Prescribing errors are relatively common and can affect patient safety and treatment outcomes. Most prescribing errors cause little to no harm, with very few resulting in severe harm or death, but many of these errors can be avoided with more knowledge and mindfulness.
Here we list the ten most important types of prescribing errors for causing severe harm or death to patients. Data for these prescribing errors were gathered from observational research, patient safety incident reports, yellow card reports and medical indemnity claims.
1: Prescriptions for medicines were omitted or delayed
A real-life example of this was a patient discharged from the hospital following an ischaemic stroke. The patient wasn’t prescribed clopidogrel on discharge, and the missing prescription wasn’t noticed by the prescribing doctor, the dispensing pharmacist or the nurse responsible for handing over the medication.
Prescribing errors for anticoagulants such as oral warfarin, injected heparin, and low-molecular-weight heparins have all been involved in severe harm or patient death. An example was a patient receiving anticoagulants that failed to attend three consecutive appointments to establish a normalised ratio (INR). Their last INR was done more than a year ago, yet the patient continued to be prescribed their anticoagulant medication.
3: Opioid analgesics
A high number of patients have died after being prescribed opioid medicines unsafely. Opioid prescriptions include diamorphine, morphine, codeine, fentanyl, oxycodone and methadone. These medications are associated with developing tolerance and often dependence in patients. Overprescribing incidents have led to patients being admitted to the hospital after experiencing mental confusion and hallucinations.
Almost a third of inpatients who have Diabetes experience medication errors during their hospital stays. In some cases, the type of insulin prescribed was wrong. For example, patients given the wrong prescription experienced hypoglycaemia, which needed to be reversed with intravenous dextrose.
5: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Prescription errors for NSAIDs are responsible for 30% of hospital admissions for ADRs. Doctors and pharmacists can see patients, but gastric protection can be failed to be prescribed. This can lead to complications during surgery, where patients can quickly deteriorate and, in some cases, die.
6: Medications that require regular blood test monitoring
Many medications require regular blood test monitoring to maintain dosage and effectiveness. These include angiotensin-converting enzyme inhibitors, clozapine, digoxin, gentamicin, lithium, loop diuretics, clozapine, methotrexate and mirtazapine. Failure to regularly monitor these medications can lead to complications, such as impaired kidney function.
7: Known allergy to medicine, including antibiotics
Patients with documented allergies to medications are exposed to them and suffer adverse effects that are entirely preventable. In some cases, prescribing errors have led to patients collapsing and arresting shortly after medications were administered.
8: Drug interactions
Significant patient harm or reduced efficacy of a medication can happen when drug interactions occur. For example, a patient admitted to the hospital with a cardiac arrest had been on a high dose of clarithromycin, resulting in digoxin toxicity. In addition, the patient was taking antibiotics known to change digoxin levels.
9: Loading doses
Loading doses need careful multi-step calculations, but if loading doses are miscalculated, it can result in additional doses continued in error. Loading doses and maintenance doses are also likely prescribed at the same time or not prescribed at all.
Oxygen is prescribed for hypoxaemic patients to increase alveolar oxygen tension and reduce the effort of breathing. Oxygen concentrations need to be calculated carefully depending on the medical condition. Administering inappropriate concentrations of oxygen can cause severe or life-threatening risks.
PDUK recommends the following online course for all non-medical prescribers.
This one-day interactive course is beneficial for all non-medical prescribers (NMP) with recorded prescribing qualifications (V300) working within the NMP role.
NMPs are required to refresh their qualifications with an annual NMP update, and this course fulfils their requirement to demonstrate ongoing CPD. This course is ideal for all NMPs with a V300, including nurses, physiotherapists, radiographers, pharmacists, optometrists, podiatrists, midwives, and paramedics.
The course runs from 10:00 am- 4:30 pm, and all course material, evaluations and certificates are provided.
The aims and objectives of this course include the following:
- Understand the legal, professional and accountability issues of non-medical prescribing.
- Assess your prescribing practice using the single Royal Pharmacy Society (RPS) competency framework.
- Describe strategies to keep up to date with developments in evidence-based practice to maintain safe prescribing.
- Reflect on your prescribing experiences with your peers and network and identify areas for improving your practice.