Analgesic medication errors are common

Medication errors involving analgesics, including mistakes in prescribing, are a major contributor to suboptimal therapeutic outcomes and preventable adverse patient events, according to a study published in The Journal of Pain, reported Newswise.com.

The frequency of analgesic drug errors in hospitals is nearly 3 per 1,000 prescriptions, a figure based on a study performed in a 631-bed tertiary care facility.

“The results of this study are not surprising and serve to highlight the importance of including a pharmacist in multidisciplinary teams and/or medical homes,” said Drug Topics Editorial Advisor Anna D. Garrett, PharmD, BCPS, manager, outpatient clinical pharmacy services, Mission Hospital, Asheville, N.C. “Allowing each healthcare professional to ‘do what they do best’ is a very important part of minimizing patient harm.”

In an era where healthcare spending is closely scrutinized, it is easy to get caught up in examining the cost of pharmacists’ services, Dr. Garrett added.  “What is often overlooked is the value that is atrributable to avoidance of medication prescribing errors,” she said. “It is imperative that pharmacists continue to work toward quantifying these cost savings so the overall benefit of having them on the health care team can be demonstrated.”

Researchers at Albany Medical Center in New York examined a large database of prescribing errors that pharmacists had detected and prevented; their objective was to quantify and define characteristics and uses associated with increased risk of errors. Previous studies had reported that a significant number of analgesic prescribing mistakes are preventable and that errors occur in all steps of the medication-use process, with prescribing errors as the major cause, the authors said.

The overall error rate was 2.87 errors per 1,000 analgesic orders, with a potentially serious prescribing error rate of .63 per 1,000. Error rates were higher in pediatric orders.

“Even with common analgesics, physicians are likely to make prescribing errors, especially in pediatric orders, and pharmacists should not only look out for these errors but work along with physicians in order to eliminate these errors,” Ripple Shah, PharmD, senior scientist Hartford Hospital and University of Connecticut, told Drug Topics.

For the analysis, pharmacists reviewed 714,290 orders for analgesics. Analgesics were organized by their drug class and dosage forms, such as anti-inflammatory agents, immediate-release opioids, injectable drugs, transdermal agents, and acetaminophen. Each reported error was evaluated by the contributing cause: failure to modify therapy based on patient-specific information, inadequate drug-therapy knowledge, inappropriate use of a dosage form, mistakes in dose calculations, improper dose for the route of administration, and others.

The authors reported a total of 2,044 prescribing errors (.29%); of these, 449 (22%) were considered potentially serious. Among pediatric cases, there were 243 errors in 40,996 analgesic orders (.59%). Pediatric drug errors accounted for 14% of mistakes rated as potentially serious.

Error rates varied widely between individual drugs, and the highest numbers of individual analgesic errors occurred with infrequently prescribed medications, such as buprenorphine and benzocaine. Also, look-alike and sound-alike drug names composed a significant proportion of the medication errors found.

For improved risk reduction, the authors suggested that computerized prescriber order entry systems can reduce but not eliminate errors. Other safeguards that should be implemented include limits on the number of similar medications available on the formulary and reviews of drug orders by pharmacists and nurses for every prescribed analgesic.