Taking Up the Cause of Health Care Safety

Every person in every part of the world will at some point in time take medicine to prevent or treat an illness. However, medicines sometimes cause serious harm if taken incorrectly or due to an error or communication problem.

Health staff, including physicians and nurses, plus the patients or their family members can make mistakes that result in severe harm, such as ordering, prescribing, preparing, administering or consuming the wrong medication or the wrong dose. However, most medication errors are potentially avoidable.

“Medication errors injure many people in the country each year. Such mistakes place an enormous and unnecessary strain on health budgets,” says Dr. Fatemeh Soleimani, secretary of the National Committee for Medication Prescription and Consumption at the Food and Drug Administration (FDA).

“It is estimated that in every 1,000 handwritten prescriptions written by the  physicians there are at least four errors. However this is just an estimate simply because no thorough and nationwide study has been conducted in this regard,” she noted.

Some of the most common errors in prescriptions include wrong or unnecessary medications, wrong dosage and drug-drug interactions (a change in a drug’s effect on the body when the drug is taken together with a second drug), Soleimani was quoted as saying by Young Journalist Club (YJC).

Medication errors can be caused also by health worker fatigue, overcrowding, staff shortages, poor training and wrong information being given to patients, among other reasons. Any one of these, or a combination thereof, can affect the prescribing, dispensing, consumption, and monitoring of medication, which can result in severe harm, disability and possibly death.

Several small-scale studies have looked into the issue of prescriber errors on prescriptions. In 2015, researchers at Shahid Beheshti University of Medical Sciences (SBUMS) screened 4,157 prescriptions from different health centers in Tehran Province.

They concluded that antibiotics and painkillers were the most overprescribed medicines and the least prescribed were vitamins and mineral supplements (while these are necessary to treat many health conditions). According to the study, at least one-third of antibiotics prescribed by the physicians were unnecessary.

 Illegible Writing

Apart from mistakes made by physicians, high numbers of medication-related mistakes also occur when patients present prescriptions written illegibly to drugstores and get wrong medications, she added.

“Some people understand that they have taken the wrong medicine when they experience severe symptoms after taking them and after showing the medications to their physicians,” she explained.

While the physicians’ illegible writing can result in errors in drug dispensing, ‘electronic prescribing’ can minimize part of such errors.

Since 2015, several e-prescribing pilot plans have been successfully implemented in small cities in the country including Paveh in Kermanshah Province, Saveh in Markazi Province, and Jahrom in Fars Province.

Earlier, head of the FDA Rasoul Dinarvand said the Health Ministry has plans to eliminate handwritten prescriptions by the year 2019.

 “The ministry also will create an organized electronics database of patients’ medical history and prescribed drugs, in the form of an electronic card.”  

A ‘transaction hub’ is the basic component of an e-prescribing system which provides the link between prescriber (physicians) and pharmacies. When the prescriber uploads new prescription information to the patient file, it is sent to the transaction hub which is accessible by pharmacies.

The costs associated with implementing, supporting and maintaining such a system are the major constraints.

 Nursing Shortage and Medical Errors

A study conducted by Tehran University of Medical Sciences (TUMS) in 2013 indicated that in hospitals most medication-related errors occur by nurses and the most prevalent mistakes include administration of wrong medications or wrong medication dosage and Inappropriate speed of administration in IV medications. “In intravenously administered medications errors may have particularly serious consequences,” the research found.

According to World Health Organization (WHO), medication errors can be caused by shortage of medical staff including nurses.

In October 2016 Mohammad Mirza Beigi, deputy director for nursing services at the Health Ministry warned that shortage of nurses in Iran had reached critical levels.

“There is a deficit of 140,000 nurses in hospitals across the country, and the average nurse-patient ratio is 1.5 per 1,000. In order to achieve the minimum standards of nurse-patient ratio, the figure should at least double,” he said.

 Global Effort to Halve Errors

Globally, the cost associated with medication errors has been estimated at $ 42 billion annually or almost 1% of total global health expenditure.

On 29 March WHO launched a global initiative to reduce severe, avoidable medication-associated harms in all countries by 50% over the next five years (2017-22).

The Global Patient Safety Challenge on Medication Safety aims to address the weaknesses in health systems that lead to medication errors and the severe harms they inflict. It lays out ways to improve the way medicines are prescribed, distributed and consumed, www.who.int reports.

The challenge calls on countries to take early priority action to address these key factors: including medicines with a high risk of harm if used improperly; patients who take multiple medications for different diseases and conditions; and patients going through transitions of care, in order to reduce medication errors and harm to patients.