Study: Pharmacists most likely to catch medication errors

Most medication errors found in primary care practices are prescribing errors. According to a new study by the Agency for Healthcare Research and Quality, although a majority of these errors reach the patients, it is pharmacists who are most likely to intercept the mistakes.

A majority of such errors could be prevented by electronic tools, the study suggested. Of a total of 1,265 medical errors voluntarily reported, 194 concerned mistakes in medication. Seventy percent of those involved prescribing errors, 10 percent each involved medication administration or documentation errors, 7 percent involved errors in dispensing drugs, and 3 percent involved medication monitoring errors.

The most common errors were incorrect dosage, incorrect drug selection, contraindications, communication problems with the pharmacy, and insufficient information on the prescription. In 59 percent of the cases, the errors reached the patients; none resulted in permanent harm or death. However, monitoring was required in 8 percent of the reports, intervention in 13 percent, and hospitalization in 3 percent.

Pharmacists were most likely to prevent the errors from reaching the patient (40 percent of intercepted errors), while physicians and patients caught 19 percent and 17 percent of the mistakes, respectively.

The researchers concluded that more widespread use of healthcare information technology, such as electronic health records (EHR) and computerized provider order entry (CPOE), could have prevented as much as 57 percent of the errors. Only 3 percent of the participants reported using technology information in their practice.

Researchers from the American Academy of Family Physicians looked at medication-error reports from two previous studies that examined mistakes from 42 family practice physicians over 20 weeks and 401 clinicians over 10 weeks. In all, reporting came from 52 diverse private practices.

More details can be found at www.ahrq.gov/research/feb09/0209RA5/htm.