The Leading Peer-Reviewed Journal for the Primary Care Nursing Team
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March 2018

Medication errors most common in primary care prescribing

A detailed review has found that more than 2.3 million medication errors occur every year in England alone, across every stage of medication use from prescribing to monitoring, and in every health setting.

Of these, 66 million are potentially clinically significant, with the majority occurring in primary care where the most NHS medicines are prescribed and dispensed.

More than 38% of the errors identified were in primary care, lower than the proportion of errors in care homes, but almost double the percentage in secondary care (20%).

However, the rate of errors per patient was lowest in primary care, even though it was second highest in absolute terms because of the size of the sector.

Almost half (48%) of the primary care medication errors related to prescribing. Dispensing errors accounted for 36% of errors, and 16% were attributed to monitoring.

Of the 237 million medication errors identified overall, 72% were classed as minor, with little or no potential for clinical harm, while 2% had the potential to cause severe harm. Medication errors were most likely in older people, or in the presence of co-morbidity and polypharmacy.

The report estimates that medication errors cost the NHS £1.6bn a year and contribute to more than 22,300 deaths. However, the authors say that there is some uncertainty about the extent of the burden because of the difficulty in determining the relationship between errors and risk of harm, and the lack of data for long-term health and cost implications.

The authors make two key recommendations – first, to improve routine collection of information about errors and patient harm, and make routine data collection about clinically important errors easier, and secondly, to implement evidence-based interventions that work ‘in the real world’, particularly in primary care prescribing.

Elliott RA et al. The burden of medication errors in the NHS in England, 2018.

March 2018