A True Story on Medication Safety

True story happened earlier in the last week- an Incident in Medication Safety

A patient came to visit a health facility for the complaint of toothache and seen in a dental clinic. He was advised to take some antipain and oral wash with hydrogen peroxide and visited an OPD pharmacy in which there were crowed queue. For the sake of better queue management, the pharmacy professionals usually collect prescription papers and call their names while the turn comes. However, it was incidental that this patient handed-in metformin and Glibenclamide. Later, in the weekend the patient admitted to emergency with hypoglycemia and complaining of worsened toothache.?Lucky this patient comes early to health facility before the worst thing happens.

This inspired me to write a little on medication safety today.

Medication safety refers to the practices and measures implemented to prevent medication errors and ensure the safe and effective use of medications. It is defined as the freedom from accidental injury due to medical care or medical errors during the medication-use process. Medication safety issues can impact health outcomes, length of stay in a healthcare facility, readmission rates, and overall costs to the healthcare system.

A systematic review and meta-analysis in a total of 14 studies with 5,552 administered medications and 5,661 prescription sheets indicate medication errors were highly common in Ethiopian hospitals. In both medication administration and prescription errors, committed errors are very sensitive to further deteriorate and complicate the health of the patients. The overall prevalence of medication error in Ethiopia was 57.6% (95% CI: 46.2, 69.0). Endalamaw A, Dessie G, Biresaw H, et al.

Medication errors can occur at many steps in patient care, from ordering the medication to the time when the patient is administered the drug. In general, medication errors usually occur at one of these points:

1.Prescribing- 46% —irrational, inappropriate, and ineffective prescribing, under prescribing and overprescribing, illegibility.

2.Dispensing and delivering medication-28% —wrong drug, wrong formulation, wrong label; wrong strength, contaminants, or adulterants, wrong or misleading packaging.

3.?Medication administration-23%—wrong dose, wrong route, wrong frequency, wrong duration.

4.Monitoring and Reporting- 2%- monitoring of medication effect on the patient.