Medication errors: definitions and classification

Authors


Dr Jeffrey K. Aronson, MA, DPhil, MBChB, FRCP, FBPharmacolS, FFPM (Hon), Department of Primary Health Care, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK.
Tel: +44 (0) 1865 289288
Fax: +44 (0) 1865 289287
E-mail: jeffrey.aronson@clinpharm.ox.ac.uk

Abstract

1. To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them.

2. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey–Lewis method (based on an understanding of theory and practice).

3. A medication error is ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’.

4. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is ‘a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient’. The converse of this, ‘balanced prescribing’ is ‘the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm’. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing.

5. A prescription error is ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration.

6. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies.

Ancillary