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Physician / Prescriber Error

Medication errors can be broadly classified as prescribing, dispensing or drug administration errors.

Prescribing errors account for somewhere between 20%-60% of all medication errors. These errors are made prescribers, including doctors, physician’s assistants, or nurse practitioners.

The numerous types of prescribing mistakes include:

• Failure to alter drug therapy in patients with impaired kidney or liver function. This mistake leads to an excessive dose of the prescribed drug.
• Failure to notice a patient’s history of allergy to the prescribed drug class or missing critical information about a patient’s known drug allergies.
Use of the wrong drug name (e.g., sound-alike or look-alike drug names), wrong dosage form (e.g., intramuscular v. intravenous injection), wrong abbreviation (e.g., “qd” [everyday] instead of “qid” [4 times per day].
Incorrect dosage calculations, including wrongly placed decimal points and wrong rate or frequency of administration.
Failure to prescribe when there is a medical indication or prescribing a drug without an indication (e.g., use of antibiotics to treat a cold).
Incorrect drug selection for a patient.
• Failure to take into account drug-drug or drug-food interactions or duplicative therapies.

Prescribing errors are caused by:

• The doctor’s, physician’s assistant’s, or nurse practitioner’s insufficient knowledge about the medication and its correct use.
• The doctor’s, physician’s assistant’s, or nurse practitioner’s lack of knowledge about the patient (e.g., incomplete medical history).
Miscommunication among doctors, nurses, and pharmacists (e.g., illegible handwriting on written orders/prescriptions, misunderstanding of verbal orders, mistakes using electronic ordering).
• Doctors or other prescribers not following policies and procedures.
• Incorrect record-keeping or charting.

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