Chapter 1

A PROSPECTIVE STUDY AND EVALUATION OF

MEDICATION ERROR AT TERTIARY CARE
TEACHING HOSPITAL

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 1

Introduction

The National Coordinating Council for Medication Error Reporting and

Prevention (NCC MERP) defines a "medication error" as "any preventable event that

may cause or lead to inappropriate medication use or patient harm while the
1.
medication is in the control of the health care professional, patient, or consumer

At many occasions a medication error can be caught or is rectified before its

administration, thereby preventing harm to patient. This is referred as near miss

medication error 2.
Adverse Medication Event

It includes adverse consequences, adverse drug reactions and medication

errors. Medication use is a complex process that includes a series of steps

medication prescribing, order processing, dispensing, administration and effects

monitoring any one of which could lead to medication error. Several national

organizations whose missions are focused on enhancing the safe use of prescription

medicines have developed practical guidelines and tips for healthcare professionals.
Different type of Adverse Medication Events:

1. Wrong drug

2. Wrong dose and/or frequency

3. Wrong form

4. Wrong route

5. Wrong rate

6. Wrong time

7. Wrong preparation

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8. Wrong patient

9. Wrong documentation

10. Omitted drug or dose

11. Allergy information missing

12. Inadequate or inappropriate monitoring

13. Administered when ceased or withheld

14. Administered but not signed

15. Extra dose given on over dose.

Types of Medication Error

The process of medication use is subdivided into five important stages

including prescribing, dispensing, transcribing, preparing and administering of which

the processes of prescribing and administering of medication are most vulnerable

3,4
stages for medication error . Medication errors are broadly categorized into

prescription error, dispensing-related error and errors-related to the administration of

medication.

Prescription errors

Medical prescribing errors (MPEs) are one of the most common and well-

studied causes of adverse events. MPEs occurs as a result of a prescribing decision or

prescription writing process, and leads to an unintentional and significant (1)

reduction in the probability of treatment being timely and effective and (2) increase in

the risk or harm when compared with generally accepted practice 5. MPE can

occur when physician writes a prescription without giving due consideration to patient

profile or the involved drug s characteristics, ambiguity in writing prescription order

(as in spelling, hand writing or non-standard abbreviations/nomenclatures) or failure

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 3

to follow system s policies and drug specific instructions. So, errors in prescribing can

be divided into irrational prescribing, inappropriate prescribing, and ineffective

prescribing, under prescribing and overprescribing, and errors in writing the

prescription 6. Several studies have reported the incidence of prescription errors as

high as 39% 7. In a prospective study conducted in New Zealand, a total of 36,200

prescription chart were reviewed by ward visiting pharmacist and around 1.5% of

prescribing errors were identified, of these 0.4% were serious medication errors. In

another study, the most common form of prescription error was writing the wrong

dose 8. In six Oxford hospitals, the most common errors on prescription charts were

writing the patient's name incorrectly and writing the wrong dose, which together

accounted approximately 50% of all errors. In a hospital study in Norway only 7%

prescription charts were correctly filled, where 79% had errors that posed minor

potential health risks and 14% had errors that could have led to serious harm 9.

Dispensing errors

Generally, process of dispensing of medication also includes transcribing and

verifying the medication in which mostly nurses and pharmacists are usually

involved. There are few studies which have examined and reported the dispensing

errors. However, because of their low incidence they are of lesser concern. In an

inpatients study Roberts et al reported 11% of dispensing errors. As per study results,

most common errors were due to wrong medicine supply, wrong strength, wrong

directions for use, wrong quantity of medicine, and wrong calculation of drug usage.

The most common causative factor for such errors was look alike and sound alike

medicines 10.

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Administration errors

It is the second most common (38%) medication error. Bates et al in 1995

reported 26% of preventable ADEs which occurred during the administration of

medication 3. This stage of medication use is crucial as associated with high risk.

Responsibility of such errors lies with nursing staff for indoor patients and with
11,12
physicians, dentists, pharmacists and patients themselves in outdoor patients .The

causative factor for administration error is similar to that of prescription and

dispensing errors. In addition, it may also include omission, wrong dose, wrong route,

and wrong patient at wrong time. It may also occur due to technical reasons, e.g.

while administering drug using viz nebulizers, infusion pump and MDIs. Patients

noncompliance is another reason for administration errors.

Prescribing error

Incorrect drug selection (based on indications, contraindications, known

allergies, existing drug therapy, and other factors), dose, dosage form, quantity, route,

concentration, rate of administration, or instructions for use of a drug product ordered or

authorized by physician (or other legitimate prescriber); illegible prescriptions or

medication orders that lead to errors that reach the patient

Monitoring error

Failure to review a prescribed regimen for appropriateness and detection of

problems, or failure to use appropriate clinical or laboratory data for adequate

assessment of patient response to prescribed therapy 24.

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Common Causes of Medication Errors

Ambiguous strength designation on labels or in packaging Drug product

nomenclature (look-alike or sound-alike names, use of lettered or numbered prefixes

and suffixes in drug names)

Equipment failure or malfunction

Illegible handwriting

Improper transcription

Inaccurate dosage calculation

Inadequately trained personnel

Inappropriate abbreviations used in prescribing ÿ

Labelling errors

Excessive workload

Lapses in individual performance

Medication unavailable

Pharmacoepidemiology of Medication Errors

Exact incidence of medication errors is difficult to access because only small

number of errors is detected and even smaller number of errors is reported. In

addition inconsistencies in error reporting, error reporting restricted to inpatient

settings, most studies reported errors of commission not the errors of omission are other

reasons lack of exact incidence. However, they may occur as frequently as 1 in

every 20 prescriptions, and 5 in every 100 medication administrations of these 1 in

every 100 medication errors results in patient injury 13.

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Pharmacoeconomics

Medication errors are undoubtedly harmful and puts financial burden to

patients, their families, hospitals, healthcare providers and insurance companies. They

affect about 44,000 to 98,000 lives/year in US alone, which is far more than the lives

affected due to AIDS. The Institute of Medicine report also estimated that more than

70,000 lives

are lost per year as a result of medication errors. In USA nationwide hospitals

financial burden due to medication error has been found to be between 17-29 $ billion

per years 14.

General Objectives :

1. To identify the various types of Medication errors occurring in the Hospital

2. To find the cause and streamline the medication process for in-patients to prevent

life threatening medication errors.

3. To determine the reasons and cause for Medication errors in the hospital.

4. To find out at which level, these medication errors are occuring commonly.

5. To determine what are the common medication errors and how can be they be

reduced or at least minimized.

6. To analyse the data and draw conclusions from the study.

7. To make recommendations on the improvement of quality service and motivate the

staff to deliver and strive for patient satisfaction.

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TABLE NO. 1 DEFENITIONS OF DIFFERENT TERMS

SL. NO TYPE OF MEDICATION ERROR. DEFINITION

1. Wrong patient. If drug is administered or ordered for the wrong patient.

2. Wrong dose, Wrong strength , Wrong Administration of a dose that is less than or greater than the amount ordered by the
frequency.
prescriber is wrong dose.

3. Wrong route of administration. When a patient is administered a drug via a route different than the intended route

which may sometimes cause harm to the patient is wrong route of administration.

4. Wrong method of administration. When a drug is administered by a method different than an intended method such a

method may sometime have a potential to bring undesirable effect.

5. Illegible prescription. Prescription not readable by a non medical professional.

6. LASA medication. LOOK ALIKE , SOUND ALIKE drugs.

7. Use of abbreviations. Abbreviations are shortened form of a word or phrase used to represent a larger

more complex idea.

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 8. Drug Duplications. Duplication is an act of prescribing a drug that has already been prescribed.

9. No signature. So signature of prescriber after prescription.

10. Omission on admission. omission on admission is an event that occurs when a patient does not receive a

medication on admission to hospital that had been prescribed before for the

underlying condition .

11. Omission on discharge. Omission on discharge is an event which occurs when a patient does not receive a

medication for underlying condition on discharge, that had been prescribed before.

12. Drug not prescribed but indicated. These are the drugs which are sometimes not prescribed by the physician but are

indicated for a particular disease.

13. Drug without indication. Drugs are prescribed when the patient doesn t require it.

14. Premature discontinuation . Premature discontinuation also know, patient drop out ,is a patients decision to stop

health treatment before they have received adequate number of sessions or before

they have adequately reduced their symptoms.

15. Administered but not signed. Some drugs are administered by the nurse , but not signed on prescription by the
physician.

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 16. Wrong time of administration. When a drug is administered at a time different than the desired time.

17. Contraindication. Contraindication is a condition or factor that serves as a reason to withhold a certain

medical treatment due to harm that it may cause to patient.

18. Formulations not specified.

19. Expired medicines . Medicines dispensed after expiry date.

20. Dose omitted or delayed. Sometimes dose of the drug is not mentioned in the prescription that may lead to

administration of under dose or overdose by the patient.

21. Monitoring error. Failure to review a prescribes regimen for appropriateness and detection of

problems , or failure to use appropriate clinical or laboratory data for adequate

assessment of patient response to prescribed therapy.

22. Inaccurate patient information. Patient past medical and medication history not mentioned.

23. IV instructions incorrect / missing. IV dosage instructions are not clear or not mentioned.

24. Drug continued for longer than needed. When a drug is given for an ailment for more than the desired period of time either

because of ignorance or lack of knowledge.

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 25. Risk of drug interactions. Prescriptions having risk of major drug- drug and drug- disease interactions.

26. Daily doses divided incorrectly. The quantity of drug to be administered at one time ,as a specified amount of

medication when divided incorrectly may bring undesirable effects to the patient.

27. Drug continued in spite of ADR. When a drug is continued even after seeing an ADR such an action may cause harm

to the patient.

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11.b Role of the Pharmacist

Pharmacists should exert leadership in the development, maintenance, and ongoing

evaluation of medication error programs. They should obtain formal endorsement or approval

of such programs through appropriate committees (eg: a Pharmacy and Therapeutics

committee and the Executive committee of the Medical staff) and the organizations

administration. In settings where applicable, input into the design of the program should be

obtained from the Medical staff, Nursing staff, quality improvement staff, Medical records

department, and risk managers.

The pharmacist should facilitate analysis of each reported medication errors,

1 Identification of drugs and Patients at high risk for being involved in medication errors,

2 The development of policies and procedures for the medication error monitoring and

reporting program,

3 A description of the responsibilities and interactions of Pharmacists, Physicians, Nurses,

risk managers, and other health professionals in the medication error program,

4 Use of the medication error program for educational purposes,

5 Development, maintenance, and evaluation of medication error records within the

organization,

6 The organizational dissemination and use of information obtained through the medication

error program,

7 Reporting of serious medication errors to the FDA or the medical professionals

involved(or both), and

8 Publication and presentation of important medication error to the Medical community.

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Detection of Medication Errors

Medication errors are mainly detected by voluntary reporting by patients, direct observation

of actual patient care of inpatients, pharmacy procedures like attending medical rounds or

comparison of medication administration record to physician orders, by returned doses to

pharmacy, urine testing or tracer drug analysis and comparison of drugs removed from

automated dispensing device with that of physician orders, although the system of voluntarily

reporting of medical errors is often incomplete and underreported. Detection and reporting of

medication error is the most important component to design the strategies to prevent such

errors. Fear of disciplinary procedures for reporting errors has been identified as one of the

barrier in detecting and reporting medication error. The establishment of a blame-free, non

punitive environment can overcome such barrier. Health care professionals and patients

should be encouraged to report the medication errors, including near-misses. The objective of

analysis of medication error is to investigate and detect the underlying factors/root-cause of

non-reporting and/or underreporting of medication errors. They should also be encouraged

and involved in data collection, cause charting, root cause identification and recommendation

generation and implementation. The process development may improve the steps involved in
15
the treatment process . A medication error reporting system should be readily accessible,

with clear information on how to report a medication error, and reporting should be followed

by feedback. Combination of these methods may improve the reporting of medication errors
16
.

Reporting medication error

Health care professionals and consumers have the opportunity to report the occurrence of

medication errors to a variety of organizations. Examples include the Institute of Safe

Medication Practices (ISMP) and the Food and Drug Administration (FDA). These

organizations collectively review error submissions. Case reports are published to educate

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health care professionals regarding errors and near errors. In some cases, the FDA may work

with drug manufacturers and others to inform them about concerns with pharmaceutical

labelling. Packaging and nomenclature to make appropriate changes to reduce the risk of

medication errors.10 AMCP has voiced support for a medication error reporting system that

encourages participation and provides confidentiality and protection of the information

reported and the person(s) reporting. To be successful a medication error reporting system

must have protections for those reporting. Often, pharmacists view mandatory reporting laws

and regulations as punitive, especially if public disclosure is included. Compliance with such

programs is likely to be less than optimal since the results of reporting could include lawsuits,

regulatory enforcement actions, forfeiture of pharmacy license, and loss of professional

reputation with accompanying loss of business.11 Regulatory and advocacy activity provides

for improving monitoring of medication errors. The FDA MedWatch reporting system

provides a comprehensive sentry position for many medication errors to be reported.

Although designed primarily for reporting adverse events from medication use, FDA's Med

Watch is an appropriate venue to discover medication errors, such as prescribing

misadventures and look-alike, sound-alike errors leading to adverse reactions. Many state

boards of pharmacy have begun medication error reporting initiatives to detect trends in

ambulatory dispensing errors. At this point in time, most are limited to mandatory internal

reporting systems within a setting, as is the case in California, where errors must be logged

and open for board inspection during routine visits and complaint investigation. Many

physician boards and associations participate in prescribing error investigations, driven

25
primarily by peer review and consumer complaint resolution.

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Measuring Extent of Medication Errors

The medication errors are categorized based upon the algorithm developed by NCC MERP

into nine categories from A to I (Table 1). Category A indicates circumstances or events that

have capacity to cause medical error and with increasing category, propensity of the medical

error to translate into direct patient harm increases. Categories A to D indicate no harm to the

patient, whereas categories E to I indicate definite harm to the patient with category I

indicating possible death because of the medication error 1.

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Table 2: NCC MERP categories for medication errors

Category Example

A (No actual error occurred) Ideal situation

B (Actual error occurred but did not reach the Prescribing error rectified either by nurse or
patient) Pharmacist

C (Actual error reached to the patient) Prescribed or dispensed wrong medicine

(look-alike or sound-alike medications)

D (The outcome of the error required Self-limiting pharmacological actions of

monitoring) medicines e.g. tachycardia following higher
dose of atropine for pre-anesthetic
medication

E (The outcome of the error required Toxic dose of digoxin causing arrhythmia
intervention) required to be managed by phenytoin

F (The outcome of the error required prolong Paracetamol overdose resulting in

hospitalization) Hepatotoxicity

G (The error resulted in permanent harm) Intra-arterial administration of thiopentone

resulting in gangrene of the limb

H (The error required intervention to sustain Administration of penicillin to already

life) hypersensitive patient to penicillin

I (The error resulted in patient death) Intra-arterial administration of adrenaline in

patient of CAD

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Prevention of Medication Errors

Eliminating the aforementioned causes for prescribing, dispensing and administration errors is

the first most step towards controlling medication errors. In addition, the NCC MERP has put

forwarded certain recommendations to check these medication errors like those related to

human errors (as in writing prescription orders or other at risk behaviours by healthcare

professionals) or those related to packaging, labelling, dispensing and administration errors 1.

Role of healthcare system in preventing medication error Developing and implementing the

fool-proof policies to combat medication errors, periodic training of staff and work

distribution as per qualification, tracking of prescription orders, interdepartmental

communication, standardization of doses and frequencies, preparation and drug distribution

system can result in obviate errors in medication use 17.

Role of information technology

Emerging technologies like computerized physician order entry (CPOE) or smart cards,

CPOE with clinical decision support systems, automated drug utilization review system,

automated drug dispensing system, bar coding, clinical pharmacy information system can
18-22
provide patient care with high accuracy, efficiency and promising advancement .

However, in spite of many studies advocating use of these tools to lessen medication errors,

their implementation in routine healthcare practice is still inadequate 23.

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1.3 A brief review of literature :

Karna et al.Medication error can increase the cost, prolong hospital stay and increase the risk

of death almost two fold. Several studies have already demonstrated that pharmacist can play

major role in detection and prevention of medication errors. Present study was aimed to

detect and evaluate the incidence, types of medication errors and to assess the severity of

medication errors in the medicine wards of Basaveshwar teaching and general hospital,

Gulbarga. Prospective study was carried out from September 2010 to March 2011.Inpatients

records of patients from six units of medicine department were reviewed during their stay in

hospital. Detected medication errors were documented and evaluated. A total of 500 cases of

the patients were selected, among them 77.4% were male and 22.6% were females. 38.5% of

them were in the age group of 40 to 60 years.167 medication errors were detected in 127

patients. Maximum medication errors (31) were detected in the month of December 2010.

The overall incidence of medication error was found to be 33.4%. A total of 167 medication

errors were observed, among them 30.5% were errors in medication ordering and

transcription, 23.3% were errors in medication dispensing and 46.1% were nursing errors in

medication administration. The causes of medication error were 61.6% were due to nurses,

22.1% were due to Pharmacists and 16.1% errors were due to physicians. Majority of

medication errors were belonging to CNS drug class (19.7%).On evaluation of severity,

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 18

majority of medication errors 89.8% were classified as category Error, No harm, followed by

7.7% were in category No Error and remaining 2.3% were in category Error, Harm. This

study concluded that 33.4% medication errors were detected during study period and revealed

that pharmacist can play a major role in preventing these errors by early Detection 29.

Khansa et al., Majority of patients where under internal medicine and lowest percentage

being in paediatrics. Mean number of discharge medications was 8 (SD ± 3). Total number of

discrepancies was 200 (8.6%). 108 (34.67%) patients had discrepancies. Out of these, 93

(86.1%) were adults and 15 (13.9%) were children. Omission error was the most common

type of discrepancy (63%), and drug interactions (0.3%) was the least. Improper dose was the

most common prescribing error (32.4%), and improper frequency (15.1%) was the least.

19.3% of patients had at least 1 discrepancy. Most of the discrepancies where under internal
medicine and cardiology. Most discrepancies were noticed in the month of February. 28

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 19

Ganeshan. S et alA medical error occurs when a health-care provider chooses an

inappropriate method of care. Medical errors are often described as human errors in

healthcare. A Prospective study was carried out in an In-patient Department at a general

hospital, Yelahanka, Bangalore for seven months. The prescriptions were chosen randomly

which includes patient s case history, diagnosis, physician medication order sheets, lab

investigations and reports of diagnostic tests. A total of 180 prescriptions which contained

392 prescribed items were collected randomly. Among 69 errors, highest no. of errors

(40.57%) were related to directions. All the errors related to others constituted (20.28%) and

all the errors for strength and dose constituted (18.8%.) Errors related to prescribing two

drugs of the same type constituted 2.89%, 11.59% errors were under category No error which

comes under sub-category A, 86.95% errors were under the category Error, No harm which

comes under sub-category B(46.37%) , sub category C (37.68%) and sub-category D

(02.89%) and 1.44% belongs to category Error, Harm which comes under sub-category E.

Study concludes that overall incidence of medication errors was found to be 38.12%., which

is quite high. Clinical Pharmacist can play major role in the early detection and prevention of

medication errors and thus can improve the quality of care to the patients. 27

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 20

References

1. National Coordinating Council for Medication Error Reporting and Prevention (NCC

MERP).

2. Acute care ISMP medication safety alert.

3. Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L . Relationship

between medication errors and adverse drug events. J Gen Intern Med . (1995) 10: 199-205.

4. Bates DW . Medication errors: how common are they and what can be done to

prevent them. Drug Safety .(1996) ; 15: 303-310.

5. Dean B, Barbera M, and Schachter M .What is prescribing error? Qual Health Care .(2000);

9: 232-237.

6. Aronson JK . Medication errors: what they are, how they happen, and how to avoid

them. QJM (2009); 8: 513-521.

7. Flynn EA and Barker KN .Medication error research. In: Cohen MR, ed.,

Medication errors: causes and prevention. Washington, DC: American Pharmaceutical

Association. (1999) ;15: 303-310.

8. Dean B, Schachter M, Vincent C, M Barber Prescribing errors in hospital

inpatients: their incidence and clinical significance. Qual Saf Health Care (2002); 11: 340 344.

9. Ritland S, Kummen M, Gjerde I Feil og mangelfull kurveføring en potensiell

kilde til feilmedisinering. Tidsskr Nor Laegeforen(2004) ; 124: 2259-2260.

10. Roberts DE, Spencer MG, Burfield R, Bowden S. An analysis of dispensing errors

in UK hospitals. Int J Pharm Pract (2002); 10: R6.

11. Cebeci F, Karazeybek E, Sucu G, Kahveci R . Nursing students' medication errors

and their opinions on the reasons of errors: A cross-sectional survey. J Pak Med Assoc

(2015); 65: 457-462.

12. Cloete L Reducing medication errors in nursing practice. Nurse Stand (2015); 20: 50 59.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 21

13. Thomas EJ, Petersen LA. Measuring errors and adverse events in healthcare. J Gen

Intern Med(2003) ; 18: 61-67.

14. Van den Bemt PM, Postma MJ, Van Roon EN, Chow MC, Fijn R, et al. Cost

benefit analysis of the detection of prescribing error by hospital pharmacy staff. Drug

Safe(2002) ; 25: 135-143.

15. Wichman K, Greenall J .Using root cause analysis to determine the system based

causes of error. CPJ/RPC (2006) ;139: 63-65.

16. Barker KN, McConnell WE. The problems of detecting medication errors in

hospitals. Am J Hosp Pharm(1962) ; 19: 360-369.

17. Skiba M .Strategies for identifying and minimizing medication errors in health care

settings. The Health Care Manager (2006) ;25: 70-77.

18. Oren E, Shaffer ER, Guglielmo BJ . Impact of emerging technologies on

medication errors and adverse drug events. Am J Healthsyst Pharm(2003) ; 60: 1447-1458.

19. Stokowski LA .Using technology to improve medication safety in 5the newborn

intensive care unit. Adv. Neonatal Care(2001) ; 25: 70-83.

20. Stolarz SA, Hartnell N, MacKinnon NJ .Approaches to improving the medication

use system. Healthcare Quarterly(2005) ; 8: 59-64.

21. Fischer JR, The impact of health care technology on medication safety. S D Med (2014) ;

67: 279-280.

22. Jozefczyk KG, Kennedy WK, Lin MJ, Glass MD, Eidam WS, Computerized

prescriber order entry and opportunities for medication errors: comparison to tradition

paper-based order entry. J Pharm Pract (2013) ; 26: 434-437.

23. Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD.
Reduction in medication errors in hospitals due to adoption of computerized provider
order .(1996) ; 15: 303-310.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 22

24. ASHP Guidelines on PreventingMedication Errors in HospitalsThe Academy of Managed

Care Pharmacy Concepts in Managed Care Pharmacy.

25. Medication Errors Are Preventable Harmeet Singh Rehan and Shashikant

BhargavaProfessor and Head, Department of Pharmacology, Lady Hardinge Medical

College, New Delhi 110 001, India.

26.GaneshanS,VishwanathA, Boguda, A. Renjith Alex and Anusha B. Prospective study on

medication errors in a general hospital. (2014) ; 67: 279-280.

27. Sara Al Khansa, Amnah Mukhtar, Merryland Abduljawad and Mohammed Aseeri King

Faisal Specialist Hospital, Jeddah, Saudi Arabia . Impact of Medication Reconciliation

upon Discharge on Reducing Medication Errors

(2005) ; 8: 59-64.

28.,khavanekarna1,sanjay sharma, shivkumar inamd , anil bhandar . Study and evaluation of

medication errors in a tertiary care teaching hospital a baseline study (2014) ; 67: 279-280.

29.,L.K.V.Reddy, A.G.Modi,B. Chaudhary, V. Modi, M. Patel medication errors a case

study, (2006) ;25: 70-77.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 23

 Study plan and methodology for a prospective study and

evaluation of medication error at tertiary care

teaching hospital

Study design:

This is a hospital based prospective study

Study location:

This study was conducted in medicine of S.N. Medical College and HSK Hospital,

Bagalkot.

Study setting:

Study was based only on those patients who have come to medicine department in

H.S.K Hospital and Research centre.

Study criteria:

a) Inclusion criteria

¸ In-patients admitted in Unit A, B, C and D of Department of Medicine.

b) Exclusion criteria

¸ Patients who refused to take medication.

¸ Patients who were not willing to participate in the study

Study duration:

The study was carried out over a period of 7 months.

Study procedure:

The medication errors was analyzed through a prospective observational study

conducted over a period seven months at Medicine department of Basaveshwar teaching and

general hospital in India. Prior approval from Institutional Ethics Committee on Human

Subject Research was obtained and documented . The prescriptions were chosen randomly

and/or the details were followed till discharge of the patients. The data for present study was

collected by chart review method. During the study inpatients case records was reviewed,

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 24

 which includes patients case history, diagnosis, physician medication order sheets,

nurse medication administration records, progress chart, laboratory investigations and report

of other diagnostic tests. This information was documented in the patient profile form.

Whenever Medication error is identified, during the review data from patient profile form is

transferred to medication error reporting and documentation form. All medication errors

documented were analyze for following parameters such as demographic status of patients,

month wise distribution of the errors, professionals involved in the errors, Causes of

medication errors, Incidence of medication errors, Types of medication errors and system

wise distribution of errors. Medication errors were also asses for its severity level by using

the national coordination council for medication error reporting prevention proposed

medication error index. Each prescription was checked twice- once for medication errors. All

the prescriptions were checked for errors using CIMS website (cimsasia.com), and these

rrors were confirmed by additional standard references (MICROMEDEX version 2, drug

today handbook, and Drug digest website. All the data was represented as percentages.

Statistical Analysis:

Data analysis was done using the statistical methods like percentages, proportion,

chi square test and student s t test to arrive at a conclusion for finding the significant

differences.

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 DEMOGRAPHIC DETAILS OF PATIENTS
TABLE : 3a

SL.N IP NO AGE/GENDER MONTH DIAGNOSIS ME

O
1. 30204. 88/M/Med B. August. A/E of COPD. Prescription error,
Transcription error.

2. 28826. 38/M/Med D. August. Dengue fever, DenovoT2DM. Prescription error,

Transcription error,
Dispensing error.

3. 32396. 40/F/Med E. August Viral fever, Old CVA, HTN, Seizure. Prescription error.
4. 29189. 75/M/Med E. August. COPD, Emphysema, Acute GE, Old CVA. Prescription error.

27070. 75/M/Iccu E. August. IHD, Anterio Septal Wall MI. Prescription error.
5 Dispensing error.
6. 30169. 40/M/Med A. August. Epilepsy. Dispensing error.

7. 30948. 45/M/Med C. August. T2DM. Prescription error,

Transcription error,
Dispensing error.

8. 29723. 30/F/Med D. August. TB, RVD. Prescription error,

Transcription error.

9. 30936. 60/M/Med C. August. DKA. Prescription error,

Transcription error..

10. 30935. 55/M/Med D. August. Malaria. Prescription error.

 DEMOGRAPHIC DETAILS OF PATIENTS
TABLE : 3b

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
11. 27217. 65/F/Med D. August. T2DM, HTN, IHD. Prescription error,
Dispensing error.
12. 27914. 22/F/Med A. August. Fever, Cough. Prescription error,
Transcription error.
14. 28830. 35/F/Med D. August. Acute GE, Dimorphic Anaemia Prescription error, Transcription error.
,Pancytopenia
15. 30346.. 95/F/Med C. August. Viral Fever. Prescription error,
Transcription error.
16. 29717. 50/F/Med D. August. Pyrexia. Prescription error,
Transcription error.
17. 27467. 26/F/Med D. August. Malaria, Multiple Calcified Granuloma. Administration error.

18. 28049. 75/F/Med E. August. Arterial Wall STEMI. Prescription error,

Transcription error.
19. 29201. 68/F/Med E. August. Metabolic Encephalopathy, PTB, CVA. Prescription error,
Administration error.
20. 27195. 23/F/Med F. August. HBsAg , Positive Military TB, Dengue Prescription error,
Fever. Transcription error.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 26

 DEMOGRAPHIC DETAILS OF PATIENTS

TABLE : 3c

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender

21. 32868. 18/M/Med D. August. Epilepsy. Transcription error.

D
22. 31189. 29/M/Med C. September. Chest Pain. Prescription error.
23. 33299. 35/M/Med C. September. Seizure Prescription error,
Administration error.
24. 32573. 65/M/Med D. September.. PTB, Oral candidiasis. Prescription error, Administration
error.
25. 33613. 49/M/Med B. September. RHD, MS, Altered sensorium in AF, Prescription error,
Malaria. Monitoring error.
27. 31948. 25/M/Med B. September. DKA. Prescription error,
Transcription error.

28. 31204. 60/M/Med C. September. T2DM. Prescription error,

Transcription error.

29. 31187. 51/M/Med B. September. RCM, AF, HTN. Prescription error,

Transcription error.

30. 30936. 40/M/Med C. September. PV Malaria. Prescription error.

DEPARTMENOFCLINICALPHARMACY,H.S.K.COP,BAGALKOT 27
 DEMOGRAPHIC DETAILS OF PATIENTS

TABLE: 3d

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
DEPARTMENT OF
31. 33490. 35/F. September. Lice powder consumption. Transcription error.
CLINICAL
32. 33003. 40/M/Med D. September. K/C/O Alzheimer. Transcription error,
Administration error.
33. 33265. 55/M/Med C. September. Anaemia , Fever, UTI. Prescription error,
Administration error.
34. 32838. 60/F/Med D. September. Viral Fever, Hepatitis. Transcription error.
35. 31936. 50/M/Med C. September. DKA. Administration error.
36. 32565. 60/M/Med A. September. PTB. Prescription error,
Administration error.
37. 30619. 40/M/Med A. September. UROSEPSIS, AKI. Transcription error.
38. 35379. 55/M/Med F. September. Lateral wall STEMI, LVF, AKI, Hepatitis. Prescription error, Transcription
error.

39. 31204. 60/F/Med A. September. PV Malaria. Transcription error.

40. 32705. 50/F/Med A. September. Anaemia. Prescription error.

41. 32256. 35/F/Med A. September. RVD, Fever. Prescription error.

42. 32583. 52/F/Med A. September. DM, HTN. Prescription error,
Transcription error.

PHARMACY,H.S.K.COP,BAGALKOT 28
 DEMOGRAPHIC DETAILS OF PATIENTS
TABLE : 3e

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
41. 32256. 35/F/Med A. September. RVD, Fever. Prescription error.
42. 32583. 52/F/Med A. September. DM, HTN. Prescription error,
Transcription error.
43. 31139. 50/F/Med B. September. Left sided Pleural fibrosis. Prescription error, Administration
error.
44. 32828. 50/F/Med B. September. IHD, LVD, Pericardial Effusion. Prescription error.

45. 32085. 70/F/Med C. September. HTN, Fever, T2DM. Prescription error,

Transcription error.
46. 26580. 38/M/Med E. September. Reccurent Stroke, left MCA Territory Prescription error.
Infract
47. 36526. 65/F/Med E. October. Sepsis,Metabolic Encephalopathy ,old PTB. Prescription error, Administration
error.
48. 34142. 51/M/Med F. October. Fever. Prescription error.

49. 34143. 71/M/Med F. October. A/E of COPD. Prescription error, Transcription

error.
50. 35787. 50/M/Med F. October. DCM, Cardiogenic Shock. Prescription error,
Transcription error.
DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3f

SL IP NO. Age Month Final Diagnosis Detected ME

51.
No. 35916. 75/M/Med A
/Gender October. Urosepsis, T2DM, HTN, CVA. Prescription error,
Transcription error,
Dispensing error.
52. 35396. 62/F/Med E. October. APB, Somatic Disorder. Prescription error.
53. 35999. 40/F/Med A. October. RVD, PTB, Anaemia. Prescription error.
54. 36551. 45/M/Med F. October. Pneumonitis. Prescription error,
Transcription error,
Monitoring error.
55. 35794. 70/M/Med F. October. Analgesic induced ULCER, GI Bleeding. Prescription error.

56. 35762. 4.3/M/Med F. October. ALD , Hepatic Encephalopathy, Enteric Prescription error.
Fever.
57. 39252. .40/M/Med F. October. CKD Stage 5 with volume overload. Prescription error.

58. 33143. 50/M/Med C. October. T2DM , IHD. Transcription error,

Dispensing error.
59. 38092. 50/F/Med F. November. RVD on ART, PTB, Anaemia. Prescription error.

60. 39627. 53/F/Med C. November. RVD, Fever. Prescription error,

Administration error,

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 29

DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3g

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
61. 37831. 50/M/Med C. November. T2DM. Prescription error, Dispensing error,
Transcription error, Monitoring
error.
62. 38412. 28/F/Med C. November. PTB. Prescription error,
Transcription error
63. 37723. 21/F/Med C. November. Fever under evaluation. Prescription error.
64. 39835. 25/M/Med B. November. Thrombocytopenia. Transcription error.
65. 38091. 30/M/Med F. November. A/E of COPD. Administration error.

66. 38304. 50/F/Med D. November. PV Malaria. Prescription error,

Transcription error, Monitoring
error.
67. 38552. 49/F/Med C. November. HTN. Administration error.

68. 39063. 20/F/Med E. November. PV Malaria, GE. Prescription error,

Transcription error.

69. 39170. 28/F/Med D. November. PV Malaria. Transcription error.

70. 38527. 50/F/Med D. November. RVD. Prescription error, Administration

error, Transcription error,
Monitoring error.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 30

DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3h

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
November.
71. 38439. 38/F/Me Rt sided Pneumonia, ARF, cystic, MRD, Prescription error,
d C. Pericardial effusion. Transcription error.

November. Prescription error, Transcription

72. 39395. 64/M/Me Syphilis, Megaloblastic Anaemia, Pancytopenia.
error.
d C.

November.
73. 40587. 40/M/Me DM, Diabetic Nephropathy, Neuropathy. Dispensing error.
d F.
November.
74. 39292. 35/F/Me RVD, ART Induced Anaemia. Prescription error.
d C.
Transcription error.
November.
75. 38607. 56/F/Me RVD, Fever, Meningitis. Prescription error.
d C.
November.
76. 38412. 25/F/Me Brucellosis, Nutritional Anaemia. Prescription error.
d C.
November.
77. 39170. 32/F/Me Viral Meningio Encephalitis, P V Malaria. Prescription error,
d C. Transcription error.

November. Prescription error, Transcription

78. 38659. 49/F/Me Anaemia.
error.
d C.
November.
80. 39516. 28/F/Me RVD, Anaemia. Prescription error.
d D.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 31

 DEMOGRAPHIC DETAILS OF PATIENTS

TABLE : 3i

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
November. DEPARTMENT OF CLINICAL
80. 39516. 28/F/Me RVD, Anaemia. Prescription error.
d D.
81. 44246. 32/M/Me December. GERD. Prescription error,
d C. Transcription error.
December.
82. 41410. 45/M/Me Mercury Consumption. Prescription error.
d F.
December.
83. 41761. 51/M/Me RVD, Old PTB, Acute GE. Prescription error.
d B.
Transcription error.
December.
84. 41773. 70/M/Me DCM RF 20%. Prescription error.
d C.
December.
85. 42582. 40/M/Me T2DM, Steroid induced Cushing Syndrome. Dispensing error.
d C.
December. Prescription error, Transcription
86. 41152. 16/F/Me Drug Induced Acute GE, T-Cell Lymphoblastic
error.
d E. Lymphoma, Paraplegia.
December. Prescription error, Transcription
87. 41483. 20/F/Me Seizure Disorder.
error.
d D.
December.
88. 41424. 65/M/Me Seizure Disorder, IHD, Pulmonary Edema. Prescription error.
d F.
90. 42021. 84/F/Me December. IHD, NSTMI, B/L Pneumonia. Prescription error.
d D.

PHARMACY,H.S.K.COP,BAGALKOT 32
DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3j

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
Prescription error, Transcription
91. 2036. 17/M/Me January. RT Pleural effusion-Tubercular.
error.
d C.
January. Transcription error,
92. 1039. 30/F/Me T2DM, UTI, AKI.
Dispensing error.
d C.
January. Transcription error.
93. 1182. 45/F/Me Fever, T2DM, Diabetic foot.
Dispensing error.
d C.
January. Administration error,
94. 1597. 50/M/Me Cardiogenic shock.
Transcription error.
d F.
January.
95. 1297. 40/M/Me AE of COPD, PTB, Hiccups Prescription error.
d C.
928. 24/M.M January. Malaria, Pancytopenia. Administration error,
96.
ED E Monitoring error.
97. 2083. 36/M/Me January. Cirrhosis, Portal HTN, Hepatic Encephalopathy. Prescription error,
d C. Transcription error.
98. 1851. 39/M/Me January. IHD, DCM, HTN. Prescription error,
d C. Transcription error.
99. 1944. 40/M/Me January. Anaemia. Prescription error.
100. 1925. d48/F/Me
B. January. RVD. Prescription error,
d B. Transcription error.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 33

DEMOGRAPHIC DETAILS OF PATIENTS

TABLE : 3k

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
101. 607. 40/F/Me January. Arthritis. Administration error,
d F. Transcription error.
102. 70. 50/M/Me January. Basal Pneumonia, Seizure , Dyslipidaemia. Prescription error,
d A. Transcription error.

103. 243. 65/M/Me January. Right Hemiplegia , Facial Palsy. ,Prescription error,
d B. Transcription error,
Monitoring error.
104. 1926. 50/M/Me January. Right Basal Pneumonia ,Sepsis , dyslipidaemia , Transcription error,
d D. T2DM. Dispensing error.

105. 2343. 52/M/Me January. Chronic Pancreatitis, GE. Transcription error,

d F. Dispensing error.
106. 499. 55/M/Me January. IHD, HTN, EF-50%, Microcytic Anaemia. Prescription error,
d C. Transcription error.
107. 2091. 58/M/Me January. Pulmonary COX, Hypoglycaemia. Prescription error.
d D.
108. 1296. 77/M/Me January. COPD, PTB, Hiccups. Prescription error,
d C. Transcription error.

109. 2067. 28/F/Me January. Seizure Disorder. Prescription error,

d C. Transcription error.
110. 2261. 28/F/Me January. Aplastic Anaemia, Seizure Disorder, Prescription error.
d F. Grade III haemorrhoids.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 34

DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3l

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
111. 3453 35/F/Me January. RVD. Prescription error
d A.
112. 2870. 56/F/Med January. T2DM. Dispensing error.
C
113. 871. 75/F/Me January. Cataract of Left Eye Uncontrolled T2DM HTN. Dispensing error.
d C.

114. 744. 87/F/Me January. Necrotising , Prescription error,

d F. Cellulites. Transcription error.
115. 4108. 60/F/Me February. Drug Induced coughing, DM, Necrotising , Prescription error,
d C. Cellulites. Dispensing error.

116. 5523. 26/F/Me February. RVD on ART. Prescription error.

d D.
117. 4954. 17/F/Me February. ALL Spine metastasis, seizure Disorder. Prescription error.
d F.
118. 4834. 23/F/Me February. UTI. Transcription error, Prescription
d E. error.
119. 5296. 74/F/Me February. T2DM. Prescription error,
d A. Dispensing error.
120. 4709. 47/F/Me February. Herpes Zoster. Transcription error,
d D. Dispensing error.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 35

DEMOGRAPHIC DETAILS OF PATIENTS

TABLE :3m

SL IP NO. Age Month Final Diagnosis Detected ME

No. /Gender
121. 3690. 41/F/Me February. SLE. Prescription error.
d C.
122. 4295. 56/F/Me February. Atrial Fibrillation. Prescription error,
d A. Transcription error.
123. 4681. 58/F/Me February. Pyrexia of unknown origin. Prescription error,
d A. Administration error.
124. 4582. 24/M/Me February. Anaemia. Administration error,
dC
125. 3721. 15/M/Me February. Fever. Prescription error,
d C. Monitoring error.
126. 3852. 70/M/Me February. T2DM, Pyelonephritis, AKI. Prescription error,
d D. Transcription error,
Dispensing error.
127. 4592. 25/M/Me February. RVD, Multiple cellulites, herpes zoster. Prescription error,
d D. Transcription error.

128. 5526. 67/M/Me February. IHD, Old CVA, Left Hemiplegia, GTC Seizure. Prescription error,
d D. Transcription error.

129. 42150. 50/M/Me February. Cardiogenic shock. Transcription error.

d D.
130. 4517. 40/M/Me February. T2DM. Dispensing error.
d D.

DEPARTMENT OF CLINICAL PHARMACY,H.S.K.COP,BAGALKOT 36

Table 2: Gender wise categorisation of study population

GENDER WISE CATEGORISATION

MALE
54.94% FEMALE

48.46 %

Figure 1 : Gender wise categorisation of study population

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 37

 Table 3 : Age -Gender wise distribution of Medication Error

≥ 60 yrs 10%

40 - 60 yrs 19.23%
MALE
FEMALE

20 - 40 yrs 18.46% 18.46%

≤ 20 yrs 3.07% 3.07%

Figure 2 : Age gender wise distribution of medication error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 38

 DEMOGRAPHIC DETAILS OF PATIENTS

Table 4: Month wise distribution of medication error

MONTH MEDICATION NO. OF %

SL. ERROR. PATIENTS MEDICATION
NO ERROR
1 AUGUST 45 21 17.78
2 SEPTEMBER 41 25 16.20
3 OCTOBER 25 12 9.88
4 NOVEMBER 47 22 18.69
5 DECEMBER 19 10 7.50
6 JANUARY 45 24 17.78
7 FEBRUARY 31 16 12.25
TOTAL 253 130 99.96

12.25 August
16.2
September
October
November
17.78 9.88
December
January
8.69
7.5

Figure 3 : Month wise distribution of medication error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 39

 Table 5: Unit wise distribution of Medication errors

UNIT NO OF PATIENTS NO OF ERRORS % ERROR

A. 18. 34. 13.43%.
B. 11. 20. 7.90%.
C. 41. 89. 35.17%.
D. 28. 54. 21.34%.
E. 12. 23. 9.09%.
F. 20. 33. 13.04%.
TOTAL 130 253 99.97%

13.04 13.43

9.09 7.9
A unit
B unit
C unit
21.34
D unit
35.17
E unit
F unit

Figure 4 : Unit wise distribution of medication error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 40

Table 6 : Professionals involved in medication error

SL.NO PROFESSIONALS NO. OF %

MEDICATION
ERRORS
1 PHYSICIANS 130 51.38
2 PHARMACIST 22 8.69
3 NURSES 101 39.9
TOTAL 253 99.97

39.9
PHYSICIANS
PHARMACIST
51.38 NURSE

8.69

Figure 5 : Professionals involved in medication error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 41

 Table 7 :Different types of medication error reported during study period

Types of Error No. of Error %

Type 1 Prescribing Error

1.1 Wrong dose/Strength 5 1.97

1.2 Risk of DI 38 15.01
1.3Drug Continued-ADR 8 3.16
1.4 Missed Patient Information 7 2.76
1.5 Oral Prescription 4 1.58
1.6 Rate Not Mentioned 12 4.74
1.7 Illegible Handwriting 4 1.58
1.8 NO Signature 5 1.97
1.9 Dug Duplication 8 3.16
1.10 Wrong Drug Selection 1 0.39
1.11 Drug Without Indication 8 3.16
1.12 Drug Indicated, Not given 6 2.37
1.13 Resistant Drugs 2 0.79
1.14 Untreated Indication 14 5.53
1.15 Contraindication 8 3.16

Type 2 Nursing/Administration Error

2.1 Failure To Administer 10 3.95

2.2 Wrong Time Administer 2 0.79
2.3 Administering After Discontinuing 2 0.79
2.4 Medication Not Given 5 1.97
Types of error No. of error %

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 42

 Type 3 Transcription Error

3.1 Enters Wrong Order to Medication 42 16.60

Administration form
3.2 Incomplete Medication Administration Form 28 11.06
3.3 NO Medication Administration Form 3 1.18

Type 4 Dispensing Error

4.1 Dispenses After Incorrect Storage 22 8.69

Type 5 Monitoring Error

5.1 Omitted/Delayed Medicine 6 2.37

5.2 Wrong Duration 3 1.18

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 43

 Dispensing error 8.69%

Transcription error 28.84%

% of error
Column1
Column2

Administrating error 7.50%

Prescribing error 51.33%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%

Figure 6 : Types of medication error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 44

 Table 8: Different Drugs involved in medication error during study period

SL Drugs Given Description OF Medication Error Error Occurred Error Category

.NO
1 Furosemide 1.Drug administered without 1 administered without Prescription. 1. Prescription error
Prescription.
2 Glimepiride 1.Drug continued After Observing 1.Drug continued After Observing ADR 1. Prescription error
ADR , drug induced asthenia.
3 Ranitidine 1.Wrong Dose prescribed, 500mg 1.Wrong Dose 1. Prescription error
instead of 150 mg.
4 Mannitol 1. Failure To Administer QID. 1. Failure To Administer
5 Amlodipine 1. Failure to add amlodipine in 1. omission on admission 1. Prescription error
medication during hospital admission.
6 Fluconazole 1. Wrong Dose prescribed. 1.Wrong dose 1. Prescription error
2.Contraindicated with ondansetron 2.contraindication
7 Insulin 1. Different brand name but same 1. Drug duplication 1. Prescription error
content.

2. Storage after breaking the seal 2. wrong storage.

8 Ceftriaxone 1. Rate Not Mentioned in prescription 1. IV instructions incorrect 1. Prescription error
for IV infusion.

2. Resistant in cultural sensitivity test 2. wrong drug selection 2. Prescription error

but prescribed.
9 Pantoprazole 1. over dose is prescribed 1. wrong dose 1. Prescription error

2. many potent antibiotics are 2.Drug Indicated But Not Given

prescribed without pantoprazole.
3. pantoprazole prescribed BD instead 3.Wrong Frequency
of OD.

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 45

10 Ondansetron 1. drug given without any symptoms. 1. Drug Given Without Indication 1. Prescription error
11 Benadone 1. Not Given With AKT. 1. drug indicated but not given 1. Prescription error
12 AKT 1. Drug Given Without Indication. 1. wrong drug selection 1. Prescription error
2. Prophylaxis Incomplete. 2. wrong duration
13 Albendazole 1.Given for two days, while being a 1. wrong dose 1. Prescription error
single dose drug.
14 IVF 1 .Rate Not Mentioned. 1. IV instructions incorrect 1. Prescription error
15 Lamivudine 1. Drug Continued After Observing 1. Drug Continued After Observing ADR 1. Prescription error
loose stools.
16 Proponolol 1.Wrong dose prescribed , 30 mg. 1. Wrong Dosing 1. Prescription error
2. Administered after taking breakfast. 2. Wrong Time Of Administration 2. Administration error
17 Multivitamins 1. Different brand name but same Drug Duplication 1. Prescription error
content.
18 Brozodex Patient suffering from severe cough Indicated Not Given 1. Prescription error
but not prescribed.
19 Metformin 1. Drug induced asthenia. Continued After Observing ADR 1. Prescription error

20 Aspirin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
21 Atorvastatin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Digoxin, Fenofibrate, Phenytoin.

22 Digoxin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Aspirin, Atorvastatin, Calcium.
23 Torsemide 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Aspirin.
24 Paracetamol 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
AKT,Linezolid,Phenytoin.
25 Amilodipine Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Glimepiride.

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 46

26 Atenolol 1. Major Drug Interaction with 1. Risk of major drug interaction 1. Prescription error
Glimepride
27 Enoxaparin Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Sodium Clopidogrel,Fenofibrate
SL.N Drugs Given Description OF Medication Error Error Occurred Error Category
O
28 Clopidogril 1.Major Drug Interaction With Aspirin 1. Risk of major drug interaction 1. Prescription error
,Piracetam, Atorvastatin.
29 Levofloxacin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Metronidazole
30 Amiodarone 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Ranitidne,Ondansetron,Carvidlol.
31 Insulin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Atenolol.
32 Ofloxacin 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Ondansetroin.
33 KCL 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
Spironolactone .
34 Amitriptyline 1. Major Drug Interaction With 1. Risk of major drug interaction 1. Prescription error
HCL Diclofenac.
2. Contraindicated With
Metoclopramide.
35 Carbamazepine 1.Contraindicated with Artemether 1.Contraindication 1. Prescription error
2.drug induced anaemia 2. Drug Continued After Observing ADR
36 Chlorpromazin 1. Contraindicated with 1.Contraindication 1. Prescription error
E Metoclopramide
37 Losartan 1Drug Continued After Observing 1. Drug Continued After Observing ADR 1. Prescription error
ADR
38 Doxycycline 1. Resistant in cultural sensitivity test 1. wrong drug selection 1. Prescription error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 47

 but prescribed.
39 Levitiracetam 1.over dose given, 1g instead of 500 1.wrong dose 1. Prescription error
mg
40 Levodopa 1. failure to administer in time 1. failure to administer 1. Administration
error

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 48

Table 9: Medication error category

CATEGORY OF LEVEL OF SEVERITY NUMBER OF ERRORS % OF ERROR

MEDICATION ERROR

CATEGORY A NO ERROR 0 0

CATEGORY B ERROR, NO HARM 105 41.5%

CATEGORY C 58 22.9%

CATEGORY D 58 22.9%

CATEGORY E ERROR,HARM 24 9.5%

CATEGORY F 8 3.2%

CATEGORY G 0 0

CATEGORY H 0 0

CATEGORY I ERROR,DEATH 0 0

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 49

 ERROR ,DEATH
0

CATEGORY I

ERROR , HARM 3.20% CATEGORY H

9.50%
0 CATEGORY G
CATEGORY F
CATEGORY E
CATEGORY D

ERROR , NO HARM CATEGORY C

CATEGORY B
22.90%
22.90%
41.50% CATEGORY A

NO ERROR
0

Figure 7: Medication error category

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 50

 Table 10: Class wise distribution of drugs

SL NO MEDICATION CLASS NO OFMEDICATION PERCENTAGE(%)

ERROR REPORTED

1. NSAIDS 31 12.8
2. Anti- Emetics 25 10.33
3. Anti Diabetic 24 9.91
4. Diuretics 23 9.50
5. Antibiotics 19 7.85
6. Parentral Nutrition 15 6.19
7. Anti- Coagulant 12 4.95
8 Multivitamins 11 4.52
9 Anti-hypertensive 11 4.52
10 Anti- Malarial 9 3.71
11 Anti- Hyperlipidemic 9 3.71
12 Anti-Tubercular 9 3.71
13 Expectorant 6 2.47
14 Anti- Fungal 6 2.47
15 Anti- Epileptic 7 2.89
16 Anti-Anxiety 5 2.06
17 Alkaniser 5 2.06
18 Nebulisation 4 1.65
19 Anti- Arrhythmic 3 1.23
20 H2 receptor antagonist 2 .82
21 ART drugs 2 .82
22 Anti- Parkinsonism 1 .41
23 Proton pump inhibitors 1 .41
24 Anti- Helminthes 1 .41
25 Neuroleptics 1 .41

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 5

 Table 11 : Percentage Patient outcome actual

PATIENT OUTCOME NO. OF MEDICATION %

ACTUAL ERROR

Fatal 0 0

Severe 8 25
( permanent harm )
Moderate 16 50
( requiring active treatment)
Mild harm 8 25

No harm 0 0

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 53

 0

25 25

fatal
severe
moderate
mild harm
no harm

50

Figure 8 : Percentage patient outcome -actual

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 54

 Table 12: Percentage patient outcome where no harm

PATIENT OUTCOME- NO. OF MEDICATION %

WHERE NO HARM ERROR

Potentially fatal 13 5.88

Potentially severe 17 7.69

( permanent harm )

Potentially moderate harm ( 45 20.36

requiring active treatment)

Potentially mild harm 146 66.06

( requiring monitoring)

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 55

 5.88
7.69

Potentially fatal
20.36 Potentially severe
potentially moderate harm
Potentially mild harm
66.06

Figure 9 : percentage patient outcome where no harm

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT 56

Table 13 : IV Oral comparison in medication error

SL MEDICATION ERROR IV ORAL

NO TYPE
1. Omitted or delayed medicine 3 4
2. Wrong duration 1 4
3. Contraindication 5 11
4. Wrong dose or strength 0 5
5. Wrong storage 22 0
6. Risk of drug interaction 39 90
7. Risk of Adverse drug reaction 0 8
8. Oral prescription 4 0
9. Rate not mentioned 12 0
10. Administration 5 14
11. Drug duplication 2 6
12. Wrong drug selection 1 0
13. Drug without indication 8 0
14. Resistant drug 2 0
15. Drug indicated not given 2 4
16 Transcription error 13 29
TOTAL 119 175

CLINICAL PHARMACY DEPARTMENT,H.S.K.COP, BAGALKOT

Table: Comparison of medication error in `oral and intra venous administration

SL Type of error Oral Intra Venous P value

NO

1 Administration error 0.7368 0.2632 0.0245̽̽

±0.1038 ±0.1038
2 Monitoring error 0.8889 0.4444 0.3466
±0.3093 ±0.1757
3 Transcription error 0.3973 0.1781 0.0148̽̽
±0.06684 ±0.0451
4 Dispensing error 0.0±0.0 1±00
̽̽
5 Prescribing error 1.24 0.75 0.0003̽̽ ̽̽ ̽̽
±0.1173 ±0.061