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Medication errors: not just a few "bad apples"

Daren Nicholson1, William Hersh, Tejal K Gandhi

  • 1Oregon Health & Science University, Portland OR.

Journal of Clinical Outcomes Management : JCOM
|July 25, 2006
PubMed
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Most physicians make medication errors, challenging the "few bad apples" theory. This study found medication errors were widely distributed among internal medicine physicians, not concentrated in a small group.

Area of Science:

  • Medical Practice
  • Patient Safety
  • Internal Medicine

Background:

  • Medication errors are a significant concern in healthcare.
  • Understanding the distribution of these errors is crucial for targeted interventions.

Purpose of the Study:

  • To describe the distribution of medication errors among physicians.
  • To investigate whether errors are concentrated in a few individuals or widely spread.

Main Methods:

  • Prospective data collection over seven months from 24 internal medicine physicians in four primary care practices.
  • Patient surveys and chart reviews were used to identify adverse drug events (ADEs).
  • Medication errors per physician and prescriptions written were the primary measurements.

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Main Results:

  • Twenty-two out of 24 physicians made at least one medication error.
  • The error rate was evenly distributed among the physicians, with one outlier.
  • This wide distribution challenges the 'few bad apples' hypothesis.

Conclusions:

  • Medication errors are not solely attributable to a small subset of physicians.
  • Interventions to reduce medication errors should consider a broader approach beyond targeting individual outliers.
  • Findings suggest systemic factors may contribute to widespread medication errors.