Pitfalls In Prescribing: How to Minimize Drug Therapy Risks

Recent headlines in the nation’s newspapers have riveted public attention on medication errors—a problem that has long plagued the medical community. ¹ Prescribing mistakes are common, and they exact a costly toll: the US Institute of Medicine estimates that 98,000 Americans die each year because of a failure in the drug treatment process.² Estimates suggest up to 5% of all inpatients will experience some type of medication error.^3,4 More people die each year of drug errors than from car accidents, AIDS, breast cancer, or workplace accidents.² A medication error is a “failure in the drug treatment process (ie, prescribing, interpreting, dispensing, and administering) that leads to—or has the potential to lead to—harm.”⁵ Many factors contribute to the prescribing errors that occur every day—both in and out of the hospital.1 They include:

• Similar drug names. More than 10,000 trade and generic names exist for currently available drugs. Numerous reports describe problems that ensued after a soundalike drug was inadvertently prescribed.
• Lack of drug knowledge. Lesar and colleagues⁶ recently found that 12.1% of errors were related to a prescription written for a patient with a known allergy to the prescribed medication class.
• Errors in calculating dosage. The Lesar study also found that dosing mistakes were among the most common type of medication error.⁶
• Wrong spot for the decimal. A stray mark from a pen or a misplaced decimal on a prescription can lead to tragic consequences.
• Wrong dosage form. Various formulations of the same medication have different bioavailabilities and pharmacokinetic patterns. Thus, a prescription for the wrong form of a medication can lead to marked discrepancies in its effect.
• Wrong dosing frequency. Mistakes are made when a prescriber is unfamiliar with the dosing regimen.
• Confusing abbreviations. Clinicians’ handwriting is often challenging to read.⁷ Medication errors occur when poorly written, ambiguous, or unfamiliar abbreviations are incorrectly interpreted.
• Drug interactions. Interactions can potentiate the therapeutic and pharmacologic properties of a medication and can lead to toxicity; they can also nullify any beneficial effects of the added drug.
• Disease states. Prescribers often forget to adjust dosages for patients with renal, hepatic, or cardiac impairment.
• Incomplete patient history. Lack of a current medication history can open the door to a serious drug interaction— or to the omission of a needed medication.

How to minimize the risk of a medication error? The answer to that vital question is the focus of a new feature, “Pitfalls In Prescribing,” which begins on page 337. Each month (in a few short pages), I will choose a commonly prescribed drug (this month the spotlight is on warfarin(), and will share key information with supporting literature to help you use that agent safely. I will emphasize drug interactions, adverse effects, and appropriate dosage adjustments for decreased renal or liver function. It is my sincere hope that the details and strategies unveiled in this series will help your patient attain the beneficial effects the medications were designed to provide.