Observational Analysis of Medication Related Errors by Clinical Pharmacists in a South Indian Hospital

Present work was done to evaluate the occurrence of medication errors in general ward of Maharaja institute of medical sciences to assess the role of clinical pharmacist in error management. The study was conducted for 9 months and Data was acquired from inpatients of general medicine dept by using standard case report form through direct patient interview. The collected data was analysed to identify medication errors by using drug informa-tion tools such as Micromedex, drug interaction checker and reputed journals and statistical interpretations were done. 400 prescriptions were analyzed and in that 300 prescriptions were presented with medication errors. 202 were found to be Prescribing errors, 111 Administration errors,45 were dispensing errors, Monitoring errors were 123. Interaction errors (81.18%), prescription in small letters (34.65%), wrong frequency of administration error (32.43%) and wrong time administration of medicine (85.58%), Dispensing wrong quantity of drug (95.5%) were the major medication errors that were observed. Medication errors have been occurring frequently in the general medicine department out of which prescribing errors were more common. Clinical Pharmacist could act as an affective medical staff by performing con-sciousness and teaching programmes to medical


INTRODUCTION
The goal of drug therapy is the gaining of de ined therapeutic outcomes that improve a patient's quality of life. The consequences that result from such risks are de ined as adverse drug events, and it includes adverse drug reaction and medication errors (Basarkar, 2015).
Medication error is de ined as any preventable event that inappropriate may cause or lead to medication use or patient harm while the medication is in the control of a health care professional, patient (Aronson, 2009).
Pharmaceutical care is the best option for getting positive outcomes which ultimately increases the quality of life of patients.. Medication errors are a well-known problem in hospitals (Shah and Solanki, 2013). The important problem in hospitals are medication errors (Tank et al., 2016;Velo and Minuz, 2009).

Types of Medication Errors
The Medication procedure includes ive steps, which provides for prescribing, transcription, veri ication, dispensing, administering, monitoring, reporting (American Society of Hospital Pharmacist, 1993). Administration errors contain dose deletion, inexact administration, wrong time, compliance error. Dispensing errors are incorrect drug, improper strength and Incorrect formulation (Fitzgerald, 2009). The problem of Medication Errors is interdisciplinary, and Medication Errors may happen due to nil understanding, inferior presentation and faults in the process (Zellmer, 1990).

Role of Clinical Pharmacist in Prevention of Medication Error
The pharmacist is an expert who knows to provide counselling to patients with mild diseases and for chronic illness patients on accepted preservation treatment options (Strand et al., 1990). A trained Pharmacist can do Drug Utilization Evaluation to prevent medication-related problems. Proper teamwork from all medical staff can cease the prevalence of Medication errors. (Parthasarathi et al., 2004).

1.
To identify all types of medication errors which may damage a patient's health.
2. To ind the rate and types of medication errors.
3. To assess the role of clinical pharmacist in minimising the laws in prescriptions.

Study site
Maharaja Institute of Medical Sciences, Vizianagaram, Andhra Pradesh. This study was done for nine months in a 700 bedded hospital. In-patients of the general ward were taken. Conceived and breastfeeding females and kids are excluded.

Data assemblage
Data were collected from the patients through a structured case report form which contains all the necessary data for interpretation.

Ethics approval
Ethical approval was acquired from Institutional Ethical Review Board of Hospital before commencement of work. Informed consent was taken from participants.

Statistical investigations
Statistical investigations were done by descriptive statistics. Student's t test -two tailed was used to analyse the level of signi icance in assessing the prescription errors.    Error death 0 0    A total of 300 prescriptions having medication errors in that infectious diseases were highly prevalent, and dermal disorders were least prevalent [Figure 3] Number of prescriptions which contained 6-10 drugs per prescription were high in number [Figure 4], This is in support of research done by Narneakhil et al., who concluded that 6-10drugs per prescription were high 54(55.7%).
The medication errors in our study were mostly seen in the age group of 40-60 years (39.3%) [ Table 1] and [ Figure 1]. This is in opposing of research by Dabaghzadeshg et al., who stated that errors were more commonly seen in the age group of 50-70(36.7%). While considering an average number of drugs prescribed per prescription, 189 prescriptions were prescribed with an average of 6 to 10 drugs. [ Figure 4] and 46 prescriptions were prescribed with an average of < 5 drugs and [ Figure 5].
In our study among 202 prescribing errors, interaction error 164(81.18%) is the most leading error which is in contrary with research done by Nikitha et al., who stated that duplication error was the most leading error in their study. Prescribing errors appeared in the highest number [ Figure 10], which is opposing the work of Patel et al. Who stated that administration errors are higher than others. Not giving importance to the medication chart after drug administration at peak hour may be the reason for documentation. Nursing staff are to be appropriately educated to control administration errors.
We have also considered the extent of severity of medication errors. 51% of errors were found to be errors which might not cause any harm followed by 31% of cases with no mistake and 14.3% of cases with error and causing harm. [  Figure 16]; which is in contrast with the study carried out by Armin Eisa -Zaei et al., where category-B errors were more identi ied. In our study probability of level of severity is 0.043, (P VALUE) which is signi icant.
1. The present study was done in a single hospital, and more number of hospitals are to be included for accuracy 2. Several prescriptions were con irmed to 300 due to time-related factors, patient-related factors.
3. The study was con ined to only the general medicine department.

CONCLUSION
Medication errors cause signi icant damage to patients safety. They create lengthy stay in the hospital, burdensome treatment; disability also increases the mortality, morbidity rates. In this study, after thorough data interpretations, we found that Medication errors have frequently been occurring in the general medicine department, out of which prescribing errors were more. The high prevalence of prescribing errors might be due to high in low of patients to the hospitals, which eventually increasing burden on physicians and also due to improper knowledge of physicians. The present study also shows the occurrence of medication errors at each stage of medication use, along with the severity assessment of medication errors. Clinical pharmacist as an essential member of health care system could play a signi icant role in identifying, rectifying and modifying the medication errors which are necessary for emerging pharmacy practice education in India and thus assure the patient safety by rendering his services like directing consciousness and training sessions to nursing staff and by maintaining positive collaboration with health care providers in identifying medication errors.