1. Medication errors Debbie Cruickshank ICU Pharmacist Life The Glynnwood

2. definition A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm ….. including prescribing, order communication, product labelling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use.“

3. prevalence 1-2% of patients in UK and US hospitals are thought to be harmed by medication errors, mostly as a result of prescribing errors The epidemiology of medication errors: how many, how serious? Michael SchachterMichael Schachter British Journal of Pharmacology 2009

4. prevalence ADEs affect nearly 5% of hospitalized patients, making them one of the most common types of inpatient errors Agency for Healthcare Research and Quality (USA)

5. prevalence At least 1.5 million Americans are injured every year by medication errors. On average, every hospital patient is probably subjected to at least one medication error every day. Fortunately, many of these errors do not cause harm. Albert Wu – Member of IOM committee

6. prevalence Medical errors now claim the spot as the third leading cause of death in the United States, dwarfing auto accidents, diabetes and everything else besides cancer and heart disease Dr David Claasen, Institute for Healthcare Improvement

7. prevalence NHS medication errors

8. cost Inpatient preventable medication errors cost approximately $16.4 billion annually. In 2008, medical errors cost the United States $19.5 billion NEHI J Health Care Finance.J Health Care Finance. 2012 Fall;39(1):39-50. The economics of health care quality and medical errors. Andel C, Davidow SL, Hollander M, Moreno DAAndel CDavidow SLHollander MMoreno DA

9. cost The costs these errors create are staggering. Over $3 billion dollars annually goes toward treating the consequences of medication errors, which does not even include lost wages and worker productivity. Albert Wu – Member of IOM committee

10. cost The NHS wastes at least £1bn – and possibly as much as £2.5bn – on preventable errors, many of which are related to improper use of medication, according to a report commissioned by the Department of Health. The Pharmaceutical JournalThe Pharmaceutical Journal 20 OCT 2014By Ingrid TorjesenIngrid Torjesen

11. Type of medication error Ordering stage – 49% Transcription – 11% Dispensing – 14% Administration – 26% Bates et al 1995

12. prescribing errors Kay Seden et al. BMJ Open 2013;3:e002036 Categories of prescribing errors made by different grades of prescriber.

13. Prescribing errors

14. Lack of knowledge of prescribed drug Lack of knowledge of patient Inaccurate history taking Illegible handwriting Inappropriate use of decimal points Use of abbreviations Use of verbal orders

15. prescribing errors

18. administration errors The administration of medication is probably the task associated with the highest risk that a registered nurse performs Anderson and Townsend, 2010.

19. administration errors Administration errors account for 26-32% of all medication errors. Medication administration error rates in an acute care setting may vary between 14.9% and 32.4% Mc Bride-Henry and Foureur, 2006

20. our hospital Medication errors – August 2013 – July 2014 All errors recorded were detected by pharmacist working in ICU Only errors accepted by the doctors were recorded as errors

21. our hospital

24. Interventions introduced to reduce prescribing errors – Feb 2014 ◦ Discussion at practice meetings – knowledge and communication ◦ Anticoagulant on every prescription – HOLD if not to be administered ◦ Intensivist to write in blue pen to distinguish changes from original MO transcribed

25. our hospital

26. Our hospital – administration errors

27. our hospital –administration errors Study looked at the nurses perceived and actual knowledge of medication Two questionnaires developed – perceived knowledge, then actual knowledge Nurses only given second questionnaire once first completed Only Nurses working in ICU included

28. our hospital –administration errors Nursing knowledge gap

29. prevention of errors

30. role of the pharmacist The presence of a pharmacist on rounds and in the unit was associated with a substantially lower rate of ADEs caused by prescribing errors and 99% of the pharmacist recommendations were accepted by the physicians Leape et.al. (2009)

31. role of the pharmacist The pharmacist’s time is dedicated to critical care patients with few commitments outside of the ICU; All drug therapy is prospectively evaluated by the pharmacist; The position paper on Critical Care Pharmacy Services by the American College of Clinical Pharmacy (2000)

32. role of the pharmacist The pharmacist participates in quality assurance programmes to enhance pharmaceutical care. The position paper on Critical Care Pharmacy Services by the American College of Clinical Pharmacy (2000)

33. role of the pharmacist Research - 1173 medication orders were assessed during this time. These assessments resulted in 659 medication related interventions of which 74% were accepted. Klopotowska, Kuiper, von Kan, de Pont, Dijkgraaf, Lie-A- Huen and Smorenburg (2010)

34. role of the pharmacist Research - Pharmacist intervened 394 times for 600 consecutive patients at a rate of 0.66 interventions per patient. Almost all interventions (94.3%) were accepted by the medical team. The majority of interventions were associated with no medication prescribed for a documented medical condition (33.3%) or incorrect dose and/or frequency of medication (28.9%). Abdulrazaq, Amal, Asiri, Ysouf, Tariq, Natham, and Bashar (2008)

35. questions