Medicine Mix-Ups Kill 2000 People
by Nick Papps

Mix-ups with medicines are killing more than 2000 Australians every year. Illegible prescriptions, poor drug packaging and mistakes with drugs cause more deaths each year than car crashes.

One of Australia's leading health experts said medication errors may be killing up to 5000 Australians every year.

A Herald Sun investigation has also revealed:

Victoria's doctors deal with an estimated 100,000 adverse drug reactions and errors every year.

One Victorian pharmacist has been linked to two deaths after mixing up prescriptions.

The state's health watchdog wants tighter drug controls and a computerised prescribing system for hospitals.

Victorian hospitals will be required to detail medical errors in a national database.

Health Services Commissioner Beth Wilson said drug safety standards had dropped in Melbourne hospitals and they needed to reduce medication mistakes. "They need to do much more," she said. "I'm having a drop in standards reported to me. We need to act on it."

Ms Wilson said clearer handwriting, more hospital pharmacists and computerised systems for managing patients' drug requirements were needed to stop mix-ups. "We need tighter controls," Ms Wilson said. "At the moment we have got good control at a (hospital) pharmacy level. Once out on the ward, there isn't as much control."

At the Alfred Hospital, 130 medicine-related incidents were recorded in a six-month period to October 2001.

A survey by the Alfred Hospital also found up to 60 per cent of patients' drug sheets failed to show any details on patients' allergy status.

Alfred medical services assistant director Dr Mark Lubliner said a new education and drug management program at the hospital resulted in 95 per cent of drug sheets detailing allergy status.

The Royal Children's Hospital detects about 100 medication errors each month. Deputy director of clinical support services Dr Colin Feekery said most were trivial. Medication mistakes are detailed on a national register kept by the Australian Patient Safety Foundation.

Foundation president Professor Bill Runciman said up to 5000 Australians die every year from medication errors. "It's at least 2000 a year. That's probably on the conservative side," he said.

Last year, 1750 Australians died in car crashes.

Professor Runciman said half of the medication errors could be prevented by better management systems, such as computerised prescriptions rather than hand-written forms. "It's been shown to reduce adverse drug events and save a huge amount of money," he said.
He said medication errors cost up to $500 million a year.

A Human Services Department committee is examining the introduction of electronic prescriptions in Victorian hospitals.

Recent figures showed that 400,000 GP visits in Australia each year are related to adverse drug reactions and prescription errors.

Pharmacy Board of Victoria registrar Stephen Marty said similar drug names and packaging often resulted in incorrect drugs being dispensed. Mr Marty said a computerised bar-coding system to cross-check drugs with prescriptions could cut dispensing errors in half.

Drug manufacturers' organisation Medicines Australia defended drug packaging and naming. Chief executive Alan Evans said all names and packaging were approved the Federal Government.
Herald Sun, 30th August 2002