- The Washington Times - Sunday, July 16, 2017

Americans increasingly are making errors in medication dosages at home that have resulted in tens of thousands of hospital admissions and more than 400 preventable deaths in the past 13 years, according to a new study published in a scholarly medical journal.

Researchers found that the drugs most often associated with unintentional errors included cardiovascular drugs, analgesics (pain medication or opioids) and hormones/hormone antagonists — like insulin — from an analysis of 67,603 cases from the U.S. Poison Control Center between 2000 and 2013.

The rate of medication errors taking place outside the hospital are increasing “and additional efforts are needed to prevent these errors,” the researchers concluded in their report published Wednesday in the journal Clinical Toxicology.

It is unlikely the use of these medications will lessen, as heart disease is the No. 1 cause of death in the U.S. and the number of people with diabetes is rising. The analgesics analyzed in the study were most closely associated with over-the-counter painkillers; dosage errors were unintentional and adverse effects were not associated with opioid abuse.

“These medication errors are a significant public health burden. A third of the cases in the study resulted in hospital admission, and so they are something we want to take seriously,” said lead author of the study Nichole Hodges, a research scientist at Nationwide Children’s Hospital in Columbus, Ohio. “As prescribing of those cardiovascular medications, opioids and insulin — as those all continue to rise, we’re likely to see an increase in these medication errors as well.”

The analysis was conducted by researchers associated with the Nationwide Children’s Hospital in Columbus.

While the Centers for Disease Control and Prevention estimates that 1 million hospital visits to emergency room departments are caused by “adverse drug events” or “harm resulting from medication use,” this study only focused on hospitalizations caused by at-home errors.

“We know there are a lot of medication errors that occur both at home and in hospital settings, but we really wanted to focus on those out-of-hospital medication errors that had the most serious outcomes,” Ms. Hodges said.

Of the results, Ms. Hodges said she was most surprised to find that a high number of errors were associated with the drug acetaminophen, a pain reliever found in Tylenol.

“Acetaminophen is commonly used: It’s an over-the-counter medication, it’s used by both children and adults, and so to find so many of the errors associated with that medication was really interesting,” she said.

Among the criteria for errors were people either administering incorrect medication dosages, taking — or giving — the wrong medication or mistakenly taking a medication twice.

Researchers considered only serious medical outcomes in their data, categorizing adverse effects as “moderate effect,” “major effect,” “death” or “death, indirect report.”

Instances were cataloged in the National Poison Database System and based on reports to Poison Control Centers (PCC) across the country.

There were 414 deaths associated with at-home medication errors over the 13-year period, with two-thirds of those deaths involving the misuse of cardiovascular and analgesic medications. Overall, there was a 100 percent increase in serious medical outcomes.

In 2012, 2.28 per 100,000 people contacted a PCC as a result of a serious medication error, compared to 1.09 in 2000. Medication error and frequency increased for all age groups above 6 years old, the researchers wrote.

“Moderate effect” — non-life-threatening and not resulting in disability or disfigurement — was most commonly reported at 93.5 percent, followed by major effect (5.8 percent) and then death (0.6 percent).

The most commonly reported errors are preventable, the authors wrote, and said pharmaceutical companies and regulating bodies can do more to make clear medication instructions.

One of the categories most associated with errors was liquid medications, Ms. Hodges pointed out, which are typically given to young children.

“We know based on prior findings that some of the measurement devices that come with those medications can be difficult to use, difficult to read, difficult to figure out,” she said. “So improving those devices is a recommendation that has been made by the FDA that would support its making those devices easier to use.

“Especially if it’s someone who has limited literacy or limited math skills, trying to figure out dosing instructions can be challenging,” she said.

The researchers make a number of recommendations on how to limit medication errors, including improvements in packaging, labeling and dosing instructions, prescription drug monitoring and better educational tools for physicians when talking to patients.

At home, caregivers should use child-resistant weekly pill organizers and keep a written record of when medications are given.

Additionally, as it’s expected that the use of the most error-prone medications will increase, surveillance bodies must increase safety monitoring.

“The rate of non-health care facility medication errors resulting in serious medical outcomes is increasing, and additional efforts are needed to prevent these errors,” the researchers concluded.


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