MEDICATION ERORR

Medication error is an error in the treatment process is still in control and responsibility of health professions, patients or consumers, and should be avoided (Cohen, 1991, Basse & Myers, 1998). In the Decree of Ministry of Health of Indonesia Number 1027/MENKES/SK/IX/2004 mentioned that understanding medication errors are adverse events patients, due to drug use during the handling of health personnel, that could be prevented. Genesis medication errors were divided into 4 phases, namely phase prescribing, transcribing phase, phase dispensing and administration phases of the patient.

Medication prescribing errors in phase are errors that occur at the prescription phase. This phase includes: prescription drugs are not appropriate indications, not just the patient or contraindications, inappropriate medication or a drug that no indication, not just the dose and the manufacturer's instructions.

In transcribing phase, an error occurred while reading the recipe for the dispensing process, such as misreading a prescription because the writing is not clear, for example, Losec (omeprazole) read Lasix (furosemide), the manufacturer's 2 times a day 1 tablet 3 times daily reads 1 tablets. Wrong in order to translate recipes and signature creation can also occur in this phase.

Errors in dispensing phase occurs during the preparation to the delivery prescription by the pharmacist. One possibility of error is wrong in taking drugs off the shelf packaging or storage for a similar drug names or can also occur due to its location nearby. In addition, one in calculating the number of tablets to be formulated, or wrong in the provision of information. While errors in the administration phase is the error that occurs in the process of drug use. This phase may involve the pharmacist and the patient or his family. Errors that occur as the patient one should use the suppository through the anus but eaten with porridge, one time supposed to take the medicine 1 hour before dinner, but be taken with food.

According to Cohen (1991) of the phases of medication errors above, it can be argued that a contributing factor could be:
1) poor communication, both in writing (in recipes) or orally (among patients, doctors and pharmacists).
2) Drug distribution system is less supportive (computerized systems, medication storage systems, and so forth).
3) Human resources (lack of knowledge, work overload).
4) Educate the patient less.
5) The role of patients and their families less.

Medication errors that occur in any phase of harming patients and can lead to treatment failure, can occur even drug effects are not expected. According to Buck (1999), some things that need to be considered by doctors in writing prescriptions for children, namely:
1) Knowing the patient's treatment needs, drug allergies, potential drug interactions.
2) Writing the pasient weight.
3) Using a generic name.
4) Avoiding the use of drug name abbreviations.
5) Beware of prescription drugs "look alike" and "sound alike", such as Celebrex and Cerebyx
6) Adjust the dose with the latest references.
7) do rounding doses to the nearest number.
8) For fractional use zeros in front of the comma (example: .., 5 mg 0.5 mg should be written) and avoid zeros behind the comma (example: 5.0 milligrams, 5 mg written enough).
9) Check the count and reset all the units.
10) Using a specific dosage instructions, instructions to avoid such a "prn" or "titrate",
11) Avoid verbal orders.

There are three ways that revealed medication errors can be prevented, namely:
a) Writing a prescription by computerized physician
Application of computerized systems for prescribing or the Computerized Physician Order Entry (CPOE) has the potential to reduce the number incident medication error (medication error rate / MER).
Based on reports from the USP Medication Error Reporting Program, the following things can be done when your doctor writes a prescription to avoid misinterpretation of the prescription, namely: 1) Provide the identity of doctors are printed in the paper prescription. 2) Writing out the full name of the drug (generic name is recommended in), strength, dosage and dosage forms. 3) Name of patient, age and address, as well as weight and name of the patient's parents to children (Lofholm and Katzung, 1997).
b) Ward Clinical Pharmacist
In the Decree of Ministry of Health of Indonesia Number 1027/MENKES/SK/IX/2004 mentioned that pharmacist should understand and realize the possibility of medication errors in the treatment process. Pharmacist in prescription services should be screened recipes include: 1) administrative requirements (a. name, address of the SIP and physician, b. The date of prescription, c. signature / initials doctors prescription writer, d. name, address, age sex and the patient's body weight, e. the name of the drug, potency, dosage and quantity demanded, f. The use of a clear way, g. any other information). 2) Suitability farmasetika (a. dosage form, dosage b., c. potentials, d. stability, incompatibility e., f. old ways and giving). 3) Consideration of clinical (a. side effects, allergic b., c. interaction, d. suitability indication, dosage, patient, etc.).
c) Improved communication between physicians, pharmacists / nurses and patients.

To facilitate the use of means, providing therapy to a group of someperson require special dosage forms, eg syrups or powders. Unfortunately, it is often not easy ways to support precision using the manufacturer's instructions that must be met. In fact, the manufacturer's instructions (signatura) is very important because it related to the availability of drugs in the body needed to achieve therapeutic goals. For example, for drugs such as simtomatika febrifuge, needed only when the fever. When the body temperature returned to normal then the medication should simtomatika.
Stop immediately because it was no longer needed. While causative drugs such as antibiotics, is necessary in a certain amount of time and in relation to its availability in the body to achieve therapeutic goals. Thus, although the condition seemed to have a good body (feels good) but the drug still must be given to the amount and time required are met. If both drugs are given together in one dish powder / syrup simtomatika the drug will continue to terminum after they were no longer needed. The situation would be able to lead to unintended effects and certainly will affect the success of therapy. This often occurs in prescribing compounded.
The results of in-depth interviews with recipients pharmacist prescription, prescription services that are not always fully confirmed to the doctor. For Installation in the Hospital Pharmacy, confirmation can be done relatively easy, but if the frequency is high enough such confirmation in case of absence of instructions dosage forms that must be made and it will interfere with both parties, both pharmaceuticals and physician installation. Supersciptio omissions occur in hospitals because the patients were hospital employees or family doctors not met in the clinic so that doctors do not prescribe the prescription blank should be.
Reviewed from the aspect of completeness of recipes it can be concluded that all prescriptions has the potential to cause medication errors with causative factor activity levels are relatively high physician and a prescription blank that do not accommodate the aspect of completeness of the required prescription. This indicates that service, especially in medicine can not be said is necessary to secure and repair. Repairs can be done with good recipe model development manual or computerized which can support the data needs of patients and medicine refers to the applicable regulations.


Reference:
Fortescue, E.B., et al.(2003). Prioritizing Strategies for Preventing Medication Errors and Adverse Drug Events in Pediatric Inpatients, Pediatrics, American Academy of Pediatrics, Vol. III. No. 4 April, p.722-729.
KepMenKes RI Nomor 26 MenKes/Per/1981, Departemen Kesehatan RI, Jakarta
KepMenKes Nomor 1027/MENKES/SK/IX/2004, Standar Pelayanan Kefarmasian di Apotek, Departemen Kesehatan RI, Jakarta