Drug Name Confusion is a Common Cause of Drug-related Errors
A medication error is generally defined as a deviation from the prescription drug order written by the prescribing physician on the patient's chart. In the hospital setting, it is estimated that medication errors occur at a rate of about one per patient per day.
A sub-set of medication errors is pharmacy dispensing errors. In the hospital setting, errors made by pharmacists or pharmacy staff in the cart-filling process is one example of a pharmacy mistake.
Medication errors in the hospital setting can be attributed to a failure to follow the basic techniques and guidelines of medication ordering, preparation, and administration. Combined, these failures result in medication errors affecting 3% to 6.9% of hospital inpatients, according to some controlled studies of medication errors in hospitals. Moreover, one such study determined that 11% of medication errors in hospitals are pharmacy-dispensing errors in which the wrong drug or incorrect strength is dispensed by the hospital pharmacist. A different report on hospital medication errors from 1999 found that 17% of medication errors in a hospital setting were due to dispensing errors by the hospital pharmacy.
Drug name confusion is among the most common causes of drug-related errors. One example of sound-alike drug names involves Lamictal, the antiepileptic drug, and Lamisil, the antifungal drug. The volume of dispensing errors involving these two drugs caused the manufacturer of Lamictal, Glaxo Wellcome Inc. (as it was known at the time), to launch a campaign warning pharmacists of the potential confusion. Staying with this example, the possible consequences of dispensing the wrong drug can be grave. Epileptic patients receiving the antifungal drug Lamisil by mistake could experience continuous seizures. Patients erroneously receiving the antiepileptic drug Lamictal might experience a serious skin rash, blood pressure changes, or other unwanted side effects.
(Posted by: Tom Lamb)