Medication Errors in Dentistry

Bhavika Satish Vidhwani^*, Kumar Gaurav Chhabra, Amit Reche and Priyanka Paul

^*Correspondence: Dr. Bhavika Satish Vidhwani, Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe) Wardha, Maharashtra, India, Email:

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Introduction

Pharmaceutical errors can occur anytime in the medication administration. As practically everyone today takes medication at some point, the risk of adverse drug effects and medication errors has elevated. The distinct aspects of dental work, on the other hand, pharmacotherapy reduces the risk of harmful medication reactions. Medication errors are unintended mistakes made while a healthcare practitioner, patient, or consumer is in charge of prescribing, distributing, or administering a medicine. As part of dental care, dentists are responsible for prescribing medicines to the patients. There are just a few medicines that are commonly utilized in dental treatments. The contraindications and side effects of the drugs that make up their own complications are all wellknown to most dentists. As a result, practicing dentists face a continuing difficulty in understanding drug errors and obtaining credible new information in this area. This article highlights the common medication errors that occur during the practice and their prevention measures (Table 1) [1].

Table 1: Types of errors are shown below.

Literature Review

Prescription error: Prescription errors are frequently the consequence of slips, lapses, or blunders, such as prescribing a dose that is of magnitude more or less than the correct one due to erroneous arithmetic, or erroneous prescription due to identical drug brand names or pharmaceutical names. One of the most important aspects of the treatment process is prescribing. A prescription can be used to assess the level of medical education, as well as the medical community's laws and regulations, socio cultural views, and medical status. Irrational prescription can be caused by mistakes such as prescribing the incorrect amount of drug, faults in writing, problems in pharmaceutical form, drug dosage, administration route, and treatment length. These mistakes might result in inadequate therapy, a protracted sickness, or worse, injury to the patient. The error will have adverse effects, to prevent that following measures can be taken:

• Automation of the prescribing process, resulting in a reduction of complexity in the act of prescribing.

• Educated prescribers and the use of online tools improved prescriber knowledge.

• Monitoring of intervention effects and feedback control systems.

Omission error: A drug omission occurs when a patient does not receive the required prescription, either because the medication was not prescribed or because it was not administered. When the patient fails to administer the drug as prescribed or the assistant fails to administer drug as per the prescription. It can be prevented by:

• Make lists: Make a list of all the critical duties that each of your reports is responsible for each week, month, and year. They should be updated on a regular basis.

• It's the equivalent of inquiring about a peer's most recent inspection or audit. Learning how others were evaluated may motivate you to ensure that you are not cited for a similar omission.

Incorrect time error: Administration errors that occur at the wrong moment are the most common. While many wrong time errors are not harmful, some drugs must be administered within a very limited time in order to achieve the desired response and to avoid adverse effects. Medications that must be administered separately from other medications, as well as specific premedication, are examples. The permissible administration window for a medicine dosed twice daily that is not time critical is one hour before or after the planned time for non-time critical scheduled medications. Nursing orientation and education must have the hospital's policy on drug administration scheduling. Further, as for time critical scheduled appointments, important information should be available at the point of service. Prevention measures to avoid wrong time errors:

• High alert drugs, which have a higher potential of causing serious harm if misused mistakenly, require extra caution at every stage of the medication use process.

• Patients, prescribers, pharmacists, and nurses should be aware of the medication's hazards and the measures in place to mitigate them.

Unauthorised drug error: Administration of medication administrating medication to a patient without corrects authorization by the prescriber also if administration is out of the guidelines. Medication of one patient given to another or if nurse gives medication without practitioner order leads to error. Refilling prescriptions that have no space left can create confusion and ultimately an error. A patient sharing the prescription is also a favourable condition for error. To prevent the error:

• Follow correct medication process.

• Checking the procedure twice or thrice.

• Have the practitioner re-read it.

• Consider a name alert.

• Mention zero before the decimal point to avoid confusion.

• Keep the record of everything.

• Medicines efficacy increases with correct storage.

• Learning about medication administration regulations and guidelines.

• A drug guide should be available every time.

Improper dose error: When a patient is given a dose that is more or less than the given dose improper dose error might occur.

Cause: Delay or absence in documenting a dose. Incorrect amount of an oral liquid is an error. Exclusive from this category are:

• Doses that can’t be measured correctly.

• Not specified like in topical application.

It is critical that pharmacists provide the correct drug at the precise dose. Like looking medicines, difficult to read physician handwriting can all lead to prescription errors. Pharmacists must take precautions while filling each prescription order. These mistakes can also cause complications, either because you take too much or too little of a drug. From prescription to dispensing and consuming the dose should be checked and rechecked. Pharmacist should explain the dose for better understanding; this can help in preventing improper dosage.

Incorrect dose form: Incorrect dose form errors are doses that are provided or dispensed in another form than which is specified by the practitioner. According to the health care facility guidelines, dosage forms can be altered as per the requirement of the patient. Like taking a liquid formulation without the prescription by the practitioner only because of inability to swallow the tablet leads to change in the dose form and ultimately increases the chances of errors. It can be prevented by using the drug in the same form as described by the dentist [2-4].

Incorrect administration technique error

• Failing to activate the drug before placing intravenously to get good mixture.

• Administrating an eye drops in the other eye than the damaged one.

• When intravenous medications are administered very rapidly

• Failure to flush an IV line.

• Mixing a drug with an incompatible solution leads to precipitated forms. Errors occur due to lack of knowledge, deficiency in performance and not binding to the protocols. Training of correct administration method and use of infusion pumps or dispensing devices which would help in reducing the error.

Deteriorated drug error: Medicines that are consumed or administered after their shelf life has ended become less effective and lack potency. Drugs that have been refrigerated and stored at room temperature may degrade and their potency is compromised. As a result, keeping track of product expiration dates and storage is crucial. It can be avoided if you do the following:

• Renewing drugs on a regular basis.

• Checking the medication's expiration date at the time of purchase.

Monitoring error: When patients are not monitored carefully before or after they received a drug, monitoring error occurs. Also, if a pharmacist fails to recheck a patient’s medication history before dispensing a medication resulting in a significant drug-drug interaction leads to emergence of such errors. Situations like:

• Ordering serum drug levels but not checking them.

• Not responding to level outside of the required range.

• No ordering of drug levels when required.

• Giving antihypertensive agents and then not recording the blood pressure. To prevent these errors correct record should be maintained regarding the requirements.

Compliance error: Patient mistake is the most common cause of non-compliance. A medication error happens when a patient's recovery is hampered because the patient took medication wrongly, maybe due to misunderstanding what the doctor and/or pharmacist said. A medication error by a patient could also be the consequence of the patient trying to save money since the prescription drug is not on the insurance plan's formulary and the patient cannot afford it. Instead of requesting an alternative medicine with a reduced copayment, the patient could take one pill every third day rather than daily. To boost the patient compliance:

• Understand each patient's medicine taking behaviours.

• Educate about side effects.

• Maintain the record.

• Include the patients.

• Consideration of the financial burden to the patient.

• Assess health literacy.

• Reduce complexity.

• Follow up with patients.

Discussion

Pharmaceutical errors can occur anytime in the medication administration. As practically everyone today takes medication at some point, the risk of adverse drug effects and medication errors has elevated. The distinct aspects of dental work, on the other hand, Pharmacotherapy reduces the risk of harmful medication reactions. Medication errors are unintended mistakes made while a healthcare practitioner, patient, or consumer is in charge of prescribing, distributing, or administering a medicine. As part of dental care, dentists are responsible for prescribing medicines to the patients. There are just a few medicines that are commonly utilized in dental treatments. The contraindications and side effects of the drugs that make up their own complications are all well-known to most dentists. As a result, practicing dentists face a continuing difficulty in understanding drug errors and obtaining credible new information in this area. This article highlights the common medication errors that occur during the practice and their prevention measures [4-8].

Conclusion

Medication errors in dentistry can occur due to various reasons and it’s the responsibility of the practitioner to be aware about various errors and the ways to prevent it. The prevention of errors saves the patient from adverse effects of the wrong medication. The dentist should always be cautious while prescribing the medications.

References

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