Medical errors refer to preventable mistakes in healthcare that can cause harm to patients. These errors can occur in diagnosis, treatment, medication administration, surgery, or even during routine medical procedures. According to a study shared by the National Library of Medicine, about 400,000 hospitalized patients experience avoidable medical errors while the same avoidable medical errors result in roughly more than 200,000 deaths every year. Following are some of the common errors and evidence-based strategies to reduce medication errors including prescribing correct psychiatry drugs and dosages.

Overview of Avoidable Medical Errors

While some medical errors are complex and difficult to prevent, many are avoidable with improved processes and safety measures. Some of the most common avoidable medical errors include:

• Medication errors – Incorrect dosages, wrong medications, or improper administration routes.
• Misdiagnosis – Failure to correctly diagnose a condition, leading to delayed or incorrect treatment.
• Surgical errors – The surgical errors include active and latent errors. Active error relates to operating on the wrong site, leaving surgical instruments inside the patient, or complications due to poor technique. While latent errors are the ones that arise due to the problems within the system, doctors or healthcare specialists who double-check the system before initiating the surgery may avoid such errors and that is known as a ‘near-miss’.
• Hospital-acquired infections – Infections caused by inadequate hygiene or sterilization protocols.
• Communication failures – Lack of clear instructions between healthcare professionals, leading to errors in patient care.

Medical Errors in Depth

Medical errors can have severe consequences, ranging from minor discomfort to life-threatening complications. Below are some of the most dangerous medical errors that can lead to serious adverse effects, including death:

1. Medication Errors

Medication errors are one of the most common and dangerous types of medical mistakes. These include:

• Prescribing the wrong drug – A doctor may prescribe a medication that interacts poorly with other drugs or does not suit the patient’s condition.
• Incorrect dosage – A small variation in drug dosage can have life-threatening consequences.
• Failure to consider patient genetics – Some patients metabolize medications differently due to genetic variations, making certain drugs ineffective or toxic.

2. Misdiagnosis and Delayed Diagnosis

Misdiagnosing or delaying the correct diagnosis can lead to incorrect treatments, worsening the patient’s condition. Some conditions commonly misdiagnosed include:

• Heart attacks – Sometimes mistaken for acid reflux or anxiety.
• Stroke – Often misdiagnosed as migraines or vertigo, delaying critical treatment.
• Infections – Sepsis (a severe infection in the bloodstream) can be misdiagnosed, leading to delayed treatment and fatal consequences.

3. Surgical Errors

Errors in surgery can cause life-threatening complications. These mistakes can be classified into active errors (errors caused by direct human action) and latent errors (system failures or hidden conditions that contribute to errors).

Active Errors in Surgery

• Wrong-site surgery – A surgeon operating on the wrong limb or organ due to miscommunication or incorrect charting.
• Anesthesia misadministration – Giving too much or too little anesthesia, causing respiratory distress, brain damage, or even death.
• Accidental organ or nerve damage – A slip of the scalpel leading to unintended injury during surgery.

Latent Errors in Surgery

• Inadequate pre-surgical protocols – Poorly designed checklists or rushed preoperative verification can lead to wrong-site surgeries or incorrect procedures.
• Defective equipment or improper sterilization – If a faulty surgical instrument is used due to a lack of routine maintenance, it may cause infections or internal injuries.
• Communication breakdown among medical staff – When nurses, anesthesiologists, or surgeons receive incomplete or incorrect patient information, the risk of surgical complications increases.
• Poor organizational policies – Inconsistent staff training, lack of double-check systems, or fatigue due to long working hours can create conditions that make errors more likely to occur.

4. Healthcare-Associated Infections (HAIs)

Hospital-acquired infections occur due to poor hygiene practices. Common HAIs include:

• Methicillin-resistant Staphylococcus aureus (MRSA) – A dangerous antibiotic-resistant infection.
• Clostridioides difficile (C. diff) – A severe infection affecting the intestines, often caused by overuse of antibiotics.
• Urinary tract infections (UTIs) – Frequently caused by prolonged catheter use.

Examples of Medical Errors

Real-world cases highlight the devastating impact of medical errors:

• Incorrect medication administration – A 13-year-old girl in the U.S. died after receiving an incorrect chemotherapy dose.
• Wrong-patient surgery – A patient underwent open-heart surgery meant for someone else due to a mix-up in medical records.
• Delayed stroke diagnosis – A young woman with stroke symptoms was sent home with migraine medication, leading to permanent disability.

Medication Errors Due to High or Low Doses

While higher doses can lead to adverse drug reactions, low doses (unnecessarily) on top of slow or delayed treatment, can lead to drug resistance.

High Medication Doses

Excessive medication doses can lead to overdose, toxicity, or death. In case of drug overdose and severe drug reactions, consult a poison control or toxicologist. Some drugs with narrow safety margins include:

• Opioids (e.g., Morphine, Fentanyl, Oxycodone) – High doses can cause respiratory depression, leading to death.
• Warfarin (blood thinner) – Overdosing can cause severe internal bleeding.
• Insulin (for diabetes) – Too much insulin can lead to dangerously low blood sugar levels (hypoglycemia), causing coma or death.

Low Medication Doses

Unless required, low-dose medications can result in drug resistance. Inadequate drug levels may:

• Fail to treat – Lower than required dosage can prolong the disease, hence worsening the illness.
• Create drug-resistant bacteria or viruses – This is especially dangerous in antibiotics, as bacteria adapt and become harder to treat (e.g., antibiotic-resistant tuberculosis).
• Reduce the effectiveness of cancer treatments – Insufficient chemotherapy doses can allow cancer cells to survive and become resistant to future treatments.

How Pharmacogenomic (PGx) Testing Helps Prevent Medical Errors

Pharmacogenomics testing, also known as PGx testing gives insights into your genetic makeup, thus, helping to determine how you metabolize (process) medications. This helps doctors prevent medical errors by ensuring:

• Personalized medication plans – Doctors can prescribe the right drug at the correct dose based on a patient’s genetic profile.
• Reduced risk of side effects – Identifying genetic variations that may cause adverse drug reactions.
• Prevention of treatment failures – Ensuring that prescribed drugs are effective for the patient.

For example, patients with a mutation in the CYP2D6 (a hepatic enzyme) gene may process painkillers like codeine too slowly or too quickly, leading to severe side effects or lack of pain relief. PGx testing helps doctors choose alternative medications that are safer and more effective.

How does a simple at-home PGx test work?

Does the FDA recognize Pharmacogenomics?

According to the FDA, “Pharmacogenomics can play an important role in identifying responders and non-responders to medications, avoiding adverse events, and optimizing drug dose.” Drugs that should specifically be genotype-based may contain the following labels:

• Risk for adverse events
• Trial design features
• Mechanisms of drug action
• Genotype-specific dosing
• Drug exposure and clinical response variability
• Polymorphic drug target and disposition genes

Here we have some of the medications in the U.S. that the FDA has labeled as they may cause adverse reactions or affect individuals differently, thus, genotype-based administration is recommended:

Amoxapine (Psychiatry): A tricyclic antidepressant drug metabolized by CYP2D6 enzyme, states on its boxed overdosage section that although the occurrence is less than 5% only, overdose may develop renal failure two to five days after toxic overdosage in patients who may appear otherwise recovered. Moreover, acute tubular necrosis with rhabdomyolysis and myoglobinuria is the most common renal complication in cases of overdose.

Citalopram (Psychiatry): Available under the brand name Celexa, Citalopram is an SSRI (selective serotonin reuptake inhibitor) drug metabolized by CYP2C19 enzyme, states under its dosage and administration section that due to the risk of QT prolongation Celexa 20 mg per/day dose is the maximum recommended in CYP2C19 poor metabolizers.

Escitalopram (Psychiatry): Available under the brand name Lexapro, Escitalopram is an SSRI drug metabolized by the CYP2C19 enzyme, states under its adverse reaction sections that commonly observed adverse reactions include ejaculation disorder (primarily ejaculatory delay), increased sweating, nausea, decreased libido, and fatigue, etc.

What Is Pharmacogenomics (PGx) Testing?

Pharmacogenomics (PGx) is the study of how genes affect a person’s response to drugs. A PGx test analyzes DNA to determine how an individual’s body will metabolize specific medications. This information helps doctors:

• Avoid prescribing drugs that may be ineffective or harmful.
• Adjust medication dosages for safer treatment.
• Reduce trial-and-error in prescribing medications.

RPh Labs offers at-home PGx testing that requires just a saliva sample. The test provides insights into how your body may respond to over 250 medications, allowing doctors to create a safer and more personalized treatment plan for you.

Conclusion

Despite the advancement in the healthcare sector, avoidable medical errors are still causing adverse reactions and even deaths in some cases. Some of the evidence-based strategies to reduce medication errors, including latent and active medical errors include following checklists, counting instruments, consulting your fellow doctors, nurses, or seniors, Antithrombotic prophylaxis, and using radio-frequency identification to identify surgical sponges, consulting fellow doctors from the same specialty (in possible cases obviously), and prescribing genome-based drugs and dosages where necessary, such as psychiatry medications which tend to affect people differently based on specific enzyme functions. FDA itself has labeled some drugs with specific terms indicating the need for genome-based dosage and precautions.

References

https://www.ncbi.nlm.nih.gov/books/NBK338596/
https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling#:~:text=Contact%20Us&text=Pharmacogenomics%20can%20play%20an%20important,exposure%20and%20clinical%20response%20variability
https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
https://www.ncbi.nlm.nih.gov/books/NBK599521/#:~:text=The%20most%20robust%20database%20of,reported%20and%20nearly%20175%2C000%20deaths.
https://www.ncbi.nlm.nih.gov/books/NBK499956/