Self-reported therapeutic errors to a poison control center.

Abstract

BACKGROUND: The techniques for avoiding medication errors in healthcare settings can be extrapolated to improving pharmaceutical care and medication safety in the patient's home. Understanding patient self-dosing errors in self dosing is important in the development of prevention strategies. OBJECTIVE: To examine cases of therapeutic errors in patient self dosing as reported to the Oklahoma Poison Control Center, with the goal of proposing prevention strategies and education. METHODS: A retrospective study of self-dosing errors was performed examining root cause, patient age, and pharmaceutical agent. RESULTS: Patient self-dosing errors accounted for 8.75% of all poison control exposures as compiled by the Oklahoma Poison Control Center in 2001. The most common reasons for therapeutic errors in all age groups involved taking or giving the wrong formulation or concentration, inadvertently taking/giving medication twice and another incorrect dose. CONCLUSION: Patient education is the key to preventing therapeutic errors in the home.