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Medication error prevention

Humans are prone to errors, and efforts over many years have attempted to reduce those errors. Perhaps, preventable errors are the worst type since their expense and trauma could or should have been avoided. We have seen colour-coding of labels where some pharmaceuticals are available in multiple strengths. Unfortunately, errors have occurred through selection of the blue label even though the medication is not the correct one. Bar codes have been used in mail service pharmacies and in high-volume hospital pharmacies with some degree of success. Other systems display a photograph of the capsule or tablet for the dispensing technician or pharmacist to see the actual appearance of the desired dosage form. That is useful except for round, white tablets for the most part. Investigators have studied the reasons for pharmaceutical errors, just as investigators search the wreckage of crashed airplanes. Fatigue has been associated with errors, as have interruptions and multitasking. Some steps have been initiated to reduce fatigue, interruptions and multi-tasking in some settings. The idea of attempting to hide or cover up errors has, of course, been attempted, especially in cases where the pharmacist, physician or technician expects no adverse events happening from the error. In recent years, health administrators have attempted to reduce or even remove the punitive aspects from recognition of an error and converting it into a learning experience. This should hopefully encourage healthcare professionals to come forward when an error is recognized to enable correcting it at the earliest possible time. In order to prevent future errors of the same type, root cause analysis is frequently undertaken by hospital and clinic administrators. Some fields use checklists to reduce errors due to memory lapses, negligence and overconfidence in some tasks. Airline pilots use such checklists to make certain all of the switches and instruments are satisfactory. This could be beneficial in operating rooms, and hopefully, it will grow in popularity. It could similarly be beneficial when conducting diagnostic procedures, in attaching prosthetic devices and in many other settings. Computer-assisted order entry (prescribing medications on the computer) has the ability to catch overor under-doses, syrups for diabetics or duplicate medications, such as two different benzodiazepines, for example. The Pharmacy Benefit Managers have other computer software to also catch inappropriate prescribing at the time of dispensing via prospective utilization review techniques. However, despite all of these and other efforts, errors continue. Handwriting interpretation errors are gradually being eliminated through prescribing on a computer terminal keyboard. In addition, there have been some exciting and positive developments. One example was the initiative to make the placement of knobs and gauges on all brands of anaesthesia machines to all be in an identical configuration, so when a sudden crisis occurs, the anaesthesiologist can reach the correct setting without having to be concerned about which brand or model of machine is used in that operating room. In 2010, the American Academy of Ophthalmology endorsed a new colour-coding scheme for the caps of topical ocular medications. It goes well beyond the colour label coding for drugs available in multiple strengths.