Much of what we know about medication errors is derived from inpatient studies and, to a lesser degree, long-term care studies. Medication errors that occur in the home or other non-healthcare settings are less well studied.
One method of identifying potential medication errors in those latter facilities is analyzing data from our multiple poison control centers. Such recent analysis of National Poison Database System (NPDS) data from 2000 through 2012 showed a significant increase in errors that result in serious medical outcomes (Hodges 2017). Those researchers found 67,603 exposures related to unintentional therapeutic pharmaceutical errors that occurred outside of health care facilities that resulted in serious medical outcomes (overall average rate 1.73 per 100,000 population). Most notably, there was a 100% rate increase over that 13-year study period. Increases were seen for all age groups except children younger than 6 years of age.
Common types of medication errors included:
The medication categories most frequently associated with serious outcomes were:
The analgesic errors were dominated by three classes:
Interestingly, serious medication errors were more frequent among females in all age categories. Two-thirds of the errors involved solid medications but 20% involved liquid medications, primarily in children.
Cough and cold medications were frequent offenders in children under the age of 6 but a suspected reason for the lack of an increase in overall errors in children under the age of 6 over the course of the study was a reduction in the number due to cough and cold medications, attributable to warnings from the FDA and numerous specialty societies.
And for children younger than 6 years, 10.9% of the errors were classified as "ten-fold dosing error", a problem weve often noted for pediatric patients (see list of columns on pediatric medication errors below). But for children 612 years old, the percentage of medication errors attributed to inadvertently taking/giving someone elses medication was nearly double that of any other age group. The authors speculate that some children in this age group may be administering their own medication, and due to their age, may be more likely to take another family members medication by mistake.
Medical outcome was most commonly reported as moderate effect (93.5%), followed by major effect (5.8%) and death (0.6%). A third of exposures resulted in hospital admission. Not surprisingly, categories of medications resulting in the highest proportion of admissions to a critical or non-critical care unit were anticoagulants, analgesics, antineoplastics, anticonvulsants, and cardiovascular medications.
The authors stress that most non-health care facility medication errors are preventable, particularly those due to dosing errors, taking or administering the wrong medication, and inadvertently taking or administering the same medication twice. They also stress the growing body of literature regarding use of proper dosing devices in children (see the list of our prior columns below and another of this months What's New in the Patient Safety World columns ).
But they also note that in young children the second most common type of medication error was health professional iatrogenic error (related to mistakes made by physicians, nurses, pharmacists, or other health care professionals, and cases in which a contraindicated medication was given).
The authors offer many potential improvements that could reduce the frequency of these medication errors, including:
Some of our prior columns on medication errors in other ambulatory settings:
June 12, 2007
August 14, 2007
March 24, 2009
October 16, 2007
January 15, 2008
April 2010 Medication Incidents Related to Cancer Chemotherapy
September 2010 Beers List and CPOE
October 19, 2010
April 12, 2011 Medication Issues in the Ambulatory Setting
June 2012 Parents' Math Ability Matters
May 7, 2013 Drug Errors in the Home
May 5, 2015 Errors with Oral Oncology Drugs
September 15, 2015 Another Possible Good Use of a Checklist
April 19, 2016
June 21, 2016
Some of our other columns on pediatric medication errors:
November 2007 1000-fold Overdoses by Transposing mg for micrograms
December 2007 1000-fold Heparin Overdoses Back in the News Again
September 9, 2008 Less is More and Do You Really Need that Decimal?
June 28, 2011 Long-Acting and Extended-Release Opioid Dangers
September 13, 2011 Do You Use Fentanyl Transdermal Patches Safely?
September 2011 Dose Rounding in Pediatrics
April 17, 2012 10x Dose Errors in Pediatrics
May 2012 Another Fentanyl Patch Warning from FDA
June 2012 Parents Math Ability Matters
September 2012 FDA Warning on Codeine Use in Children Following Tonsillectomy
May 7, 2013 Drug Errors in the Home
May 2014 Pediatric Codeine Prescriptions in the ER
November 2014 Out-of-Hospital Pediatric Medication Errors
January 13, 2015 More on Numeracy
April 2015 Pediatric Dosing Unit Recommendations
September 2015 Alert: Use Only Medication Dosing Cups with mL Measurements
January 31, 2017
Hodges NL, Spiller HA, Casavant MJ, et al. Non-health care facility medication errors resulting in serious medical outcomes. Journal of Clinical Toxicology 2017; Published online: 10 Jul 2017