Emergency room errors usually include drug mistakes

On television, hospital Emergency Rooms (or Emergency Departments as they are now called) are filled with highly trained and efficient doctors who seem almost always to be able to revive and save patients, whether they arrived after a heart attack or a car accident. Studies at real life ERs tell a different story. Medical errors abound, leading to deaths and injuries.  In fact, the United States Pharmacopeia (USP) national database contains more than 360,000 medication error reports since its inception in 1998.

A recent report by the USP noted that the leading medication errors in emergency departments are:

* Prescribing errors -- when a physician or other authorized provider fails to prescribe the correct medication through verbal or written communication;

* Omission errors -- involving the failure to administer a prescribed medication; and

* Improper dosage errors -- when a patient receives the incorrect dose of a medication.

In 2001 alone, 105,603 errors were documented by Medmarx, the USP’s national database for medication errors. Of the total, 2,063 errors (two percent), occurred in the emergency department of a hospital or health care system. Although the majority of errors were corrected before causing harm to the patient, 147, or 7.6 percent of total errors, resulted in patient injury. Of this number, 123 resulted in temporary harm to the patient and required intervention, 21 required initial or prolonged hospitalization, one may have contributed to or resulted in permanent patient harm, one required intervention to sustain life, and one error resulted in a patient's death.

The Medmarx 2001 data report indicates that health care facilities attribute medication errors to many causes, and often cite distractions (47%), workload increases (24%) and staffing issues (36%) as contributing factors.

Additionally, weight calculations are critical in determining appropriate medication dosages for children. Miscalculations in patient weight conversions from pounds to kilograms, which result in improper dosing errors, were common in pediatric departments. Failure to record drug allergies also was identified as a top pediatric mistake.

In the emergency department, the combination of interruptions and multiple concurrent tasks is prevalent in medication errors. More than 58% of emergency department errors can be attributed to an improper dose, an omission, or a prescribing error (i.e. wrong drug, wrong dose or incorrect directions). Heparin, a blood thinner used to treat and prevent blood clots, received the most reports of improper dosage. Diltiazem (for hypertension and angina) and pediatric diphtheria tetanus toxoid (vaccine for disease prevention) were also frequently cited for improper dosages.

SOURCE: “Leading Medication Errors in Hospital Emergency Departments,” U.S. Pharmacopeia, March 13, 2003.