Hayes et al reviewed therapeutic errors in older adults reported in the American Association of Poison Control Center's National Poison Data System. These are potentially high risk situations which should be prevented. The authors are from the University of Maryland.
Patient selection: >= 65 years old
Types of error:
(1) medication given or taken twice (double dosing)
(2) wrong medication given or taken
(3) incorrect dose given or taken (10-fold dosing error, wrong units of measure, other)
(4) doses taken too close together (dosing interval)
(5) someone else's medication given or taken
(6) incorrect administration route
(7) incorrect formulation or concentration given
Major adverse effects were seen with:
(1) drug interaction
(2) health professional or iatrogenic error
(3) same active ingredient in more than one product, or two prescriptions for the same drug
(4) patient confusion or mental incompetence
(5) hazardous medications
Medications and medication classes that were the most hazardous:
(1) analgesics (acetaminophen, oxycodone, hydrocodone, morphine, aspirin)
(2) anticoagulants (heparin, warfarin)
(3) anticonvulsants (phenytoin, carbamazepine)
(4) asthma therapies (aminophylline, theophylline)
(5) psychotherapeutics (atypical antipsychotic, benzodiazepine, lithium)
(6) cardiovascular agents (cardiac glycoside, beta-clocker, calcium channel blocker, lidocaine)
(7) hypoglycemics (insulin, sulfonylurea)
(8) colchicine
Comments:
(1) Polypharmacy and multiple caregivers might increase the opportunities for errors.
(2) The study was based on review of poison control center data. This would skew the data towards toxic effects. Undertreatment can also be a problem.
