medication errors. A better understanding of these costs is important for a number of reasons, including informing decisions about investments in technological interventions designed to reduce the risk of medication errors. Accordingly, the committee recommends that additional studies be carried out on these costs in hospitals, nursing homes, and ambulatory care. These studies should include (1) the costs of medication errors in pediatric and psychiatric care, (2) the costs of errors associated with OTC and complementary and alternative medications, (3) the costs of the failure to receive drugs that should have been prescribed, and (4) the costs of over-utilization of drugs (for example, antibiotics). Moreover, some of these studies should examine not just additional health care costs relating to medication errors, but also the economic and social costs borne by patients and their families.

Prevention Strategies

The committee acknowledges that it is not possible to put forward a fully comprehensive set of corrective medication error strategies. The area best understood is the incidence of medication errors and preventable ADEs in various care settings where significant problems and their causes have been identified. More research is needed to evaluate the impact of system problems in the research and development, regulatory review, and distribution/ marketing stages on the incidence of errors in the use of medications and the impact of the underutilization of medications.

As suggested above, the primary focus of research on medication errors should be on informing, developing, and then testing prevention strategies. In the next sections, the committee outlines suggestions for further research on such strategies for hospital care, nursing home care, ambulatory care, pediatric care, psychiatric care, and care transitions.

As reported in Chapter 3, the universe of preventable ADEs is a minority of total ADEs. Although most of the development of error prevention strategies to date has been focused on the ADEs that are known to be preventable today, it will likely be possible in the future to prevent many events currently considered nonpreventable. In particular, better tools for detecting drug sensitivities and the use of pharmacogenomics offer great promise in this regard (Gandhi et al., 2005). In addition, innovations in the way compounds are constructed or delivered may result in a safer drug administration process.

Finally, further cost/benefit studies of all prevention strategies are urgently needed. Most such studies carried out to date have involved hospitals and a limited number of decision-support tools. Particularly needed are studies of vendor-based systems, a broad range of decision-support tools, and care settings other than hospitals. The aim should be to identify a



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