Although proper administration of medications can be lifesaving, errors in the prescription or dispensation of these drugs can severely harm patients. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.”

According to a 1999 report from the Institute of Medicine, there are over 7,000 medication-related deaths every year. Of those fatal medication errors, 41% were due to improper dosing of the correct drug, 16% were caused by administration of the wrong drug entirely, and 16% were caused by use of the wrong route of administration, just to name the top three causes found by the Food and Drug Administration in its evaluation of medication-related deaths from 1993-1998.

However, a 2009 study published in the British Journal of Clinical Pharmacology determined that “errors and faults in prescribing are in most cases preventable.” Errors in writing a prescription are typically caused by simple mistakes, such as an erroneous calculation that leads to a dosage that is orders of magnitude higher or lower than appropriate or a mix-up of two similar drug names.

One recommendation to reduce these types of errors is the widespread use of automated prescribing systems, which can remove some of the “human error” from the process of dispensing and administering drugs. Although many hospitals are transitioning to these systems, they are expensive and require training for doctors and staff.

Inappropriate prescribing, by contrast, is a more serious lapse in medical judgment caused by inadequate knowledge or training. Inexperienced doctors, in particular, sometimes fail to check for a medication’s interactions with a patient’s existing prescriptions or even drug allergies. To address this problem, prescriptions should be reviewed by a hospital pharmacist, who has the specialized knowledge and training necessary to spot mistakes and prevent adverse effects on patients.

The input of a hospital pharmacist on rounds or reviewing drug orders in the hospital’s pharmacy “has been regarded as a major contribution to the identification and reduction of error.” Unfortunately, although patients require their medications around the clock, some hospital pharmacies are not staffed at night, leading to dangerous lapses in patient care. A patient safety analyst from the Pennsylvania Patient Safety Advisory determined that “when pharmaceutical services are not available, the medication-use process can be more vulnerable to errors.”

Encouragingly, the 2014 national survey of pharmacy practice in hospital settings conducted by the American Society of Health-System Pharmacists found improvement in these suggested interventions. An increasing number of hospitals are automating the drug prescription and distribution processes. In addition, in 81.2% of all hospitals surveyed, pharmacists reviewed and approved all medication orders prior to administration of the first dose to non-emergency or surgical patients. This survey also indicates that the overnight care gap is shrinking. Since 2005, the percentage of hospitals that do not have 24-hour on-site or remote pharmacist review available has decreased from 60% to about 20%.

Hopefully this increasing involvement and oversight of drug prescription and administration by those who specialize in the field will continue to reduce medication errors and improve health outcomes for patients.

Sources:

[Hospital pharmacists increasingly involved in direct patient care](https://www.pharmacist.com/hospital-pharmacists-increasingly-involved-direct-patient-care-0)

[Medication Errors: When Pharmacy Is Closed](http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Mar;9(1)/Pages/11.aspx)

[Strategies to Reduce Medication Errors: Working to Improve Medication Safety](http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm)

[Medication Errors in Hospitals: An Analysis](http://www.pharmacytimes.com/publications/issue/2004/2004-10/2004-10-4616)

[Medication errors: prescribing faults and prescription errors](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723200/)