Drug errors are unacceptable in any situation

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Drug errors are unacceptable in any situation involving medical treatment or medications,but the reality is that they will never disappear. It is a human trait that people make mistakes. Attimes, errors may not be realized before they cause harm. When discussing drug errors, it isimportant to note that not all errors are harmful and not all are caused by the pharmacy. In thischapter, the types and incidence of errors are discussed, and specific cases that unfortunatelycaused harm are presented. An attempt is made to identify the common causes of many drugerrors and ultimately the ways in which they can be avoided. Other topics discussed in thischapter include the process of drug error reporting (i.e., when errors should be reported and whoshould be contacted) and the importance of helping patients learn to take responsibility for theirown medical treatment, including their medications.Pharmacy technicians are at the forefront in the effort to prevent drug errors; ironically,they also can cause errors relatively easily. Many technicians have relied on the pharmacist tocatch their mistakes, but this is not the correct approach to preventing medication errors. Anyonecan make a mistake, including pharmacists, physicians, and nurses.It takes a team working together to prevent medication errors. The knowledgerequirements for technicians are increasing, along with their additional responsibilities. Today'spharmacy techs must understand their scope of practice and strive to meet the highest standard.OverviewIn 2010 the Office of the Inspector General for Health and Human Services reported thatbad hospital care contributed to the deaths of 180,000 Medicare patients (Allen, 2013; Office ofInspector General, n.d.). A study published in the Journal of Patient Safety in September 2013estimated that 210,000 to more than 400,000 patients per year suffer some type of preventableadverse event while in the hospital that contributes to their death; this was a much higherestimate than the estimate in a 1999 study completed by theInstitute of Medicine(IOM). Thehigher estimate was developed by John T. James, PhD, a toxicologist at NASA's space center inHouston, Texas. Mr. James became involved in patient safety issues after his 19-year-old sondied as a result of insufficient hospital care (James, 2013).The Institute for Safe MedicationPractices(ISMP) estimates that about 7000 deaths per year are linked to actual medicationerrors (Anderson, 2015). High-alert medications are drugs with a heightened risk of causing
significant patient harm when used in error. According to the ISMP, some medicationsconsidered “highest alert” in connection with errors are insulin, narcotics and opiates,methotrexate, warfarin, and potassium chloride (KCl) injections (Box 14.1).

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