Pharmacoeconomics and Safe Medication Use

The Joint Commission medication management standard requires hospitals to respond to actual or

potential ADEs, significant ADRs, and medication errors. At the very least, hospitals need to respond,

document and report, and manage ADEs. The pharmacist, who is the drug expert, should play an integral

role in prospective order verification to prevent ADEs by intervening as needed.

This figure details types of drug-related events including medication errors, adverse drug events (ADEs), and adverse drug reactions (ADRs). The largest circle

illustrates all medications administered, with the next largest circle indicating which medications administered were associated with a medication error that reached

the patient. The third largest circle illustrates ADEs, which may be a result of medication errors (i.e., overlap between circles). ADEs that are a result of medication

errors are therefore preventable. The smallest circle illustrates ADRs, which are a type of ADE that causes patient harm/injury. Some of these are the result of

medication errors, as suggested by the overlap between the “Medication Errors” and “ADR” circles.

Mishaps that occur during the medication use process (e.g., reconciling, prescribing/ordering,

transcribing, dispensing, administering, monitoring)

Medication errors that are intercepted and stopped before they occur are called “near misses.”

ii.

Some medication errors cause harm (result in an ADE), and some do not. Medication errors

should be reported through the health system’s patient incident reporting system. Harm is

physical or psychologic injury or damage to a patient’s health, including both temporary and

permanent injury.

Medications errors can be categorized as the following:

Category A: No error – Scenarios that can cause error

ii.

Category B: An error occurred but did not reach the patient

iii.

Category C: An error occurred and reached the patient but did not cause harm

iv.

Category D: An error occurred that reached the patient and required monitoring to confirm that

it resulted in no harm to the patient or required intervention to prevent harm

Category E: An error occurred that may have contributed to or resulted in temporary harm to

the patient and required intervention