At-Home Medication Errors Are on the Rise: Why?

Why are people having trouble with medication at home?

A  new study published in the journal Clinical Toxicology takes on this question. The study, conducted by researchers from Nationwide Children’s Hospital in Ohio, concludes that medication errors in non-health care facilities is on the rise. The team analyzed data from 2000-2012 and identified a 100 percent increase in the rate of medication errors. So, what exactly is going on?

First, there are some data anomalies to account for. The majority of medication errors studied were related to cardiovascular drugs, painkillers, and hormone/hormone antagonists (such as insulin). This is consistent with the rising prevalence of conditions that require such medications. Heart failure, for example, now affects almost a million more people than it did almost a decade ago.

Because these diseases are increasing within the population, this may account for why the numbers of medication errors in non-health care facilities are on the rise. However, this explanation doesn’t provide a clear answer as to why these errors are occurring.

The FDA, in its continued monitoring of medication errors, has outlined some common causes of medication errors that might explain the study’s findings. They include:

  • Ambiguous product names and directions
  • Insufficient dosing procedures or techniques
  • Patient limitations including stress levels, knowledge, physical capabilities, etc.

FDA’s analysis seems to suggest that, when it comes to medication adherence, human factors influence whether the drug is used correctly or not.

Use Environments and User Capabilities

One of the biggest influences on how patients use a drug is the use environment. A concept in human factors engineering, the use environment encompasses many factors that involve where and when the device or drug is being used. Whether the setting is a hospital, clinic, nursing facility, or the patient’s home, it has an effect on use. Time of day is also a factor; a nurse’s energy level might be affected by whether it is night or day outside, potentially affecting their ability to administer medication.

Cleanliness and organization of the household impacts how medicines are kept and administered. A patient’s home is less antiseptic than a clinical setting. Multiple medications kept together can get mixed up depending on variations in the environment, potentially resulting in improper administration. Even changes in lighting have the potential to affect the user’s ability to take their medicine correctly. Many of these factors are constant in a clinical setting, which reduces the chances for error. Understanding the variability of the home environment is the first step to correcting potential use errors.

The other major factor in medication errors at home is the capabilities of is the person administering the drug. While a clinical setting, such as a nursing facility, has knowledgeable professionals managing doses, they don’t go home with the patient. Some patients will elect (or be prescribed) at-home nursing treatment, but many will have to manage their medications on their own.

This is immediately a challenge: depending on the patient’s condition, their faculties could be compromised. This poses real risk to the self-administration of medication: if the user’s capabilities are not optimal, how can they reasonably be expected to avoid medication errors?

This concern is reflected in an FDA guidance document titled Safety Considerations for Product Design to Minimize Medication Errors: Guidance for Industry.  Within the guidance, FDA suggests product development teams ask themselves questions about the user’s abilities and environmental concerns that will impact use:

In what environments might the product be used? What are the typical lighting levels, noise levels, distractions, physical environments, and available technology? What else might the end users be attending to while using the product? How likely are the end users to be distracted when using the product?Safety Considerations for Product Design to Minimize Medication Errors: Guidance for Industry

All of these questions reflect factors in the medication administration process that will impact use in the home environment. They are interrelated and therefore should be evaluated together. Determining the answers will lead to a product better designed for use in a non-health care setting.

Even considering growing disease populations being treated at home, instances of errors on the rise are of concern to med device, pharmaceutical, and combination products industries. Use errors resulting from insufficient dosing instructions and patient limitations put patients at unnecessary risk. Understanding what human factors contribute to these use errors and working to overcome them are considerations organizations can take into account in making their products safer for use in the home.

About the Author

Nick Schofield is a content creator for Cognition Corporation. A graduate of the University of Massachusetts Lowell, he has written for newspapers, the IT industry, and cybersecurity firms. In his spare time, he is writing, hanging out with his girlfriend and his cats, or geeking out over craft beer. He can be reached at nick.schofield@cognition.us.