Medication Error: A Closer Look at Cost and Consequences

Medication errors happen when something goes wrong with giving or taking medicine. This could be the wrong dose, the wrong medicine, or administering it at the wrong time. These mistakes can sometimes cause harm, but they are often preventable with careful checks.

Medication errors are the leading cause of avoidable patient harm globally, estimated to cost $42 billion USD annually.

These errors cost the NHS approximately £98 million every year.

This is why preventing medication errors is the most important step when we teach nurses and carers medication training. Our Level 2 medication training is highly focused on administering rightly using the seven rights of medication principles.

It is estimated that 5% of all patients admitted to hospitals experience a medication error, and an average hospital has one medication error every 23 hours or every 20 admissions [WFSA, 2022 Report].

If medication errors are addressed, there is likely to be a 50% reduction in preventable harms to patient care.

What are Medication Errors?

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines Medication errors as “any preventable incidents that may cause or lead to incorrect medication use or patient harm”.

These types of errors can occur at any stage of the medication use process.

The common stages that medication error occurs are during:

• prescribing,
• Transcribing
• dispensing,
• administering, and
• monitoring.

The National Health Service (NHS) in the UK also defines medication error as “any Patient Safety Incidents (PSI) where there has been an error in the process of prescribing, preparing, dispensing, and administering, monitoring or providing advice on medicines.”

To see how the NHS is affected, there were more than 487 claims from 1 April 2015 to 31 March 2020. These claims cost the organisation a massive £35 million, not including legal fees.

Besides the money, losing reputation and trust also comes at a cost.

Types of Medication Errors

Medication errors can be grouped in various ways. The list of the errors are explained below:

1. Prescribing Errors
   • Incorrect drug selection
   • Wrong dose or strength
   • Inappropriate frequency of administration
   • Incorrect duration of treatment
   • Prescribing a drug to which the patient is allergic
   • Prescribing a drug without considering potential drug interactions
2. Dispensing Errors
   • Dispensing the wrong drug
   • Dispensing the wrong dose or strength
   • Providing incorrect instructions on the label
   • Dispensing expired medications
3. Administration Errors
   • Giving the medication to the wrong patient
   • Administering the wrong dose
   • Using the wrong route of administration
   • Administering the medication at the wrong time
   • Omitting a scheduled dose
   • Administering an extra dose
4. Monitoring Errors
   • Failure to review prescribed treatment
   • Failure to monitor drug levels when required
   • Failure to act on monitoring results
5. Transcribing Errors
   • Incorrectly transcribing the original prescription
   • Misreading handwritten prescriptions
6. Patient Compliance Errors
   • Patient taking more or less than the prescribed dose
   • Patient taking the medication at the wrong time
   • Patient stopping the medication too soon or continuing it for too long
7. Communication Errors
   • Miscommunication between healthcare providers
   • Failure to communicate important information about the medication to the patient
8. Product-Related Errors
   • Errors due to similarity in drug names or packaging
   • Errors related to drug device usage (e.g., inhalers, injections)
9. Storage Errors
   • Storing medications at incorrect temperatures
   • Failing to secure high-risk medications properly
10. Calculation Errors
    • Mistakes in calculating doses, especially for weight-based dosing in children
    • Errors in calculating infusion rates

What are the Common Causes of Medication Errors?

Medication errors often occur due to common factors.

Communication problems, such as unclear handwriting or misinterpreted orders, can lead to mistakes.

Confusion between similar drug names or packaging is another factor. Dosage errors frequently happen, like misplaced decimal points or incorrect dose calculations.

Distractions and disorganised storage areas also contribute, as well as a lack of training or knowledge about medications.

Technology issues, such as incorrect data entry, and patient-related problems, including misidentification or language barriers, play a role.

Heavy workloads, improper medication storage, and failure to follow protocols further increase the risk.

Documentation mistakes, such as incomplete records or errors in transcribing orders, are another cause.

Understanding these factors will help you improve patient safety by reducing medication mistakes.

One of the impacts of medication mistakes is Adverse Drug Events (ADE) [World Patient Safety Day, September 2022].

In primary care, ADEs cause 627 deaths and cost £83.7 million in hospital admissions. In secondary care, they cost £14.8 million, lead to 85 deaths, and contribute to 1,081 more.

How You Can Minimise Medication Errors

Preventing medication errors is a key part of keeping patients safe, especially for nurses and carers.

You can follow these practical ways to help stop or prevent medication mistakes by:

Following the “Five Rights” of giving medication:

• Right patient
• Right medication
• Right dose
• Right route
• Right time

Double-checking medications:

• Always confirm orders with another nurse or healthcare worker.
• Use barcode scanning systems if available.

Keeping communication clear:

• Make sure handwriting on orders is easy to read.
• Ask the doctor if anything in the order is unclear.
• Speak clearly during handovers.

Staying informed about medications:

• Regularly update your knowledge about medicines.
• Attend training courses on new drugs and how to give them.

Minimising distractions:

• Create a quiet space when preparing medications.
• Use “Do Not Disturb” signs during medication rounds.

Storing and organising medications properly:

• Keep similar-looking or sounding medicines apart.
• Store medications correctly, like in a fridge if needed.

Educating your patients:

• Teach patients about their medicines and encourage them to ask questions.
• Help them be active in managing their own medication.

Using technology carefully:

• Use electronic prescribing systems if you can.
• Double-check all entries to avoid tech-related errors.

Reporting and learning from your mistakes:

• Support a culture where people report near-misses and errors without fear.
• Take part in reviews to prevent future mistakes.

Looking after yourself:

• Get enough rest and manage stress to stay alert and focused.

When you follow these steps, you can greatly reduce medication errors and keep patients safe.

Remember, medication management training and sticking to best practices are important to giving medicine correctly.

Medication Error Stats UK & Global

Global Stats

• Medication errors are a leading cause of avoidable harm in healthcare systems worldwide.
• Globally, the cost associated with medication errors has been estimated at $42 billion USD annually.
• In Europe, medication harm accounts for more than half of the overall preventable harm in medical care.
• It is estimated that 5% of all patients admitted to hospitals experience a medication error.
• An average hospital has one medication error every 23 hours or every 20 admissions.
• The rate of medication errors in hospitals ranges from 0.3% to 9.1% in prescriptions and 1.6% to 2.1% at the dispensing stage.
• 29% of patients have unintended medication discrepancies or errors at admission or discharge from hospital.
• In the US, 5.3% of medication administrations during anesthesia involved an error, adverse event, or both, with 79% considered preventable.
• In high-income countries, around 1 in 10 patients are harmed during hospital care, with medication errors being a major cause of this harm.
• In low- and middle-income countries, the risk is higher because healthcare systems are less organised, with about 1 in 7 patients affected.
• 29% of patients face unintended medication errors or changes when they enter or leave the hospital.

UK Stats

• An estimated 237 million medication errors occur annually in England at some point in the medication process.
• 38.4% of these errors occur in primary care settings.
• 72% of the errors have little or no potential for harm, while 66 million are potentially clinically significant.
• Adverse drug events (ADEs) in primary care result in 627 deaths and cost £83.7 million due to hospital admissions. In secondary care, ADEs lead to longer hospital stays, costing £14.8 million, causing 85 deaths, and contributing to 1,081 more.

Medication process error in the UK

Within England Healthcare Settings

References

• BMJ Medication Report: Economic analysis of the prevalence and clinical and economic burden of medication error in England
• PubMed: Economic analysis of the prevalence and clinical and economic burden of medication error in England
• University of Sheffield: PREVALENCE AND ECONOMIC BURDEN OF MEDICATION ERRORS IN THE NHS IN ENGLAND.
• World Health Organization: Medication Without Harm
• WFSA Article: World Patient Safety Day: Medication Without Harm.
• WHO Europe Region: KEY FACTS ABOUT MEDICATION ERRORS (MEs) IN THE WHO EUROPEAN REGION.
• NCCMERP: Medication Errror Definition.