin during this process. Devices that have multiple medications in each drawer and/or that do not require pharmacist review of orders before access have drawbacks that are identical to the flaws in traditional floor-stock systems ... 

Poon EG, Cina JL, Churchill W, et al. 2006. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 145 426. 

The medication use system in an institutional setting offers even more complexity, with more chances for error. The five subsystems of the medication system in a hospital are selection and procurement of drugs, drug prescribing, preparation and dispensing, drug administration, and monitoring for medication or related effects (11). Evaluation and improvement of medication use quality require consideration of all of these subsystems. 

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