Introduction
Medication
errors are errors in prescribing, dispensing and administering pharmaceutical
agents 1. There has been widespread reports of medication errors and the harm
it poses to body tissues 2. These errors could arise from the clinician, the
dispenser or the drug user.
The Nigerian Situation
I
have experienced, heard and witnessed dispensing faults. One recent case was on
prescribing artificial tears, the patient presented a topical antifungal drug
(Fluconazole gutta) purchased from a local chemist.
Relevant
research papers have shown that the Nigerian health care system has had a share
in the battle of medication errors 3, 4, 5. This has been attributed on the
part of health care workers in Nigeria to not enough
age consideration in dosing, omission of dosage duration in prescribing, wrong
dosage duration, over dosing, under dosing and seemingly unsatisfactory
labelling of drugs by manufacturers
Where does the Nigerian Optometrist come in?
The
training curriculum for optometrists in Nigeria allows for competency up to
level four of the Global Competency Model for Optometry (Ocular Therapeutics).
This puts the optometrists in the battle against medication errors as they
strive to provide quality eye care services to the populace. Even though it is
accepted by the ophthalmic world that ophthalmic topical drugs have little
adverse effects compared to systemically administered drugs, this does not
exclude the optometrist from this battle in any way. Leaving aside the fact
that optometrists also prescribe systemic drugs in Nigeria, misuse of some
topical ophthalmic preparations can cause adverse effects on the ocular tissues
and adnexa. We of course shouldn't forget documentations of topical steroid
induced glaucoma and cataract or fungal infections of the conjunctiva and
cornea due to abuse of topical antibiotics.
How do we optometrists tackle this?
These
errors comes from three main sources, the prescribing optometrist, the
dispenser and the patient.
On
the part of the optometrist, he/she must be conversant with the
pharmacokinetics and pharmacodynamics of the drug to be prescribed taking into
special consideration children, nursing mothers and the aged. To reduce the
errors made by the optometrist, one can employ the use of online tools like drugs.com
and cataloguing drug dosage information in readily available hard copy prescription charts
in clinics.
Medication
errors from the dispenser can be prevented by having a pharmacy with monitored
dugs in the same optometry clinic facility that prescriptions are made, by a feedback system allows for the patient to present
the drug purchased outside the clinical facility to the prescribing optometrist
before administration.
Medication
errors in administration can be tackled by proper education of the patient by
the optometrist on the use the use of the drug with the incorporation of the
dos and donts method.
I
should also add that the optometry schools must take pharmacology courses much more
seriously with an approach that enables students not only know the pharmacological details of ophthalmic drugs but also to be
conversant with the ophthalmic drugs in the Nigerian market. In our
Continuing Education Programmes, the newer ODs who seem more prone to such
errors should be specially educated.
It
is believed that through considering and implementing these
recommendations, we can serve the vision of the populace better and create a
better name for the profession in Nigeria. You can add more recommendations in
the comments section.
References
1.
Medical Dictionary 2015, Medication Errors, viewed 9 March 2015.
2.
Velo GP, Minuz P 2009, Medication Errors: prescribing faults and
prescription errors, British Journal of Clinical Pharmacology, vol 67, no 6, pp
624-628, viewed 9 March 2015.
3.
Oshikoya KA, Ojo OI 2007, Medication errors in paediatric outpatient
prescriptions of a teaching hospital in Nigeria, Nig Q J Hosp Med, vol 17, no
2, pp. 74-78, viewed 9 March 2015.
4.
Nwasor EO, Sule ST, Mshelia DB 2014, Audit of medication errors by anesthetists
in North Western Nigeria, Niger J Clin Pract, vol 17, no 2, pp 226-31,
doi:10.4103/1119-3077.127563.
5.
Oyedunni S. Arulogun*, Simon K. Oluwole and Musibau A. Titiloye 2011,
Prescription Errors Prevalent in Four Units of a University Teaching Hospital
in Nigeria, Journal of Public Health and Epidemiology, vol 3, no 11, pp
513-519. viewed 9 March 2015.
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