Chapter 62
Medication Errors
To Err Is Human
The Medication Error Problem
The 2000 Institute of Medicine (IOM) report To Err Is Human brought errors in medicine to national attention, estimating 44,000-98,000 deaths per year from medical errors, of which about 7,000 result from medication errors. The report issued a call to action to improve patient safety. Tragic cases -- chemotherapy overdoses, wrong-route penicillin, compounding errors, and heparin vial mix-ups -- have focused attention on patient safety.
The NCCMERP defines a medication error as any PREVENTABLE event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of a health care professional, patient, or consumer.
The Key Word Is Preventable
The defining feature of a medication error is that it is PREVENTABLE. Errors span the entire medication-use process: prescribing, order communication, labeling and packaging, compounding, dispensing, distribution, administration, education, monitoring, and use. The 2000 IOM report shifted the emphasis toward error prevention and system improvement.
📖 “2000 IOM report To Err Is Human: 44,000-98,000 deaths/year from medical errors, ~7,000 from medication errors; call to action for patient safety. Tragic cases: chemo overdose, wrong-route penicillin, compounding error, heparin vial mix-ups. NCCMERP: medication error = preventable event causing inappropriate use/harm while med in control of professional/patient/consumer; spans prescribing to use.”