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July 2020

Medication errors cause 1,700 avoidable deaths

An estimated 237 million medication errors are made every year in England, costing the NHS upwards of £98 million and more than 1,700 lives every year, according to an online report from the journal BMJ Quality & Safety.

To obtain up to date estimates of the number of medication errors, and their potential financial and human impact on the NHS in England, the researchers pooled prevalence estimates from the available evidence and studies measuring the harms caused, up to October 2018.

And they calculated the number of opportunities for medication error by stage and setting – primary care, care homes, hospitals and at the point of discharge – using published statistics on the annual number of medicines dispensed and used, bed occupancy data, and numbers of care home residents, for the whole of England for one calendar year.

Based on all this information, they estimated that more than 237 million medication errors are made every year in England.

Errors are made at every stage of the process, with over half (54%) made at the point of administration and around 1 in 5 made during prescribing (21%). Dispensing accounts for 16% of the total.

Error rates are lowest in primary care, but because of the sector’s size, these account for nearly 4 out of every 10 (38%). Error rates are highest in care homes (42%), despite covering fewer patients than the other sectors. Around 1 in 5 medication errors are made in hospitals.

The researchers estimated that nearly 3 out of 4 medication errors (72%) are minor, while just under 26% have the potential to cause moderate harm; 2% could potentially result in serious harm.

Around a third (34%) of potentially harmful medication errors are made during prescribing in primary care.

The available evidence shows that the medicines most often implicated in hospital admissions attributable to medication errors are non-steroidal anti-inflammatories (NSAIDs); anti-platelet drugs; drugs to treat epilepsy and low blood glucose; diuretics; inhaled corticosteroids; and certain types of heart drugs (cardiac glycosides and beta blockers), say the researchers.

Most (80%) of the resulting deaths are caused by gastrointestinal bleeds from NSAIDs, aspirin, or warfarin.

The findings have prompted the Department of Health and Social Care to commission a new system to monitor and prevent medication errors.

Elliott RA, et al. BMJ Qual Saf 2020; ePub June 2020.