With the vast amount of prescription medications dispensed each year, mistakes or errors are likely to occur simply because of the tremendous volume. In 2016, retail pharmacies in Maryland filled 66,245,139 prescriptions. This quantity of over 66 million does not account for the many products used in non-retail settings throughout the state.
There have been significant advancements through new technologies and practices in recent years to better streamline the four-step process involved in providing medications to patients. Despite the improvements, medication-based errors are the fourth leading source of claims of medical malpractice. We will review these four key parts of the medication continuum which include ordering, dispensing, administering and monitoring & management.
There are four distinctive steps where the potential for errors may surface that we will review.
The process of ordering may include the following considerations:
- Medical assessment
- The choice of drug and its schedule of classification
- Creation of documentation (medical record)
- The method of ordering: written, verbal (vocal), or electronic submission
- Educating the patient
This initial step of ordering is the phase where approximately 35% of prescription based claims originate and has many potential pitfalls. Often an error can result from orders for child patients, such as a medication prescribed for a three-year-old that is intended only for those ages six and up. An order that states the medication is to be taken at frequent intervals, such as every four hours, for a patient whose condition or level of cognition is unsuitable for properly adhering to such instructions. The medical assessment may have been insufficient in documenting the patient's allergies to ingredients contained in a medication.
The process of dispensing may include the following considerations:
- Entry of data
- Necessary preparation of a medication
- Review by the pharmacist
- Packaging the medicine
The dispensing process is the phase that has best benefitted from the implementation of new technologies and automation. This is evidenced by it being the least likely step where an error may occur, leading to only 3% of claims.
Administration of Medication
- Interpretation of instructions
- Measuring & preparing dosage
- Providing the dose
- Confirming the “five critical rights”
Errors within this phase account for roughly 31% of prescription drug-related claims of liability. The five critical rights include: right patient, right medication, right dosage, right means of administration (topical, oral, injection etc.), and at the right time.
Medical Management & Monitoring
- Assessing the effectiveness of medication
- Side effects
- Reconciling medications
- Documentation (medical record)
Approximately 31% of medication-based liability claims occur at this critical phase. Properly monitoring and reconciling the overall medications the patient is taking is a potential pitfall. This requires probing for all prescription products being taken, over-the-counter products and supplements, which all will need to be checked for potentially harmful interactions. A critical component of the management and monitoring process is based on having solid communication. Both the physician and patient must maintain a firm understanding of the treatment plan moving forward.