Medication error: An unfortunate reality

Abstract

Although a substantial body of literature exists describing medication errors and preventable adverse drug events, medication safety has not been a topic that has generated much attention. The release of Institute of medicine (IOM) report “To Err is Human” brought the scope of medical errors and patient safety in front of the world.1 With estimates of 44,000 to 98,000 deaths annually due to medical errors, out of which 7000 deaths per year can be traced to medication errors have generated substantial interest and debate on the subject in recent years. The first IOM report defined an error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Medication errors by nature are largely preventable, do not always cause harm and can be caused by errors in planning (prescribing) and execution (dispensing and administering medications). We report a case of medication error reported in a service hospital, with a series of errors precipitating an adverse event requiring hospitalization and in – patient management.