Volume 10, Issue 4, April – 2025 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25apr042

A Comprehensive Review of Medication Errors in

Healthcare: Analyzing their Causes, Categories,
and Prevention Methods in India
Simran Rai1; Shakshi Ghangola2; Tathastu Sharma3; Pooja Bidhlan4*
4
Assistant Professor
1,2,3,4
Department of Pharmacy, Sushant University, Gurugram, Haryana-122002

Corresponding Author: Pooja Bidhlan4*

Publication Date: 2025/08/26

Abstract: Medication errors pose a significant challenge in healthcare, potentially leading to harmful consequences,
increased hospital stays, and rising medical costs. Such errors encompass any avoidable incidents arising from improper
medication administration or patient harm during care provided by healthcare practitioners, patients, or caregivers.
Medication errors can occur at any stage of the medication process, including prescribing, dispensing, administering,
transcribing, and monitoring. Pharmacists, alongside doctors, nurses, and administrators, play a crucial role in evaluating
and improving the healthcare system to ensure patient safety. These errors contribute to increased illness rates, higher
healthcare costs, and a decline in patients' trust in the healthcare system.This article reviews the literature on medication
errors, their types, causes, and prevention approaches. The main contributing aspects to medication errors include patient-
related aspects, healthcare provider-related aspects, and system related aspects. Understanding the different kinds and
causes of medication errors is key to develop effective prevention strategies to decrease the medication error rates. Countries
like India, which are developing rapidly, urgently need to implement specialized training programs to enhance the
prescribing skills and knowledge of healthcare providers, while also promoting the advancement of nurses' drug
administration practices. Several strategies for preventing medication errors have been identified, and their effective
application can significantly enhance healthcare services. This review article aims to emphasize the critical role of healthcare
professionals, identify the different types and causes of medication errors, and discuss effective strategies for their
prevention.

Keywords: Medication Errors, Types of Errors, Causes of Error, Preventive Strategies.

How to Cite: Simran Rai; Shakshi Ghangola; Tathastu Sharma; Pooja Bidhlan (2025). A Comprehensive Review of Medication
Errors in Healthcare: Analyzing their Causes, Categories, and Prevention Methods in India. International Journal of
Innovative Science and Research Technology, 10(4), 4505-4510. https://doi.org/10.38124/ijisrt/25apr042

I. INTRODUCTION and enhancing the healthcare system to ensure patient safety

[1].
It is universally acknowledged that medication therapy
is a vital component of modern healthcare. The intricate Medication errors increase illness rates, strain
process of prescribing and managing medications often leads healthcare costs, and undermine patients' trust in healthcare
to errors, which can significantly impact patient health, settings. Several factors heighten the risk of medication
resulting in increased mortality and morbidity. Concerns errors, including individuals with severe health conditions,
about medication errors have existed since the introduction of the elderly, pediatric patients, and those on multiple
pharmaceuticals in medical practice. “Any preventable prescribed medications. Errors can arise from a lack of
incident that may result in improper drug usage or patient information, subpar performance, and psychological stress
harm when the medication is within the control of patients, among healthcare providers. Both experienced and novice
healthcare providers, and consumers.” refer as Medication staff, such as pharmacists, physicians, nurses, students, and
Error according to NCCMERP. Medication errors can happen others, can commit medication errors. It's crucial to
at any stage of the medication management process, including understand that medication errors differ from adverse drug
transcribing, administering, prescribing, dispensing, and events; while errors may not always cause harm, adverse drug
monitoring. Pharmacists, in collaboration with doctors, events result from medication errors that lead to actual patient
nurses, and administrators, play a crucial role in evaluating harm. Assessing these errors and identifying factors that

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Volume 10, Issue 4, April – 2025 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25apr042
contribute to them can be highly beneficial. Additionally, information, prescriber details, patient’s department visit, and
most studies focus on errors of commission, often diagnosis). Additionally, commission errors encompass
overlooking errors of omission, which can give a misleading mistakes like prescribing the wrong drug strength, incorrect
impression of a lower frequency of medication errors. drug name, inappropriate dosage form, and potential drug-
drug interactions [5].
Patient safety has become a critical concern in
healthcare environments, with medication errors receiving  Dispensing Error:
considerable focus due to their serious consequences. [2]. Dispensing errors refer to any discrepancies between
the prescribed instructions on the prescription order and how
they are executed by the pharmacy when providing
medication to patients or hospital staff. Different hospital
units utilize various medication dispensing systems, each
with its own set of expectations regarding potential errors [6].
Common dispensing errors include missed doses, omitted
items, incorrect patient and medication names, and inaccurate
patient details. One potential cause of these errors is that some
pharmacists may fail to verify patients' identification before
dispensing medication. [7].

 Administration Error:
The most frequent errors committed by nursing staff
during medication administration involve mistakes such as
giving medications to the wrong patient, incorrect
prescriptions, inaccurate instructions, wrong dosages,
inappropriate indications, timing, and duration. Other errors
in drug administration include using improper techniques and
administering incorrect or expired medications. Two key
Fig1 Types of Medication Errors factors that contribute to these errors are failing to verify the
patient's identity before giving medication and storing similar
 Prescription Error: medications in the same location, which can lead to
Prescription error can be defined as a set of planned confusion. [8, 9].
acts that may not produce the expected result, according to
theories of human error, because actions did not go as  Monitoring Error:
planned or because the plan was insufficient [3]. The A monitoring error occurs when prescribed medication
prescribing error is a common drug error that can be is not observed in accordance with established standards of
prevented in hospitals around the world [4]. Prescription care in routine clinical practice. This includes situations
errors can be categorized into various types, including errors where tests are not conducted at the recommended frequency,
related to the administration route, incorrect dosage, improper with a tolerance of up to 50%. However, if a patient refuses
frequency, wrong dosage form, and omission errors to consent to a test, it is not considered a monitoring error.
associated with the prescriber (such as incorrect patient [10].

Table 1 Commonly Misinterpreted Abbreviations, Symbols, and Dosage Notations

S. No. Abbreviations Intended Meaning Misunderstood Correction
1. U Units Mistaken as 0 or 4 leading to overdose. Use “unit”
2. Ug Micrograms Mistaken as “mg” Use “mcg”
3. D/C Discharge or Discontinue Premature discontinuation of medication Use“discharge”
if D/C (intended to mean discharge) and“discontinue”
4. SC or SQ Subcutaneous SC mistaken as SL(sublingual) Use “subcut” or
“subcutaneously”
5. IU International Unit Mistaken as 10 or IV (intravenous) Use “International
unit”
6. q.d. or QD Everyday Mistaken as Q.I.D. Use “daily”
7. o.d. or OD Once daily Misinterpreted as QD (daily) Use “daily’
8. HS Half-strength Mistaken as Bedtime Use “half-strength”
9. T.I.W Three times a week Mistaken as 3 times a day or Twice in a Use“3 times weekly”
week
10. BT Bedtime Mistaken as BID “Twice daily” Use “bedtime”
11. IN Intranasal Mistaken as IV or IM. Use “intranasal” or
“NAS”
12. Cc Cubic centimetre Mistaken as u “unit” Use “ml”

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Volume 10, Issue 4, April – 2025 International Journal of Innovative Science and Research Technology
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II. REASONS OF MEDICATION ERRORS  Medication Misuse or Non-Compliance:
Patients may not follow prescribed instructions, taking
The causes of medication errors are complex and incorrect doses or skipping doses, leading to ineffective
typically involve a combination of human, systemic, and treatment or adverse effects. Self-medication or use of over-
environmental factors. The following section provides an in- the-counter drugs alongside prescribed medications can lead
depth analysis of the various factors contributing to to harmful interactions.
medication errors:
 Pharmacological Factors:
 Human Factors:
 Drug Interactions:
 Lack of Knowledge or Training: Few medications might interact with others, altering their
Lack of understanding of pharmacology, drug effectiveness or leading to harmful side effects. These
interactions, or dosing advices may lead to medication error interactions may not constantly be anticipated, particularly
due to prescribing or administering the wrong drug or with new or unusual drug combinations.
medication.
 Changes in Pharmacokinetics:
 Over Workload and Pressure: Changes in a patient’s health status (e.g., renal or liver
Healthcare professionals especially those working dysfunction) can alter how a drug is absorbed, metabolized,
extended shifts or under high-pressure circumstances, may and excreted, requiring dose adjustments to avoid adverse
become exhausted or stressed, damaging their ability to make effects [11,12,13].
precise decisions.
 Role of Health Care Professionals in Medication Error:
 Systemic and Organizational Factors:
 Prescribers' Contribution to Prescription Errors:
 Unsuitable Labeling or Packing of Drug: These errors occur when the prescriber's written
Poor labeling or unclear packaging can lead to instructions are unclear, incomplete, or contain inaccuracies
misinterpretation of the medication’s dosage or that are typically expected to be clearly communicated. Such
administration directions. errors may involve the selection of inappropriate medication,
incorrect dosage, or improper dosing regimen, all of which
 Poorly Planned Workflow: can pose a risk of harm to the patient. [14]. "Prescription
Medication errors might occur when the physical errors (PEs) occur when a prescribing decision or the process
environment or workflows do not ease suitable attention to of writing a prescription unintentionally leads to either a
detail. For example, poorly organized medication carts, significant decrease in the likelihood of timely and effective
inadequate lighting, or high noise levels in a healthcare treatment or an increased risk of harm." PEs typically arises
setting can lead to turbulences or faults which can cause during two key stages of the prescribing process. The first is
medication error. the decision-making stage, where the prescriber selects the
most appropriate medication for the patient. This requires a
 Medication-Related Factors: comprehensive review of the patient’s medical history and a
thorough physical examination; neglecting these steps can
 Multi-Layered Drug Regimens: result in irrational prescribing. [14, 15].
Patients who are on multiple medications have higher
risk of errors due to the complex nature of drug interactions  The Role of Pharmacists in Dispensing Errors (DEs):
and dosage modifications. Complex regimens with multiple Dispensing errors occur when incorrect medication is
steps, like the administration of intravenous drugs, may lead provided to a patient. These errors often result from
to mistakes if not carefully followed. discrepancies between the prescription and the medication
dispensed by the pharmacist. While the correct drug may be
 Look-Alike, Sound-Alike Drugs: supplied, issues can arise from incorrect dosage, dosing
Medications with similar names (e.g., "lamotrigine" vs. regimen, route of administration, or even dispensing the
"lamivudine") or similar appearances (e.g., similar color, medication to the wrong patient. [16]. DEs can be categorized
shape, or size of tablets) can be mistaken for one another.This into three types: failure to identify and correct prescription
concern is mainly prevalent when drugs are stored unsuitably errors, failure to detect errors from manufacturers, and
or not clearly labeled. inadequate patient counseling. These errors reflect
shortcomings in quality assurance and pharmaceutical care,
 Patient-Related Factors: which fall under the primary responsibilities of the pharmacy
team. Given that the pharmacy acts as the central control
 Non-Disclosure of Medical History: point for medications, thorough prescription review and
Patients may fail to tell their full medical history, precise dispensing are crucial for protecting patients from
including allergic condition, previous medication use, or various types of medication errors.
underlying illnesses, which could lead to incorrect
prescriptions or unsafe drug interactions.

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 The Contribution of Nurses to Drug Administration before sending it to the pharmacist. The pharmacist then
Errors (DAEs): dispenses the medication based on the bar-code information
Drug administration errors occur when medications are and passes it to the nurse. The nurse uses the bar-code scanner
given in a manner that does not align with the prescription to verify that the medication is being administered to the right
order. They can also result from failures to identify and patient. [22]. CPOE includes the usage of computer by
correct errors made during prescription, transcription, prescriber to send prescription to the pharmacy using specific
dispensing, and the final administration of the drug [17, 18]. patient information. This system was implemented to lessen
The prevalence of DAEs can be assessed by evaluating their the Prescription Error by 83% [24, 26]. Another study
occurrence rate, with observational methods being the most indicated that CPOE has significantly reduced the incidence
effective approach [17]. Research indicates that the of ADRs due to MEs by 55% [22]. The physician typically
prevalence of DAEs ranges from 14.9% to 32.4% [17, 19, diagnoses the patient and enters the diagnosis into the
20]. Additionally, the rate of errors is notably higher when computer, which then analyzes the risk of allergies, drug
administering intravenous medications compared to other incompatibilities, and interactions based on the patient's
types of drugs [17]. documented medical history and diagnosis. The resulting
prescription usually includes the correct medication, proper
 Strategies for Preventing Medication Errors: dosage, and appropriate dosage form for the intended patient.
Preventing medication errors involves addressing the [22, 26]. Pharmacists play a vital role in clinical settings,
shortcomings of individual healthcare professionals, systemic contributing to quality assurance and effective patient care.
failures, and the challenge of underreporting incidents. Three Their involvement in healthcare teams enhances patient
key strategies are commonly employed to address medication outcomes, promotes the rational use of medicines, and
errors: enhancing medication safety practices, implementing supports the prompt identification and reporting of adverse
measures to reduce the occurrence of errors, and establishing drug reactions (ADRs) and medication errors (MEs) [22].
effective systems for reporting and providing feedback on
medication errors.  Reporting and Feedback Regarding Medication Error:
Medication errors reporting is essential for
 Strategy to Enhance Medication Safety: understanding the types and causes of medication errors and
The first step in preventing medication errors is to for creating effective prevention strategies. To encourage
enhance medication safety by ensuring the availability of reporting, the process should be straightforward and user-
essential resources, such as reference books, journals, and friendly. Healthcare providers should be educated about the
online tools, within the hospital. This should be supported by importance of reporting medication errors and their
a collaborative work environment and a well-staffed professional obligations in this area. To ensure
workforce. The Commission on Quality of Health Care in confidentiality, medication error reports should be kept
America (CQHA) has developed strategies aimed at private, and in certain situations, the identity of the reporter
improving treatment processes and promoting patient safety may need to be concealed. Prompt reporting after an error is
[21]. The strategies involve the development of standardized detected is crucial, as it enables healthcare specialists to take
prescription guidelines, offering thorough information to immediate action to prevent adverse drug reactions [27]. The
patients, implementing electronic prescribing software, and following step is to distribute this information among
prescribing medications by their generic names. The healthcare professionals to help prevent future occurrences.
monitoring and evaluation of prescription errors (PEs) should Research indicates that medication errors can be effectively
be carried out by the drug and therapeutic committee. [22]. evaluated, identified, and reported through active
The committee recommended that all medications and related intervention strategies, including chart reviews and patient
products be stored in the designated drugstore. High-risk observations. This method has been shown to be ten times
drugs should be supplied to wards only when needed. Similar more effective in managing medication errors and adverse
medications and equipment should be kept apart, and drug reactions than relying on spontaneous reporting [27].
pharmacists should offer clear guidance to both patients and The comprehensive process of active intervention involves
nurses. Furthermore, druggists should collaborate with the the proactive identification of medication errors, a reporting
drug and therapeutic committee to identify, report, and and feedback control system, enhancing the knowledge of all
manage medication errors. [23]. healthcare professionals, and simplifying the complex
procedures related to prescription, drug administration, and
 Strategy to Decrease Medication Error: dispensing. [28].
To reduce medication errors linked to individual
healthcare providers and systemic issues, three approaches III. CONCLUSION
have been adopted: the implementation of barcoding, the use
of physician computer order entry (CPOE), and the All healthcare professionals are responsible for
integration of pharmacists into clinical practices. [22, 24-25]. recognizing the factors that contribute to medication errors
The use of barcoding verifies that the prescriber, pharmacist, and using this knowledge to reduce their occurrence. This
or nurse is giving the correct medication to the right patient, review aimed to identify scientific literature that has
in the proper dose, at the right time, and through the correct evaluated and documented medication errors. Although
route. This method is highly reliable, with less than one error focused on medication errors, our findings revealed that
occurring per million scans. [24]. The prescriber typically inadequate knowledge of medications was a significant factor
uses a bar-code to link a prescription to the correct patient

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leading to drug administration errors among both prescribers  Given the higher risk of medication errors among elderly
and nurses. patients, healthcare providers should adopt a patient-
centered approach that accounts for polypharmacy and the
Medication errors are caused by a combination of potential for drug interactions.
factors and require a multidisciplinary approach,
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