It is difficult to quantify the extent of errors related to medication prescribing. Existing evidence from several external studies of large numbers of hospitalised patients indicated that each year many patients are harmed, injured or experienced adverse drug events as a result of medication errors.

Between 1993 and 1998, the US Food and Drug Administration Adverse Event Reporting System recorded 5307 medication error reports. The findings were:

	Medication errors were fatal in 9.8% (N=469) of cases.
	48.6% of deaths occurred in patients greater than 60 years of age.
	The three most common causes of death were improper dose, wrong drug, and wrong route of administration; collectively these represented approximately 66% of all deaths associated with medication errors.

The Institute of Medicine reported that in the US,

	7000 deaths occur yearly due to medication errors.
	Medication errors account for one out of 131 outpatient deaths and one out of 854 inpatient deaths.

Bates et al. reported that 42% of Adverse Drug Events were preventable and were caused by:

	Ordering errors (56%)
	Administration errors (34%)
	Transcription errors (6%)
	Dispensing errors (4%)

Currently there are no similar published statistics or data on local medication errors or near misses.

Physicians play vital roles, as they are the first individuals who can take steps to prevent medication error in the medication use process. Below are tips a dapted from BMJ Career Focus(2005 vol.331 pp 110) for physicians to consider when prescribing.

Basic principles of prescribing safely

Before prescribing,
	Assess the patient thoroughly, making sure the drug is appropriate and not contraindicated
	Always ask if the patient is allergic to any drugs; if this is not already documented, write it down
	Take into consideration any medication the patient is already taking, checking there are no interactions
	Consider alternative therapies and discuss these with the patient
When prescribing,
	Check that you are prescribing the correct medication to the correct patient
	Use generic drug names rather than brand names. Don't use abbreviations
	Check the dose, frequency, and route of administration are correct and appropriate for the patient. Include a start date and a review date
	Avoid unnecessary zeros (for example, 1.0 mg), which may be misread, and make sure the units you use are correct
	If in doubt, refer to appropriate reference
	Make sure your prescription is legible and easy to read
	Explain what you are prescribing to the patient and why; describing how and when to take medication increases compliance and reduces confusion
After prescribing,
	Watch out for any unprecedented reactions
	Make sure you monitor levels or organise follow-up tests if indicated
	Review the indications for the drug regularly. This prevents patients from taking medications they don't need to take

 

Lita Chew
Manager
Onco Pharmacy
National Cancer Centre, Singapore