Centre of the Joanna Briggs Institute.1. The primary references included in the systematic review on which this information sheet is based are available online at ...
Volume 9, issue 4, 2005 ISSN 1329 - 1874
BestPractice Evidence Based Practice Information Sheets for Health Professionals
Strategies to reduce medication errors with reference to older adults Information source This Best Practice Information Sheet is
This Information Sheet covers the following:
based on a systematic review of research, published by Blackwell
•
Computerised systems
•
Individual patient medication supply
Publishing Asia and conducted by the Australian Centre for Evidence Based Aged Care, formerly a Collaborating Centre of the Joanna Briggs Institute.1 The primary references included in the systematic review on which this information
sheet
is
based
are
available online at www.blackwellvia
the
web
•
Education and training
•
Use of pharmacists
•
Nursing care models
site: medication
www.joannabriggs.edu.au
related.
The
Harvard
Medical Practice study in the USA
Background
These Grades of Recommendation have been based upon the JBI developed Grades of Effectiveness: Grade A: Effectiveness established to a degree that merits application
synergy.com and to members of the Institute
Grades of Recommendation
found that in hospital patients disabled
Grade B: Effectiveness established to a degree that suggests application Grade C: Effectiveness established to a degree that warrants consideration of applying the findings Grade D: Effectiveness established to a limited degree Grade E: Effectiveness not established
In Australia, around 59% of the general
by some form of medical treatment,
population
19% of recorded adverse events were
staggering with one estimate putting
medication with this number increasing
related
Older
the cost of preventable medication
to about 86% in those aged 65 and
Australians have higher rates of
errors the USA alone between $17 and
over, and with 83% of the population
medication incidents due to higher
$29 billion per year. In Australia, the
aged over 85 using two or more
levels of medication intake and
cost has been estimated at over $350
medications simultaneously. In a study
increased likelihood of being admitted
million annually. As medication errors
of 11 medical and surgical units in the
to hospital (hospital statistics being the
can occur at all stages in the
United States of America (USA) over a
main source of medication incident
medication process, from prescription
six month period the rate of adverse
reporting). In the community setting it
by physicians to delivery of medication
drug
100
has been estimated that up to 400,000
to the patient by nurses, and in any site
admissions. A recent report suggests
adverse drug events may be managed
in the health system, it is essential that
that between 2% and 3% of all hospital
in general practices each year in
interventions be targeted at all aspects
admissions in Australia may be
Australia. The financial burden is
of medication delivery.
events
uses
was
prescription
6.5
per
to
medications.
Volume 9, issue 4, page 1, 2005
misunderstanding
the
label
Types and causes of medication errors
Table 1: Types of medication errors in general medical practice
Studies examining the types and
Inappropriate medication
30
causes of medication errors occurring
Prescribing error
22
in older adults (≥65 years) are limited.
Administration error
18
However, evidence is available on the
Inappropriate dose
15
The most common errors and their
general population and is taken to be
Side effect
13
causes related to medication that are
representative of those issues that
Allergic reaction
11
encountered in community practice (ie.
Dispensing error
10
community pharmacies and general
Overdose
8
Medication errors in the hospital setting
System inadequacies
7
have been studied extensively. In a
Medication omitted or withheld 6
USA study of 11 medical and surgical
the patient (14%), eg. inappropriate
units followed over a six month period
surveyed and not from empirical
medication for that patient.
evidence.
There is limited Australian data on the
reasons for medication errors are
causes of these errors in a hospital
shown in Table 2.
would arise in the geriatric setting.
the most common types of errors identified were wrong dose (28%), wrong choice of medication (9%), wrong medication (9%), known allergy
Type of incident
instructions. However, the effect of
Rate/100 incidents
these factors on medication error and adverse drug events has not been studied.
practices) are shown in Table 1. The factors contributing to these errors were
setting, however for prescription errors,
forwarded Most
by
the
commonly
doctors cited
approximately 2% of all prescriptions
Objective
have the potential to cause an adverse
The objective of this information sheet
event with the most common causes
is to present the best available
being the wrong or ambiguous dose,
evidence related to management of
missing dose, or the directions for use
medication
were unclear or absent.
associated
categorised as omissions (>25%),
The most common types of dispensing
dispensing and administration of
overdoses (20%), wrong medicines
errors reported by pharmacists are the
medications in the acute, subacute and
(10%), drug of addiction discrepancy
selection of the incorrect strength,
residential care settings with particular
(
