Look-Alike Medications: A Formula for Possible Morbidity and Mortality in the Long-Term Care Facility

The impact of community-pharmacist-led medication reconciliation process: Pharmacist-patient-centered medication reconciliation

Background and Purpose:

Patients and their healthcare providers’ are in need to access a correct and complete list of all patients’ active bills for safe and effective clinical care. Currently, Healthcare Information Systems are not providing a proper access to the patients’ medications lists. Thus, this study aimed to evaluate the impact of community pharmacist-led medication reconciliation process in community pharmacies in the UAE through applying a pharmacist–patient-centered medication reconciliation (PPCMR).

Materials and Methods:

This was an interventional study of medication reconciliation process in 25 pharmacies in the UAE during July 1, 2019 till September 1, 2019. The participant pharmacists were surveyed and interviewed to gather more information about the barriers and enablers of the process before and after the implementation of PPCMR.

Results:

After the implementation of PPCMR, medication reconciliation service was available in 84% of the pharmacies compared to 40% before the PPCMR (Z = –2.84, P = 0.005). The main workforce barriers to implement this service were reduced to 27% compared to 47% before the PPCMR. The operational barriers for the service were decreased from 56% to 28%. The facilitators in delivering the service in community pharmacies were improved from 29% to 63%. The active collaboration between the pharmacists and physicians was enhanced from 28% to 72% (Z = –3.2, P = 0.001) in the participated pharmacies. There is a statistically significant difference toward the impact of the PPCMR on the whole medication reconciliation service χ²(df = 3) = 200, P < 0.001.

Conclusion:

Community pharmacists are not always accessible or well placed to provide a medication reconciliation service. The implementation of PPCMR in each community pharmacy will raise the expectations regarding the appropriateness of medication management and use.

Drug identification by the patient: Perception of patients, physicians and pharmacists

INTRODUCTION

Faced with the increasing number of pharmaceutical products on the market, several pharmacovigilance notifications regarding confusion between look-alike and sound-alike drugs have been reported. This study of perception among patients, family physicians and pharmacists aims to evaluate drug identification factors and the risk of errors of confusion for patients.

MATERIAL AND METHODS

Patients were systematically approached in randomly selected pharmacies within the Midi-Pyrénées region in France and invited to complete a questionnaire. Two other questionnaires were respectively sent to family physicians and pharmacists in the same region asking for their opinion on patients' perception of the identification of prescribed medicines.

RESULTS

Of the 768 patients interviewed, most report identifying their medications by name (brand name: 50%; generic: 21%), while a smaller number cite physical appearance (box: 16%, tablet: 7% and blister packaging: 3%). In practice the factors considered most likely to cause confusion by patients relate to drug appearance (look-alike tablets: 28%, look-alike boxes: 20% and look-alike blister packaging: 13%). In contrast, look-alike and sound-alike names (generic and brand names combined) were cited in 31% of cases. Physicians (n=345) and pharmacists (n=198) understimate that patients identify their treatment by name (physicians: 46%; pharmacists: 26% vs. patients: 71%), reporting instead that problems arise mainly from the appearance of medicines (physicians: identification: 52% and risk factors for confusion: 74%; pharmacists: identification: 74% and risk factors for confusion: 83%; versus patients: identification: 26%; risk factors for confusion: 61%).

DISCUSSION

Our study highlights the critical role of medication name in identifying drugs among patients. However, confusion of look-alike tablets or pills figures prominently among fears surrounding medication errors. Despite several notifications of pharmacovigilance, this issue appears to be underestimated within the body of medical literature. Proper identification of medicines by patients is essential to improving medication safety and therapeutic compliance. Concrete measures can be undertaken to reach this goal.

Medication errors in anaesthetic practice: a report of two cases and review of the literature

BACKGROUND

Mistakes in the identification and administration of drugs may be fatal. This is especially so in the practice of anaesthesia. This is a report of 2 cases of near fatality due to mistakes in drug administration from look-alike medications.

OBJECTIVE

To highlight the significance of medication errors in our practice and to discuss the best methods of prevention.

METHOD

A report of two cases of errors in the administration of drugs during the conduct of anaesthesia. The subsequent management of the cases is presented, and the findings from the literature are discussed.

RESULT

In case 1, an adult male presented for herniorrhaphy and after induction with propofol 1mg/kg intravenously, Pancuronium bromide injection 4 mg was administered intravenously, in the place of suxamethonium chloride injection. In case 2, For induction of anaesthesia, 100mg of thiopentone sodium was administered in place of 25mg of the same drug because Thiopentone 1 gm vial was mistaken for Thiopentone 500 mg vial in a 2 year old girl. In both cases, the errors were detected early and there were no adverse sequelae.

CONCLUSION

Medication errors are a potential source of iatrogenic harm to patients undergoing anaesthesia. Strict adherence to principles as well as constant vigilance would minimize this problem.

Environmental issues related to medication errors in long-term care: lessons from the literature

OBJECTIVE

Medication errors contribute significantly to patient morbidity and mortality and are associated with a considerable cost to the healthcare system. The purpose of this study was to conduct a review and synthesis of the literature on the effect of physical and organizational aspects of the environment on medication and nursing errors in long-term care environments.

METHODS

Extensive database searches were conducted for relevant publications. In total, 46 empirical and 19 nonempirical (descriptive and conceptual) journal articles, books, book chapters, and reports were analyzed.

RESULTS

Environmental variables related to medication and nursing errors are: lighting/illumination, noise, inefficient layout or use of space, disorganized medication storage or administration areas, look-alike or sound-alike drugs, and equipment.

CONCLUSIONS

A supportive physical environment is important to reduce factors that may directly or indirectly contribute to errors. Both physical and organizational environments need to be addressed for an effective intervention to reduce medication and nursing errors.

Carbidopa/levodopa pharmacy errors in Parkinson's disease

Outpatient pharmacy errors are common, but little is known about their occurrence in Parkinson's disease (PD). We prospectively studied carbidopa/levodopa pharmacy errors in a cohort of PD outpatients. Over 1 year, pharmacy errors occurred in 8/73 (11%) subjects treated with this medication, producing adverse drug events (ADEs) in 7/8 (87.5%) and increased healthcare utilization in 6/8 (75%) cases. The most common errors were substitution of controlled-release for immediate-release carbidopa/levodopa 25/100 mg (5/8; 62.5%) or dispensation of the wrong carbidopa/levodopa dosage (2/8; 25%). All errors involved ongoing prescriptions, including three interpharmacy transfers. Three subjects (37.5%) questioned pharmacy staff about the change in appearance of the tablets, but the error was corrected in only 1/3 of these cases. Carbidopa/levodopa outpatient pharmacy errors are a common, preventable cause of morbidity and excessive healthcare utilization in PD. Education of healthcare providers, patients, and pharmacy staff is warranted to reduce these errors and associated ADEs.