On a usual routine shift at the pharmacy, I received a refill prescription that read fluoxetine 150mg every other two days for 14 doses plus metronidazole/miconazole vaginal cream that the client had already got on the previous visit. The previous medicine package she got was labelled Fluoxetine 20mg taken every morning. Probing further into how she was doing, she said there was no improvement at all though she experienced a slight improvement in mood whenever she took the capsule. Looking closely at her prescription, the diagnosis was bacterial vaginitis with recurrent candidiasis. When asked about her symptoms, they were consistent with the diagnosis. Next was to reach out to her prescriber, who quickly remembered the patient and admitted to have written a wrong medication for the right disease and advised us to give Fluconazole 150mg every other two days for 14 doses.

This and more are examples of common medication errors in pharmacies and hospitals. A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient or consumer. This usually can lead to adverse drug reactions, ineffective treatment or even life threatening situations. Some of the common errors include; incorrect duration, incorrect preparation, incorrect strength, incorrect rate, incorrect timing, incorrect route of administration and wrong patient.

From a study by A Dorothy et.al, prevalence of medication errors and the associated factors, out of 110 participants, 52 (43.7%) experienced atleast a medication error. This is consistent with most studies conducted across Africa and the US. To prevent these errors, here are a few strategies.

  1. Clear communication

Perhaps the most important of all. Effective communication between healthcare professionals, including doctors, pharmacists, nurses and patients is crucial. This helps ensure accurate information transfer and minimizes misunderstandings.

  1. Double-checking

Pharmacists and healthcare providers should double-check the medication orders and verify the accuracy of prescriptions before dispensing them.

  1. Training and education

CMEs for healthcare professionals, particularly those involved in medication dispensing and prescription can enhance their knowledge and skills. Proper training and up-to-date information helps them keep informed with the best practices and reduces the likelihood of making errors.

  1. Use of technology

Leveraging technology such as barcode scanning systems, automated dispensing and electronic prescribing can significantly minimize medication errors. These technologies provide additional layers of verification and reduce manual errors.

  1. Proper labelling

Medication should be properly labeled with clear instructions including the name, dosage and administration instructions. This reduces the chances of confusion or mix-ups.

By implementing these preventive measures and fostering a culture of safety, medication errors can be reduced, promoting better patient outcomes and minimizing potential harm.


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