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1.3 million people have injuries that result from medication errors annually in the United States. A study recently published in Pediatrics found that one American child was given the wrong medication every eight minutes, although many of these errors were caregiver errors. A definition of 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 healthcare professional, patient, or consumer. Medications that are associated more commonly with death or severe adverse drug events are those medications that involve the central nervous system, the cardiovascular system, or cancer chemotherapy drugs.
The black box warning system that was established by the FDA in 1995 alerts doctors to the increased risks that are associated with some drugs.
In my own family, my father was discharged from the hospital with a prescription for a medication that would have caused a fatal drug interaction with another medication he had been taking for a long time. Anyone who begins a new prescription should understand the drug and its effects, and any interactions with other medications they are taking. Prescription drug abuse is an epidemic in the United States, and sometimes a physician may be negligent by prescribing a dangerous drug to a patient at risk. One problem arises when a doctor prescribes a narcotic to a patient who may be dependent upon narcotics or may be abusing them.
Overdose death drugs rise yearly, and in 2010, 38,329 people died of drug doses in this country, according to the US Center for Disease Control’s National Center for Health Statistics.
Prescription drug overdoses are usually unintentional, with 74% of prescription drug overdoses resulting from accidental ingestion.
Although hospitals and pharmacies have tightened restrictions on prescribing, it is still relatively simple for many people to obtain a large supply of painkillers or anti-anxiety drugs like Xanax or Ativan. Although the FDA requires the manufacturers of opioid drugs, like Vicodin or Oxycontin, to provide education for doctors, their track record is poor. Plaintiffs have been successful in lawsuits against physicians who have prescribed dangerous drugs irresponsibly.
Doctors who are specialists in pain management should be especially careful, as they are often responsible for the prescription of powerful and addictive drugs over an extended period of time. If you or a family member has suffered as a result of negligent prescribing practices by your doctor, you may have legal recourse. Many nursing homes under-employ staff with the experience and ability to administer medications correctly. If your loved one in a nursing home has suffered a serious injury or death as a result of neglect or outright reckless conduct, call Passen Law Group at 312-527-4500. Among the most common drugs involved in medication errors are blood thinners and antihypoglycemic medications prescribed for diabetes. A recent study  found that warfarin (Coumadin), oral anti-platelet medications (Plavix, aspirin), insulin and medications like metformin or glipizide. Sometimes equipment malfunctions, and large doses of drugs that should be administered over a long time period are delivered too rapidly. Morphine and other uploads are stacked together in a locked cabinet, with similar packaging, contributing to errors. Acetaminophen causes multiple problems, due to its various strengths and measuring devises for dispensing it. With antibiotics, liquid concentrations cause confusion, especially over the measurement m: and the teaspoon. System errors include inadequate staffing, handwritten orders, and doses with trailing zeros or ambiguous labeling.
If you or a loved one has been the victim of a medication error, you should see an attorney who specializes in medical malpractice. Another recent peer-reviewed study by Accredo Health Group and several university hospitals highlights how the wrong medication and other administration errors can be life-threatening. To speak with a top Chicago medical malpractice lawyer, call Passen Law Group at (312) 527-4500 for a free consultation. Medical error is clearly the Number One problem in healthcare, contributing to more deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined—see Figure 1 below.
Most medical errors are related to system problems, not individual negligence or misconduct, and are preventable (see our other Summary Statistic on the preventability of adverse events).
Zegers M, Bruijne MC de, Wagner C, Hoonhout LHF, Waaijman R, Smits M, Hout FAG, Zwaan L, Christiaans-Dingelhoff I, Timmermans DRM, Groenewegen PP, Wal G van der.
Distribution of the characteristics of patients included in the study, numbers of orders, and numbers of medications in the two study periods, POE and NOEView this tableMedication errors were reduced to an equal extent during both the POE and NOE periods (Table 3).
Drugs may have similar names and the order or prescription may be written wrong, written illegibly, or incorrectly transcribed. The most common error is improper dosing of a medication, and in 1998, the FDA found that dosing errors caused 41% of fatalities resulting from medication errors. Every patient who receives a prescription for a medication is potentially at harm, despite the many benefits of effective medication management. If your doctor has wrongly prescribed a medication or if you were a hospital patient who received the wrong dose or wrong medication with serious consequences, you should consult a Chicago malpractice attorney at Passen Law Group for a review of your records. There have been a number of lawsuits in the news as a result of alleged medical negligence in prescribing.
Some doctors refer to these patients as “frequent fliers.” At one time, emergency departments would keep a card file with these patients, but that practice has been outlawed.
Many overdoses occur in people who are treated by their doctors with a combination of narcotics and sedatives. In the past, knowing the risks of addiction and overdose, pharmaceutical representatives continued to encourage physicians to over-prescribe. An Alabama widower won $500,000 in a lawsuit after his wife died of an overdose from narcotics and sedative-hypnotic drugs. These physicians should be especially careful by screening their patients for drug abuse or addiction, and they should sign a pain contract, which allows them to terminate care if patients obtain narcotics from another physician. Sometimes these errors are not only due to lack of qualified staff but to failure to train and supervise employees. The 2006 study described harmful medication errors as 1.5 million incidences ranging from the prescription to administration.
Additionally, interactions are not checked when new medications are prescribed and this can even be fatal in some instances, particularly with cardiac medications. Medications errors may be due to negligence and it is important to call attention to these systemic problems.


For the sake of simplicity, I have summarised the study results to one figure—10% (or one in every ten hospital admissions). Medical errors cause more accidental deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined.
The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. As we adjust to the new server, we expect that there will be technical issues in various sections of the site. Physicians' resistance and users' frustration seem to be two of the most important barriers. To reduce possible data entry errors, a nurse verified and countersigned each electronic order that physicians had entered into the computer.
This study, published by the Institute of Medicine, titled To Err Is Human: Building a Safer Health System, found that medication errors accounted for more than 7,000 annual deaths at that time. In nearly half the cases in one study, patients taking a medication with a black box warning were not monitored appropriately.
A list of drugs with a black box warning or post-market safety concerns can be found on the FDA Drug Safety website. Another family member was given the incorrect instructions for Coumadin, or warfarin, and ended up taking 10x the dose, putting him at high risk for an intracranial hemorrhage. Today, most states keep detailed prescribing records of scheduled drugs, and in some states, before writing a narcotic, a physician is obligated to check the state database to determine if the patient has been “doctor-shopping,” or visiting a number of physicians to acquire a steady supply of narcotic drugs. In its place, however, there is a computerized registry that can be easily accessed by physicians to determine with some likelihood if a patient is abusing his or her prescriptions. Many heroin addicts, who are by and large a young population, get their start with prescription drug experimentation, often stealing drugs from their parents or grandparents. A nurse in Mississippi died of an overdose in the hospital when her doctor prescribed one opiate when she was already under the influence of another powerful opiate.
However, after signing such a contract, they should also check the state registry to be certain the patient is compliant. There should be protocols and guidelines for facilities in which these drugs are utilized, and failure to follow created protocols is malpractice.
Doctors may right the wrong medication, or may fail to look up interaction with other drugs. One solution might be to involve nurses in the order entry process to reduce physicians’ data entry workload and resistance. This verification was designed to reduce the likelihood of making typographical errors or of selecting incorrect drugs from the drop-down menus. Most of the intercepted errors were caught by the warnings at the prescription stage; only a few errors were subsequently detected and intercepted by nurses or physicians before they were administered to the patients. An adverse drug reaction is any response to a drug that occurs at a dose normally used for therapy that results in a noxious effect that is not the result of medication error. This happens more frequently than the general public might imagine, and, because physicians are vested with the power to prescribe powerful drugs, they have the responsibility to prescribe cautiously and responsibly. Many older people in the country complain of chronic pain disorders, and, rather than prescribing physical therapy, non-narcotic analgesics, or topical treatments, doctors today tend to write prescriptions for narcotics. Since doctors are dependent upon these surveys for employment, they are frequently afraid to deny narcotics to patients who may be drug abusers or addicts. A further design consideration was to remind physicians about obvious dosing errors of those medications that were not included in the knowledge base (ie, drug groups other than antibiotics and anticonvulsants) and consequently warnings could not help to prevent them. Doctors and hospital pharmacists may fail to check drug interactions, resulting in serious side effects or even death.
This trend is a real change, as narcotics were primarily limited in the past to patients suffering from cancer pain. At the same time, doctors don’t want to deny pain medications to patients who may legitimately be suffering. Because Iranian law does not permit electronic signatures, each electronic order was printed and saved in the patient's medical file after it was countersigned [30] (Table 1).Also in this period, each prescription line was assessed by the decision support system as it was prescribed by the resident physician. Doctors may ignore or overlook compromised kidney or liver function, failing to reduce doses or discontinue harmful drugs. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. When a resident had ignored a warning, the ignored warning appeared each time the resident renewed the order with the same erroneous dose and frequency, or when the resident prescribed a new dosage that was also erroneous (Figure 2).The design, programming, and testing of the decision support system for the POE method started in February 2007 (Figure 2). When a dose is calculated by a doctor or nurse to be given IV, the drug dose may be off by a factor of ten or more, simply by misplacing a decimal point. Physicians’ responses to the warnings were recorded in a database and subsequently analyzed. During period 1 of the current study, the frequency and format of the displayed warnings had been optimized, and these remained unchanged in period 2.
During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Resident physicians wrote the initial orders on the prescription papers and delivered them to the nurses who subsequently entered them into the computer. Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P = .005). Therefore, in this new model, warnings appeared to the residents but not to the nurses (Figure 3). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. This strategy was adopted because in a previous study of CPOE in Iran, physicians were reluctant to let their errors be disclosed to nurses and wished to receive the warnings themselves [20].
However, after the implementation of POE, the residents started to resist performing the order entry because they perceived it to be very time consuming. However, they still wanted to receive the warnings themselves without allowing the nurses to see them.


The new model was designed in close collaboration with the involved physicians and nurses to address this issue.After the physician's verification and countersignature, the electronic prescription was printed, and if a warning had been complied with that led to a change of dose or frequency, both the nursing Kardex and the patient file were updated (Figure 3).
Pediatric patients are at higher risk of medication errors because of weight-based dosing and difficulties in communicating with care providers [2].
Among all pediatric patients, neonates are the most vulnerable to medication errors because of their small body mass and extensive exposure to multiple medications in the neonatal ward or neonatal intensive care unit (NICU) [3]. Neonatal patients have special requirements, and during hospitalization, their weight and renal function may change frequently [4]. These changes demand frequent adjustment of prescription and administration dosages, which increases the risk of medication errors [5,6].
Dosing errors are the most prevalent type of errors in neonates, and most of these occur at the time of prescription [7].
The median and the 25th and 75th percentiles of medication errors and the medians of age at admission, gestational age, and length of hospital stay were computed.
Antibiotics are the most frequently prescribed type of drug involved in neonatal dosing errors [7,8].
Also reported have been severe adverse events due to miscalculated doses of anticonvulsants [9]. For continuous variables, the nonparametric Mann-Whitney tests were employed to determine differences in the median error rates between the POE and NOE periods when there was remarkable deviation from normality. Therefore, strategies to prevent dosing errors of antibiotics and anticonvulsants in neonates should be prioritized.In previous studies, computerized physician order entry (CPOE) with decision support functionalities has reduced dosing errors of antibiotics among inpatient neonates [10,11]. Rates of errors were reported pertaining to orders, ordered medications, medication days, and patient days. Despite promising results, only about 2% to 20% of the hospitals in high-income countries have successfully implemented CPOE [12]. Error rate differences between the POE and NOE periods were calculated as d = absolute value of the error rate during the POE period minus the error rate during the NOE period. Among several barriers to implementation, high implementation costs, physician resistance, and user frustration have been found to be the most important [13-15]. Rate ratio (RR) was defined as the rate of errors during the NOE period divided by the rate of errors during the POE period. In many hospitals' order entry systems, nurses or other nonphysician health personnel enter medical orders into the computer [16]. Even in hospitals that have successfully implemented strictly physician order entry (POE), some orders are entered by the nurses [17]. Confidence intervals for the ratios were determined under the assumption that the number of events per 100 patient-days followed a Poisson distribution.
Some investigations have shown that nurses often have more positive attitudes toward computerized systems than physicians [18]. Miettinen’s test-based approximation was used to calculate the confidence interval for the rate ratios.
Therefore, the involvement of nurses in the order entry process may increase the rate of success and reduce physicians' resistance [16,17]. In a number of recent studies, researchers have defined CPOE as computerized provider order entry that includes participation by credentialed nurses [19].The successful implementation of POE becomes even more complicated in middle- and low-income countries with economic and human resource constraints [20]. One such country is the Islamic republic of Iran, a country in the Middle East with a population of 70 million as of 2006 [20,21]. Iran is cooperating with the World Health Organization to extend the use of information technology and evidence-based decision making in the health sector [22].Studies performed in Iran demonstrate that medication dosing errors and adverse drug events (ADE) are significant problems for the Iranian healthcare system [23,24]. All physicians and nurses who participated volunteered to take part in the study, and a verbal informed consent was obtained and tape recorded.ResultsA total of 158 neonates were included in this study (Table 2). In almost all Iranian hospitals that have implemented electronic medical record systems, nurses or professional operators enter medical information into the computer. Physicians do not interact with the system at all, or their interaction is limited [20].In 2007, a POE system was implemented in the neonatal ward of an Iranian teaching hospital.
The aim of this project was to investigate whether the implementation of the system reduced medication errors and to investigate transferability of the system to other wards of this hospital as well as to other teaching hospitals in Iran [20]. The introduction of the system was found to reduce medication errors of antibiotics and anticonvulsants [25]. However, the busy residents were reluctant to enter all prescribed orders into the computer.
After several interview sessions with attending physicians, residents, and nurses, a new implementation model was introduced to address this challenge.In the new order entry model, nurses entered the orders into the computer, and the resident physicians verified the correctness of the orders and countersigned them electronically.
Besat's neonatal ward is a 17-bed clinical ward that includes two NICU beds.System descriptionHospital Information System (HIS)Sayan-HIS (Sayan Rayan Co Ltd, Hamadan, Iran) is a commercial patient-centered hospital information system (HIS) that is used in all fifteen university-affiliated hospitals in Hamadan. Users interact with the system in a local area network and through desktop computers installed at workstations. The administrative information system handles patient billing and the insurance company interface as well as providing various reports for the financial controllers and management.Clinical Information SystemThe clinical information system of Sayan-HIS includes an order-entry based prescription system. When the physician’s orders are entered into the computer, the prescription system delivers the requested orders for medications, lab tests, and imaging to the relevant hospital sections at the appropriate time. The system limits the selection of drugs and their pharmaceutical forms (vial, ampoule, tablet, etc) through drop-down lists and preconstructed orders.
The system was functional and routinely used with all explained features in all wards of the Besat hospital at the time of this study. The system also includes a rule-based clinical decision support system that is capable of alerting and correcting an erroneously prescribed dose or frequency of an antibiotic or anticonvulsant for neonatal patients.Clinical Decision Support System (CDSS)The dose and frequency decision support system was developed in 2007. The knowledge base was completed for all routine antibiotics and anticonvulsants by using the local guidelines of best practice based on pediatric reference books approved by the National Board of Pediatrics in Iran [26-29]. Prescription decision criteria were based on each patient’s clinical diagnosis, age, weight, gestational age, and estimated glomerular filtration rate (GFR). Three neonatal specialists and one pediatric nephrologist reviewed and approved the CDSS calculation methods.The system displayed warning messages on the prescription page whenever it detected a dose or frequency medication error based on the previously mentioned criteria (Figure 1).
The prescriber was then allowed to comply with the warning's recommended dosage or to ignore it. The responses of the prescribers to the warnings were recorded by the system in an error registration table.



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