Two out of every three office visits results in a prescription. Each year over 1.3 billion drugs are prescribed. A study from Colorado family practices suggests that over 60% of office-based medical errors resulting in harm involve prescription. 25% of ambulatory patients experience an adverse drug event, 13% of which result in serious harm. The annual incidence of medication error per capita is 5%. A significant risk factor for medication error is number of medications. The mean number of events per patient increased by 10% for each additional medication. Errors can occur in drug selection, prescription writing, interaction and allergy assessment, pharmacy fill, and medication taking. Any of the 5 “wrongs” can occur.
In addition, there can be errors of discontinuity between settings. For instance, 42% of patients discharged from the hospital experience an adverse drug event. The most common drug classes associated with medication errors include serotonin-reuptake inhibitors (SSRIs), beta-blockers, ACEs, and NSAIDs.
Specific strategies to reduce medication error include:
- Use electronic prescribing writing systems, particularly systems that have interaction clinical decision making function as a component
- If writing paper prescription, ensure that indications are routinely added
- Avoid abbreviations if possible. For example, us “once daily” rather than qd
- Use teach back to ensure patients understand indications, dosing, and adverse effects and what to do if experienced.
- Avoid using Beer list medications in patients who are frail and elderly americangeriatrics.org/files/documents/beers/2012AGSBeersCriteriaCitations.pdf
- Avoid using sample medications
- Keep medication lists up to date and fully reconciled.
This last point is key. Only 20% (1 in 5) medication lists are accurate. Having a standardized and fully implemented medication reconciliation process will go a long way towards reducing adverse drug events in your patient population. Important steps for developing a med rec program includes:
- Assign a role for collecting updated medication information in your practice
- Utilize frequently any pharmacy resource that might be available in your setting
- Review medications at every visit, including medications the patient may have started on their own (including over the counter medications) and those started by outside physicians.
- Record: name of medication, dosage, and route as well as start date and intended duration as stated by the patient
- Reconcile with what is written on the medication list
- Verify if needed by contacting pharmacies or outside physicians. This is especially important at every transition of the patient such as discharge from hospital
- Periodically, “brown bag” it- ask your patients to bring in every medication whether prescribed or not- any medication sitting on their shelf that they are taking and verify with what is on your medication list for them. If medications are out of date or not to be used, dispose of them in office.
- Provide at every visit, a medication information sheet for medications they are taking, especially for newly prescribed medication along with a contact information if they are experiencing side effects or have questions regarding how to take the medicine
- Utilize medication decision making tools such as Hippocrates
Patient safety in your office begins with what prescriptions you hand your patients, and how you actively engage them in managing their medication therapy.