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Therapeutic Errors reported to the Victorian Poisons Information Centre—Pilot Study
Author(s) -
Taylor David McD,
Robinson Jeffrey,
MacLeod Dawson,
Braitberg George
Publication year - 2006
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2006.tb00579.x
Subject(s) - medicine , asymptomatic , drug , emergency medicine , surgery , psychiatry
Aim To analyse a sample of therapeutic errors reported to the Victorian Poisons Information Centre. Method A retrospective series of 102 cases of therapeutic error reported in March 2005 were examined. Data were extracted from the Victorian Poisons Information Centre database. Results Of the 102 cases of therapeutic error, females (64%) and adults (72%) predominated. Most errors (91%) occurred in patients' homes. 87 (85%) cases did not require medical attention. In 68 (67%) cases, the subject made the error and in almost all (93%) cases the error involved oral drug administration. Most (84%) subjects were asymptomatic at the time of the call. In total, 125 drugs were taken in error and 11 (11%) subjects made multiple errors. The predominant drug classes were analgesics, anti‐inflammatory drugs, cardiac drugs, antipsychotics and antidepressants. An incorrect dose was taken in 47 (46%) cases and drugs were taken too early in 12 (12%) cases. An incorrect administration route was used in 9 (9%) cases. Incorrect labelling, formulating and packaging accounted for 4 (4%) errors. Conclusion Although most errors reported during the study were unlikely to cause harm, a large prospective study is indicated to clarify error patterns and inform prevention strategies.