MEDICATION RELATED

PROBLEMS
Dr. Mark Anthony O. Ellana, RPh PharmD
 MEDICATION ERROR
According to National Coordinating
Council for Medication Error Reporting
and Prevention (NCC MERP)

A medication error is any preventable

event that may cause or lead to
inappropriate medication use or
patient harm while the medication is in
the control of the health care
professional, patient, or consumer.
 MEDICATION RELATED
PROBLEMS
As defined by Hepler and Strand,
is “an event or situation involving
drug therapy that actually and
potentially interferes with
optimum outcome for a specific
patient.”
 MEDICATION RELATED PROBLEMS
MRPs can be broken down into the following
eight categories:
1. Untreated conditions: The patient has a
medical condition that requires drug therapy
but is not receiving a drug for that condition.
2. Drug use without indication: The patient is
taking a medication for no medically valid
condition or reason.
3. Improper drug selection: The patient’s
medical condition is being treated with the
wrong drug or a drug that is not the most
appropriate for the patient’s special needs.
4. Subtherapeutic dosage: The patient has a
medical problem that is being treated with too
little of the correct medication.
 MEDICATION RELATED PROBLEMS
MRPs can be broken down into the following eight
categories:
5. Overdosage: The patient has a medical problem that
is being treated with too much of the correct medication.
6. Adverse drug reactions: The patient has a medical
condition that is the result of an adverse drug reaction or
adverse effect. In the case of older adults, adverse drug
reactions contribute to already existing geriatric problems
such as falls, urinary incontinence, constipation, and
weight loss.
7. Drug interactions: The patient has a medical condition
that is the result of a drug interacting negatively with
another drug, food, or laboratory test.
8. Failure to receive medication: The patient has a
medical condition that is the result of not receiving a
medication due to economic, psychological, sociological,
or pharmaceutical reasons.
CAUSES OF
MEDICATION ERROR

HUMAN FACTORS

WORKPLACE FACTORS

PHARMACEUTICAL FACTORS
CLASSIFICATION OF
MEDICATION ERROR

PRESCRIBING ERROR

DISPENSING ERROR

ADMINISTRATION ERROR
 PRESCRIBING ERRORS
Lack of adherence
Failure to consider
to guidelines and Disregard for Prescribing the
in patients with
best practice patient allergies wrong drug
altered physiology
recommendations

PHYSICAL INCOMPATIBILITY

Incorrect Poor communication

Illegible Inadequate
CHEMICAL INCOMPATIBILITY
computation of
monitoring or
with the patient and
dosage and handwriting of to the rest of the
frequency prescriptions follow-up healthcare team

THERAPEUTIC INCOMPATIBILITY
 • Failure to interpret doctor's prescription
(particularly their handwriting) DISPENSING
• Failing to ask if medication
record is complete ERRORS
• Failure to check prescriptions
against allergy history, existing
drugs, and possible interactions
• Dispensing wrong drug
• Wrong patient
• Wrong instructions

• Poor communication with patient

ADMINISTRATION ERRORS Wrong patient

Wrong Drug Inadequate monitoring

or Follow-up

Wrong Dose given Poor communication

Wrong route and Duplication in administration -

manner of a failure in documentation
administration Wrong Time and
duration
CATEGORIES OF MEDICATION
ERROR FOR REPORTING AND
MONITORING
 NO ERROR

Category A
Circumstances or events that have
the capacity to cause error
 ERROR, NO HARM
Category B
An error occurred but the error did not reach the
patient (An "error of omission" does reach the
patient)
Category C
An error occurred that reached the patient but
did not cause patient harm
Category D
An error occurred that reached the patient and
required monitoring to confirm that it resulted in
no harm to the patient and/or required
intervention to preclude harm
 ERROR, HARM
Category E
An error occurred that may have contributed to
or resulted in temporary harm to the patient and
required intervention
Category F
An error occurred that may have contributed to
or resulted in temporary harm to the patient and
required initial or prolonged hospitalization
Category G
An error occurred that may have contributed to
or resulted in permanent patient harm
Category H
An error occurred that required intervention
necessary to sustain life
 ERROR, DEATH

Category I
An error occurred that may have
contributed to or resulted in the
patient’s death
 • Establish consensus group of physicians, nurses
and pharmacists to select best practices.
• Develop written procedure with guidelines and
checklist for IV fluids and high risk medicine
• Doctors should have knowledge of generic
names & brand names of available drugs in
their local setting.
• Specify dosage form, drug strength &
complete directions on prescriptions
• Require legible handwriting or and complete
PREVENTION OF spelling of medicine name
• Use of standard notation
MEDICATION ERROR
 • Write the route of administration on all orders.
• Write out directions completely
• Limit the use of telephone and oral orders to
emergency situations
• Refer back to doctor if any confusion
• Confirm identity of patients before administering
medication
• Stickers of ‘Alert’ in areas where LASA drugs
stored
• Use of standard administration times for
hospitalized patients.
• Education & proper training important in reducing
PREVENTION OF medication related errors.
• Should be aware of correct storage requirements
MEDICATION ERROR for drugs
LOOK ALIKE, SOUND ALIKE
MEDICATIONS (LASA)
Involve medications that are
visually similar in physical
appearance or packaging and
names of medications that have
spelling similarities and/or similar
phonetics.
SOUND ALIKE
EXAMPLES
E X A M P L E O F LO O K - A L I K E D RU G S
E X A M P L E O F LO O K - A L I K E D RU G S
E X A M P L E O F LO O K - A L I K E D RU G S
 Illegible handwriting

Incomplete knowledge of drug names

Newly available products

Similar packaging or labelling

Similar strengths, dosage forms,

frequency of administration

COMMON RISK FACTORS Similar clinical use

 PROCUREMENT

Minimize the availability of multiple

medicines strengths.

STRATEGIES TO AVOID
ERRORS WITH LASA
 STORAGE

Use Tall Man lettering to emphasize

differences in medications with sound-
alike names.

ex. metFORMIN and metoPROLOL.

STRATEGIES TO AVOID
ERRORS WITH LASA
 STORAGE

Use additional warning labels for look-

alike medicines.

STRATEGIES TO AVOID
ERRORS WITH LASA
 STORAGE

For SOUND ALIKE MEDICATIONS where tall

man lettering is not applicable, proprietary
(brand names or tradenames) name may be
added to distinguish medications.

STRATEGIES TO AVOID
ERRORS WITH LASA
 STORAGE

Store LASA MEDICATIONS separately from

their LASA pair. Whenever possible, avoid
storing the products in immediate proximity
to one another.

STRATEGIES TO AVOID
ERRORS WITH LASA
 PRESCRIBING

• Write legibly. Write clearly whether on

an inpatient order or on a prescription.
• Prescription should clearly specify
name of medication, dosage form,
dose and complete direction for use.
• Include the diagnosis or medication’s
indication for use.
• Communicate clearly.

STRATEGIES TO AVOID
ERRORS WITH LASA
 DISPENSING/SUPPLY

• Identify medicines based on its name and

strength and not by its appearance or
location.
• Check the appropriateness of dose for the
medicines dispensed.
• READ medication labels carefully at all
dispensing stages and perform triangle check.

STRATEGIES TO AVOID
ERRORS WITH LASA
 MONITORING
• The LASA list should be or needs to be
reviewed and updated periodically at
least once a year.
• Implement feedback mechanism to
inform on LASA.

STRATEGIES TO AVOID
ERRORS WITH LASA
 INFORMATION
• All relevant personnel should have an
access to the LASA.
• Staff should be informed on new
medications listed as LASA in the
hospital or pharmacy.

STRATEGIES TO AVOID
ERRORS WITH LASA
 PATIENT EDUCATION

• Inform patients on changes in

medication appearances.
• Educate patients and their caregivers
to alert healthcare providers whenever
a medication appears to vary from
what is usually taken or administered.
• Encourage patients and their
STRATEGIES TO AVOID caregivers to learn the names of their
medications.
ERRORS WITH LASA
 EVALUATION
• Evaluate medication errors related to
LASA medications.

STRATEGIES TO AVOID
ERRORS WITH LASA
 HIGH-ALERT MEDICATIONS
Drugs that bear a heightened risk
of causing significant patient harm
when they are used in error.
EXAMPLES
 THE TOP FIVE HIGH-ALERT MEDICATIONS

Insulin Injectable
Anticoagulant
Opiate and
Narcotics Sodium chloride
solution above
Injectable 0.9%
Potassium chloride
EXAMPLES or phosphate
Thank You