Practice of Medicine


10 Strategies for Reducing Medication Errors

Executive Summary

Physicians face significant liability if they make mistakes when providing patients with prescriptions. The following summarizes 10 important strategies physicians should implement to reduce medication errors.

Recommended Actions
  • Document each patient’s medications and allergies before providing prescriptions.
  • Consult the state's Prescription Drug Monitoring Program website before recommending long-term opioid treatment for chronic pain.
  • Monitor and evaluate your patient’s reactions to prescriptions, especially when prescribing medications that have significant risks.

1. Accurate and legible

Accuracy and legibility for written and EMR-based prescriptions and medication orders are critical. To ensure accuracy, use only approved abbreviations. When using an electronic format, carefully select the appropriate medication using drop-down functionality and be wary when the system auto-completes your request. Be especially careful if you delegate this function to someone who might not be as aware of the exact spelling and dosage of the intended medication. Be sure to double-check your order after it is written or typed and do read-backs on verbal orders.

2. Allergies

Check for allergies before prescribing. Allergies should be documented by all providers in a consistent place so that lists are accurate and do not diverge. It is very important to list the medication and the allergy the patient experiences from the drug. Critical allergies such as anaphylaxis or hepatic or renal injury obviously rank higher than reactions such as nausea and vomiting.

3. Drug-drug interactions

Be aware of possible drug-drug interactions. Know the patient’s current medications. Remember that your EMR or hand-held device may have drug-drug interaction information on different screens, as well as different thresholds of alarm. Be mindful that alarm fatigue can lead to errors.

4. High-risk meds

Understand high-risk medications and those with narrow therapeutic ranges and interactions. For example, warfarin, anti-epileptics, lithium, gentamicin, pitocin, and chemotherapy need additional consideration. You may wish to obtain written consent for long-term anticoagulation, opioid and chronic steroid therapy. Even for medications not deemed high-risk, it may be appropriate to discuss and document informed consent.

5. Long-term pain management

Before you recommend a long-term opioid treatment, consult your state's Prescription Drug Monitoring Program website. Monitor the patient’s progress and responses to chronic opioid prescriptions to ensure optimal compliance. Having an opioid agreement with the patient is helpful in the management of long-term pain.

6. Look-alike, sound alike

Crosscheck medications for dosages and look-alike, sound-alike errors - particularly parenterals.

7. Herbals/OTCs

Ask the patient about any herbal or over-the-counter medications as they may interact with prescriptions. Ask patients if they use medical marijuana as this may interfere with prescriptions, especially opioids, psychiatric medications and medications with sedative properties.

8. Monitor and evaluate

It is important to adequately evaluate and monitor prescriptions. For example, evaluate the patient’s risk of thrombosis for oral contraceptives and hormone replacement therapy. Monitor the effect of medications like anticoagulants and those that may cause liver or renal compromise.

9. FDA warnings

Stay informed about Food and Drug Administration warnings on medications, especially black-box warnings. Even drugs that have been on the market for a long time can be issued new limitations or be withdrawn. 

10. Samples and phone-in prescriptions 

Record all samples given to patients. The patient’s record must include when the samples are distributed, the amount and dosage instructions. A sample log can prevent inappropriate use or diversion by staff or others outside a physician-patient relationship. Document all phone-in prescriptions, especially those phoned in at night and on weekends.

Lessons Learned:
  • Develop a standardized log for patient records to track when patients receive samples or prescriptions over the phone.
  • Stay informed and up-to-date on all FDA medication warnings.
  • When prescribing controlled substances, follow your state’s PDMP requirements, including obtaining medical history, screening for any drug misuse and educating patients on the high risk of abuse.
Potential Damages

Medication errors by physicians may result in civil litigation for negligence, medical board discipline and criminal charges. Although claims for medication errors are relatively low, paying for the cost of injuries or pain and suffering sustained by patients due to a medication error can be expensive.


1. Physicians can use any abbreviation they choose when writing prescriptions.
2. Physicians should monitor a patient’s reaction to prescription medication.
3. It is important to ask patients about other substances they consume that could interact with their prescription medications.


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The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.