Therapeutic Error Calls Among Older Adults Reported to a Regional Poison Control Center in Alabama

Abstract

Therapeutic error calls represent a significant and increasing proportion of calls made by older adults to the RPCC. The frequent interactions between healthcare providers and patients create opportunities to prospectively prevent medication problems in older adult patients. Healthcare providers, specifically pharmacists, should encourage clients to always read the label on medications and should counsel patients carefully when dispensing a product that is not an oral preparation. In addition, although national drug take-back days are conducted biennially, patients should be encouraged to dispose of old medications and expired over-the-counter medications. The RPCC toll-free telephone number (800-222-1222) may be displayed to educate patients on its 24-hour/day availability. Current data will be used to implement programs for pharmacist interventions and to create appropriate educational material.

A poison information centre can provide important assessment and guidance regarding medication errors in nursing homes: A prospective cohort study

“…Thus, most medication errors seem to have either no or minimal serious consequences. In the just‐mentioned studies, the proportion of cases resulting in “major” harm or death ranged from 0% to 2% 13‐15 . Similar findings were done in studies based on incident reports 2,17 .…”

“…For the studies based on poison centre data, hospitalization was advised in 17%‐32% of cases 13‐15 . The proportion found in the present study was 21%.…”

“…As regards error types, Willis et al, who used regional poison centre data from Alabama, USA, to retrospectively analyse 1699 calls regarding medication errors involving adults over the age of 65, found that the types of errors mainly concerned taking/receiving the same medication twice (37%), taking/receiving the wrong medication (15%), using an incorrect dosing route (13%) or taking/receiving doses too closely together (8%) 15 . Hayes et al, who focused on a similar population and retrospectively analysed 49,320 calls registered in the American Association of Poison Control Centre's National Poison Data System (NPDS), found similar results 14 .…”

“…The above‐referenced study by Willis et al is the only one in which tiotropium inhalation capsules were found to be the primary individual substance involved in medication errors (11%). Per pharmacological category, cardiovascular medicines were involved in more than one‐third (36%) of errors 15 …”

“…Flowchart illustrating the number of inquiries coming from nursing homes and a (pre-) hospital setting, respectively, as well as provided recommendations according to risk assessment necessarily nursing home) setting involving older individuals over 60-65 years of age which have led to consultation with a poison information centre [12][13][14][15] Other studies with a different approach have examined medication errors happening in nursing homes based primarily on medication incident reporting systems (including the Medication Error Quality Initiative (MEQI), a mandatory self-reporting system of medication incidents in North Carolina, USA). 2,[16][17][18] Settings and study design, including size and characteristics of included populations as well as defined outcomes, differ between studies; this should be kept in mind when comparing and extrapolating findings from these studies.…”