Medication Errors Identification: A Major Source of Evaluating Prescribing Errors in Liver Disease Patients

Aim: The aim of this study was to retrospectively review the patient profiles with liver diseases in
order to determine the frequency of medication errors among patients with liver diseases.
Study Designed: Retrospective study was performed.
Place and Duration of Study: Abbasi Shaheed Hospital (ASH), Civil Hospital (CIVIL) and Dow
University Hospital (DUH) Karachi Pakistan, conducted from April 2014 to June 2014.
Methodology: The retrospective study was conducted by evaluating 61 patient profiles. These
patients were admitted in three different hospitals of Karachi city mentioned above. Toxic hepatitis or
drug-induced liver injury comprises a spectrum of clinical diseases that initiates with mild biochemical
abnormalities and extends to acute liver failure. In this study 61patient’s profiles were collected and
evaluated. The patients were aged 25 years and above. A quantitative analysis and investigation of
clinically significant drug-drug interactions, drug-disease interactions, inappropriate medication, over
dose and sub therapeutic dose has been studied. Moreover these patients were suffering from either
hepatitis B, hepatitis C, hepatitis E, ascites, jaundice, liver abscess, hepatoma, chronic liver disease
(CLD), cirrhosis, hepatic encephalopathy or acute hepatitis.
Results: A total 257 medication errors were observed, out of which 40% (n=102) were drug-drug
interactions, 14.5% (n=37) were drug-disease interactions, 37.7% (n=97) were inappropriate
medications, 7.05% (n=18) were related to over-dose and 1.17% (n=3) were identified as subtherapeutic
dose errors. The occurrence of different types of medication errors was significantly
different among the named hospitals.
Conclusion: It can be concluded that a large number of medication errors in a minimal patient’s
profiles were observed. This shows a high percentage of irrational prescribing practice among liver
disease patients. Furthermore, there is a need to revise the proper structure of hospital and clinical
pharmacies. Additionally, the proper prescribing patterns should be followed via employing
computerized physician order entry system (CPOE). The result of our study shows high number of
medication errors. The rate of medication errors can be minimized by inclusion of clinical pharmacists
in hospitals because pharmacist can play a vital role in the identification and prevention of medication
errors and can educate all health care professionals with up-to-date information related to drugs.
Implementation of electronic based system like COPE system can be beneficial to minimize the
chances of errors and it is also essential to educate the patients about their medications along with
Staff orientation/development in order to reduce the possibility of these errors.