India, being a highly populated country with very low qualified human resources in healthcare is troubled and plagued with a continuous challenge of medication errors.
Medication errors are primarily divided into
- Administration errors
- Prescription errors
- Dispensing errors
The following fall under Dispensing errors.
- Wrong medicine (may be alternate drugs in case of non- availability of prescribed drug)
- Wrong quantity
- Expired medicines
While the hospital in reference could address the challenge of Administration errors and Prescription errors to a large extent through process re-engineering, the concern of dispensing errors endangering patient safety still persists.
The methodology of tracking the data of dispensing errors being – Voluntary reporting by nurses/doctors; leaves a lot to be addressed because the patients once after leaving the hospital and pharmacy post consultation, do not usually come back to the prescribing doctor / nurse owing to lack of awareness. As the patients are free to choose the doctor in Indian healthcare scenario, they typically tend to approach another doctor for improving their possible deteriorated condition owing to wrong medication (they might not be aware of the possible cause in many cases).
Indian healthcare where EMR utilization is not significant, and the data of the patient not captured, stored and shared between healthcare providers in addition to the lack of awareness in the patient makes it nearly impossible for the healthcare provider to understand and address the complications arising out of possible dispensing errors, more in Out Patient scenario.
To minimize medication dispensing errors, the following efforts have been put
- Look alike and sound alike drugs are stored separately
- High risk medicines stored separately
- All loose medications are stored in pouches with name, strength and expiry
- Double check before Dispensing medications.
Another major hurdle noticed is that in India where the patients are free to choose their pharmacy, there is higher probability of such dispensing errors (as such efforts to minimizing dispensing errors may not be implemented in the pharmacy not related to the hospital).
To understand the utilization of hospital associated pharmacy, a study was conducted (sample size of 873 prescriptions) and the results were as below ( image attached)
Certain measures were taken to encourage the patients purchase prescription from the hospital associated pharmacy. Despite the above efforts, the dispensing errors continued risking patient safety and it had been agreed that use of HIS is the only solution. When this is discussed with the doctors, there is a clear resistance owing to the reasons cited (a few)
- Use of EMR (keying into the computer) would intervene with the physician – patient eye contact as physicians are not effectively trained in using computers, resulting in a dissatisfied patient.
- Employing physician assistants for the job would increase the burden of healthcare costs.
- Physician burn out with EMR in a country where patient load is quite high.
- There is no mechanism to ensure that the patient purchases prescription in the hospital associated pharmacy despite using the current EMR.
Owing to the above scenario, the hospital is seeking solutions to increase patient safety minimizing Out patient medication dispensing errors.