Reducing medication errors

PHOTO: Reducing medication errors

Everyone gets sick from time to time. The illness is self-limiting in many instances, but in others, they are treated with medication. Sometimes, other treatment modalities like surgery or radiotherapy are required.

The use of medicines carries with it benefits and risks. There are many benefits of medicines, which include the curing of infections, pain relief, as well as control of high blood pressure, diabetes, and fits.

The risks of medicines are often unexpected, and undesirable adverse effects, some of which are mild like diarrhoea, whilst others are serious like liver or kidney damage, can occur. They include interactions between the medicines and food, drink, dietary supplement and another medicines.

In addition, the medicine may not function as expected or it may cause problems or even harm a person.

Before prescribing a medicine for a patient, the doctor would have made a diagnosis after having taken a history, done a physical examination and/or carried out imaging and/or laboratory investigations.

After a medicine is prescribed, it would be dispensed by hospital or clinic staff and then administered to the patient. It can be seen that errors can occur at any stage in the process.

The Malaysian National Patient Safety Council defines medication error as

"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. Such an event may be related to professional practices, healthcare products, procedures and systems including prescribing, order communication, product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use."

There are different types of medication errors, i.e. prescribing, omission, wrong timing, unauthorised drug, dose, dosage form, drug preparation, route of administration, administration technique, deteriorated drug, monitoring and compliance.

Medication errors may not cause harm. When it causes harm, the degree may vary, i.e. temporary harm requiring treatment, temporary harm requiring hospitalisation which may be prolonged, cause permanent harm, or measures are needed to sustain life.

Medication errors can also contribute to, or cause, a patient's death.

According to the American Hospital Association, the common causes of medication errors are incomplete patient information, unavailable information about medicines, miscommunication of prescription orders, lack of appropriate labeling and environmental factors.

The incidence of medication errors vary because of different study methodologies and definitions. Its incidence ranges from 2 - 14 per cent of admissions to hospitals in the United States, with about 1-2 per cent. It has been estimated to account for about one in 20 hospital admissions in the US. Similar results have been reported from other developed countries.

An observational study of drug administration errors in a Malaysian hospital reported by Chua SS, Tea MH and Rahman MH in April 2009 concluded that "the frequency of drug administration errors in developing countries such as Malaysia is similar to that of developed countries. Incorrect time errors were also the most common type of drug administration errors."

Medication errors can be committed by doctors, pharmacists, nurses, other healthcare professionals, manufacturers, caregivers and patients. They are the single most preventable cause of harm to patients.

This article is about what patients and caregivers can do to prevent and reduce medication errors.


Know your drugs

It is essential to know the medicines prescribed to you. This includes its name, what it looks like, and whether it is the original product or a generic. It would be preferable to know where it was manufactured and who the manufacturer is, especially when there are counterfeit drugs available at prices much lower than that of original products.

The patient should know the reason for the prescription of the medicine, how and when to administer it, how long to take it, and the time needed for it to take effect.

There are various routes of administration of medicines. They include taking it by mouth; injecting into the fat below the skin, into the muscle or into a blood vessel, usually a vein; inserting it into the body's orifices like the nose, rectum or vagina; or applying it locally.

The medicine has to be administered by the correct route for it to act. For example, although most tablets are taken by mouth, there are also tablets that are inserted into the vagina. Taking a vaginal tablet orally would not address the health problem.

You should know what the side effects and interactions of the medicine are, and what to do should they occur. It is important to know how and under what conditions you should cease using the medicines. This information can be asked of the doctor or pharmacist. More information can be found in the package inserts of the medicine provided by the manufacturer.

Such information is comprehensive in the case of medicines which are original products. As such, it may be advisable to seek clarification from the doctor or pharmacist if you are concerned about anything that you read in these package inserts.

You should also know what to do if a dose is missed and whether any tests or monitoring are required.

As it may be challenging to remember every bit of information, it is advisable to always ask for written information to take home.


Read and follow

It is essential to read the directions on the label on the container of the medicine, understand and adhere to the instructions given by the doctor, pharmacist, nurse or other healthcare professional.

If you have any questions or concerns, you should not hesitate to ask.

The first thing that you should do when given a medicine is to check that it is the correct one, i.e. name and dose.

It is important that you know how to store the medicines properly. Some medicines can be stored at room temperature; others need to be stored in the refrigerator.

It is crucial to keep the medicines out of the reach of young children who may consume it inadvertently.

The medicines should be kept in their original labeled containers. It is potentially dangerous to combine medicines in the same bottle. If you use a medicine container with compartments, you should know the medicines in the different compartments, ie name, dose, and time of administration.

It is prudent to consult the doctor before stopping the medicine or using it differently than directed. Playing doctor can be potentially dangerous.


Things to avoid

Medicines may interact with other medicines or dietary supplements, which include vitamins, herbs or traditional medicines, beverages, or foods.

Many traditional medicines are considered by the public as dietary supplements or tonics. As such, it is essential to inform the doctor or pharmacist of the dietary supplements or traditional medicines that you are taking and to ask the doctor or pharmacist about the interactions with the medicine prescribed by the doctor.

You should ask the doctor or pharmacist about possible interactions with the current medicines prior to commencing any new medicine, dietary supplement or traditional medicine.

Many doctors do not advise combining medicines with traditional medicines because the effects of the latter are not well known and/or understood.

It is advisable to get all of one's medicine needs from the same supplier, whether it be a hospital, clinic or pharmacy.


Most medicines have side effects and they can be minimised by taking certain measures, eg eating prior to taking a medicine to reduce abdominal upset, avoiding alcohol, etc. It is advisable to ask the doctor or pharmacist about these measures.

You should also know what to do when side effects are experienced and when to inform the doctor.

When taking a medicine, you should be aware of how you feel and whether there are any bodily changes. If there are any changes, it is advisable to write it down so that you can remember to inform the doctor, pharmacist or nurse.

You should also know when an improvement will be felt and when the next appointment with the doctor is.



Good communication with the doctor, pharmacist, nurse and other healthcare professional goes a long way in helping a person recover from an illness. It is important to remember that communication always involve both the parties as the doctor, pharmacist, nurse or other healthcare professional does not have the ability to read a patient's mind.

You should keep an updated list, in writing, of all the medicines, whether they are prescription or over-the-counter, dietary supplements, including vitamins and herbs as well as traditional medicines that you use, even if the use is occasional.

This list should be shown to any doctor, pharmacist, nurse or other healthcare professional whenever you see them.

This will help prevent medication errors, including undesirable and potentially serious interactions among the medicines.

The doctor or pharmacist should be informed of any allergies that a patient has. Other information that should be provided to the doctor or pharmacist includes the ability to take medicines, eg difficulty swallowing or remembering to take them.

If one is pregnant or intending to get pregnant, or breastfeeding, the doctor should be informed. This is because certain medicines cannot be prescribed to pregnant or lactating women.

Patients should never be afraid to raise their thoughts or concerns with the doctor, pharmacist, nurse or other healthcare professional who have a responsibility to provide healthcare. If necessary, you can request a family member or close friend to assist in such communications.

The doctor or pharmacist should always be informed immediately if the name of the medicine on the prescription appears different than expected, if the directions appear different, or if the medicines appear different.

By asking questions whenever there are any concerns at all, you can ensure that you do not become a victim of a medication error.


Medication errors are one of the most preventable causes of patient injury, although its incidence varies in different healthcare settings. The sources and avoidance of medication errors are multifactorial and multidisciplinary.

Healthcare providers and patients and/or their caregivers have their respective roles to play in reducing the occurrence of medication errors.

Patients and/or their caregivers can do so by knowing the medicines, understanding and adhering to instructions, monitoring the effects of the medicines and ensuring there is good communication between patients and their healthcare providers.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.