Years ago, before therapeutic prescriptive authority was earned by our profession, the magnitude of our incidental “goofs” was limited to errors writing the spectacle prescription, especially with transposing errors. These mistakes were quickly corrected by remaking the lenses and apologizing profusely to the patient. Now, however, we provide medical care with accompanying therapeutic prescriptions, so the risk of injury to the patient goes up dramatically. As doctors, we need to be on guard against any error regarding a prescription medication.
Ensure Conscientious Prescribing
Almost everyone in the modern world takes medication at one time or another. According to one estimate, in any given week four out of every five U.S. adults will use prescription medicines, over-the-counter drugs or dietary supplements of some sort, and nearly one-third of adults will take five or more different medications.1 Older people may be at greatest risk for medication errors because they often take multiple prescription medications. Most of the time, these drugs are beneficial, or at least they cause no harm. But on occasion, they do injure the person taking them. This is precisely what none of us want.
A study conducted in a British intensive care unit sought to determine the incidence and variations in prescription writing errors. All prescriptions were tracked for 24 units in a four-week period. Over the course of time, 21,589 prescriptions were produced, and of those, 85% were deemed safe. But a little over 3,141 had errors.2 While most of the errors were not considered significant, 618 (19.7% of all the errors) were considered life threatening. In other words, almost one in every five errors that occurred could have resulted in the death of the patient.2 Keep in mind this was in an intensive care unit!
With all 50 states enjoying therapeutic prescriptive authority won in hard-fought legislative battles, optometrists are able to provide medical care to the patients they serve. But, we also have to be diligent with our responsibility. Medication errors are among the most common and preventable mistake, harming at least 1.5 million people every year according to Preventing Medication Errors, a report from the Institute of Medicine of the National Academies.1 Drug errors encompass all mistakes involving prescription drugs, over-the-counter products, vitamins, minerals or herbal supplements. Errors are common at every stage, from prescribing and administering a drug to monitoring the patient’s response. Not all errors lead to injury or death, but the number of preventable injuries that do occur is disturbing. Roughly one third of the errors—530,000—occur annually just among Medicare recipients in outpatient clinics, similar to the places where most practitioners practice. And, these numbers are likely underestimates.1
The cost of these medication errors is staggering. A study of outpatient clinics found that medication-related injuries resulted in roughly $887 million in extra medical costs in 2000, and the study looked only at injuries experienced by Medicare recipients, a subset of clinic visitors.2 Note that none of these figures take into account lost wages and productivity or other costs.
Eliminate Errors Today
One of the most effective ways to reduce medication errors is by forming a partnership between patients and their health care providers.1 Patients should understand more about their medications and take more responsibility for monitoring them, while providers should take steps to educate, consult with and listen to their patients. Patients should maintain an up-to-date list of all medications they use—including over-the-counter products and dietary supplements—and share it with all of their health care providers. Doctors must communicate with patients at every step of their care and make that communication a two-way street: listening to the patients as well as talking to them fully about the risks, contraindications and possible side effects of the medications they are taking and what to do if they experience any side effects. While we are all very busy in our practices, and time is at a premium, it is important to remember that our patients may not completely understand what we are saying. Many will simply nod in agreement without really understanding what has been said. We must make use of written sheets that outline the medications, their dosage and frequency, in order to bolster what has been said.
A New Frontier
New computerized systems for prescribing drugs and other applications of information technology show great promise for reducing the number of drug-related mistakes. Paper-based prescribing is associated with high error rates because they are often illegible or the instructions for the medications not properly filled out. Even for the most seasoned practitioner, this is stunning. Electronic prescribing should be safer because it eliminates problems with handwriting legibility (my personal demon), and when combined with decision-support tools, automatically alerts prescribers to possible interactions, allergies and other potential problems. But, it is not foolproof.
It wont be long before most providers will be using e-prescribing systems, and all pharmacies will be able to receive prescriptions electronically. Theoretically, it is beneficial to interface data electronically on prescriptions in case there are interactions to which the patient might be prone. This way, we can be aware of it ahead of time. Wouldn’t it be nice to know that your recently presenting glaucoma patient can’t tolerate a certain IOP-lowering drug because of a previously developed sensitivity, especially after the patient failed to disclose this to you? Any improvement in patient care adds to improvement of the accuracy and outcome of that care. Isn’t that what we are all trying to do?
1. Institute of Medicine, National Academies. Preventing Medication Errors: Quality Chasm Series. National Academies Press. Jul 20. 2006.
2. Ridley SA, Booth SA, Thompson CM. Intensive care society’s working group on adverse incidents. Prescription errors in UK critical care units. Anaesthesia. 2004 Dec;59(12):1193-200.