Medication errors drug selection

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while medication is in the control of a healthcare professional/ patient/ or consumer (6). Not all medication errors reach the patient. These are often referred to as "near misses." They are not usually considered to be ADEs only because no harm was done. Preventable ADEs are a subset of medication errors that cause harm to a patient (7). Figure 26.1 depicts the relationship between ADES/ medication errorS/ and adverse drug reactions (8). Because adverse drug reactions are generally unexpected/ they are not presently considered to be a reflection of medication use quality in a classic sense. However/ as genetic variances become a more prominent consideration in drug selection and monitoring/ it may be possible to predict and avoid some of the reactions that have been previously unexpected. This offers an opportunity to improve the quality of medication use. 

The medication use process is a complex system intended to optimize patient outcomes within organizational constraints. Quality medication use involves selection of the optimal drug, avoidance of adverse medication events, and completion of the therapeutic objective. Safe medication practices focus on the avoidance of medication errors. Medication use review and ongoing medication monitoring activities focus on optimizing medication selection and use. These two approaches are important means of assessing and optimizing the quality of medication use. 

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. 

It is quite impractical to study specimens taken only during periods without administration of drugs, particularly in the mentally subnormal patient and the acutely ill infant, and care should always be taken to have details of any medication, however apparently trivial, given to the patient or subject under study. With this information, careful selection of the best analytical procedures, and use of gas chromatography-mass spectrometry to confirm the identity of unknown and elevated acidic metabolites, errors and considerable unnecessary effort in identifying metabolites may be avoided. 

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