Medication errors account for 78 per cent of serious medical errors in intensive care, but strategies such as keeping medication lists up to date can help, doctors say.

In research detailed in Monday's online issue of the Canadian Medical Association Journal, Dr. Tom Stelfox of the University of Calgary and his colleagues reviewed strategies to prevent medication errors.

In can take up to 100 steps to administer one dose of a single medication to a critically ill patient in the intensive care unit, they noted.

The review suggested that effective strategies for reducing errors include:

• Eliminating extended work schedules for physicians.
• Computerizing orders and intravenous devices.
• Having pharmacists participate in the ICU.
• Reconciling medications after admission and discharge from the ICU.
• Maintaining detailed, up-to-date medication lists.

Research published in the U.S. on Monday came to many of the same conclusions.

Writing in the Archives of Internal Medicine, U.S. researchers estimated medication errors affect at least 1.5 million people every year and cost the health-care system in the U.S. between $77 billion and $177 billion US annually.

In one study, Dr. Jeffrey Schnipper of Brigham and Women's Hospital and Harvard Medical School in Boston used a computer system to keep track of the medications patients were taking when admitted and discharged.

The researchers also had different people take medical histories, such as doctors and nurses, who also tracked medications.

Communication cuts errors

Among 162 people who had their information entered into the computer, there were 1.05 medication errors per patient compared with 1.44 errors among patients receiving usual care — a 28 per cent reduction in error, the researchers said.

The errors had the potential to cause serious harm in 43 cases in the computerized group compared to 55 in the control group.

Schnipper's team concluded the changes were successful because they encouraged interdisciplinary communication and checks.

A second study led by Michael Murray, chair of the department of pharmaceutical policy and evaluative sciences at the University of North Carolina at Chapel Hill, looked at how medication errors were reduced when pharmacists, doctors and 800 outpatients with high blood pressure communicated.

The patients not only received instructions on how to use the drugs, but their pharmacists also spent more of their time monitoring the drugs and communicating with doctors.

Compared to the control group, the group with the extra measures taken by their pharmacist had a 34 per cent lower risk of any event, including a 35 per cent lower risk of adverse drug events and a 37 per cent lower risk of medication errors.

There were a total of 210 adverse drug events or medical errors.

Common errors that occurred in 68 people were:

• Receiving a prescription for a drug that should be avoided in elderly patients.
• Yeast infections resulting from antibiotic pills.
• Inadequate monitoring after prescription.
• Prescribing multiple drugs containing acetaminophen.

The Joint Commission on Accreditation of Healthcare Organizations has said that reconciling medications — identifying the most accurate list of medications a patient is taking and using it regardless of where the patient is in the health-care system — is a priority.