Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand (original) (raw)
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Pharmacy World & Science, 2009
Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patients. However, allergies can be prevented if the patient's history of drug allergy is known and coded. Assessment of the value of the widely used ICD-10 codes for drug-allergies (e.g. Z88, L27) as triggers for decision support in an electronic prescription system and evaluation of the potential impact of such an alert system. We also evaluated the usefulness of manual drug allergy notes recorded in patients' charts in the prevention of prescribing errors due to drug allergies. University hospital providing primary and tertiary care. Using Anatomical Therapeutic Chemical (ATC) classification codes we allocated to drug specifying ICD-10 codes (i.e. Z88) all drugs belonging to the same group of compounds or those known to induce cross-allergy. In a randomly selected cohort of 200 in-patients we then assessed documentation and coding of drug allergies and incident prescribing errors ignoring patients' drug allergies. Eighteen of the 200 patients had an allergy-related ICD code in the chart, 51 had a written note, and 13 had both. About 21% of patients with documented drug allergies were prescribed a drug potentially triggering the allergy. There was no difference in prescribing errors due to drugs potentially inducing allergies when the allergy was only documented as an ICD-10 code or the information was available in the paper record (P > 0.05). The findings of this study emphasise the necessity of a more precise and efficient documentation system of drug allergies along with the implementation of an electronic CDS for drug allergies that makes physicians aware of patients' drug allergies during the prescribing process.
Medication Prescribing Error:A Source of Concern
Journal of applied pharmacy, 2015
Background: There are different types of medication errors which are experienced by the pharmacists in hospital settings.In Pakistan number of attending Pharmacist per bed is low and is a major cause of fatal and life threatening events. Aim: The aim of present retrospective study was to assess the extent and type of medication error in inpatient medical charts. Method: The physician’s orders were analyzed by the clinical pharmacists in hospital setting during 2007- 2008 in different wards. Various types of prescription errors had been reported and expressed in percentages. Result:Out of 450 medical treatment charts, 381 medication errors were found in 350 charts. The highest rate of error was the wrong dose (25%) prescribed by physicians.Infrequent errors were lack of dosage frequency, protocol for treatment, dosage form and continuation of antibiotic after prescribed treatment days. However, most frequently occurring serious errors were wrong dosing frequency (17%) and no dose adj...
Causes of prescribing errors in hospital inpatients: a prospective study
The Lancet, 2002
Background To prevent errors made during the prescription of drugs, we need to know why they arise. Theories of human error used to understand the causes of mistakes made in high-risk industries are being used in health-care. They have not, however, been applied to prescribing errors, which are a great cause of patient harm. Our aim was to use this approach to investigate the causes of such errors.
Prescribing errors during hospital inpatient care: factors influencing identification by pharmacists
Pharmacy World & Science, 2009
Objective: To investigate the prevalence of prescribing errors identified by pharmacists in hospital inpatients and the factors influencing error identification rates by pharmacists throughout hospital admission. Setting: 880-bed university teaching hospital in Northwest England. Methods: Data about prescribing errors identified by pharmacists (median: 9 (range 4-17) collecting data per day) when conducting routine work were prospectively recorded on 38 randomly selected days over 18 months. Main outcome measures: Proportion of new medication orders in which an error was identified; predictors of error identification rate, adjusted for workload and seniority of pharmacist, day of week, type of ward or stage of patient admission. Results: 33,012 new medication orders were reviewed for 5,199 patients; 3,455 errors (in 10.5% of orders) were identified for 2,040 patients (39.2%; median 1, range 1-12). Most were problem orders (1,456, 42.1%) or potentially significant errors (1,748, 50.6%); 197 (5.7%) were potentially serious; 1.6% (n = 54) were potentially severe or fatal. Errors were 41% (CI: 28-56%) more likely to be identified at patient's admission than at other times, independent of confounders. Workload was the strongest predictor of error identification rates, with 40% (33-46%) less errors identified on the busiest days than at other times. Errors identified fell by 1.9% (1.5-2.3%) for every additional chart checked, independent of confounders. Conclusions: Pharmacists routinely identify errors but increasing workload may reduce identification rates. Where resources are limited, they may be better spent on identifying and addressing errors immediately after admission to hospital.
Detecting Medication Errors in the New Zealand Pharmacovigilance Database
Drug Safety, 2011
Background: Despite the traditional focus being adverse drug reactions (ADRs), pharmacovigilance centres have recently been identified as a potentially rich and important source of medication error data. Objective: To identify medication errors in the New Zealand Pharmacovigilance database (Centre for Adverse Reactions Monitoring [CARM]), and to describe the frequency and characteristics of these events. Methods: A retrospective analysis of the CARM pharmacovigilance database operated by the New Zealand Pharmacovigilance Centre was undertaken for the year 1 January-31 December 2007. All reports, excluding those relating to vaccines, clinical trials and pharmaceutical company reports, underwent a preventability assessment using predetermined criteria. Those events deemed preventable were subsequently classified to identify the degree of patient harm, type of error, stage of medication use process where the error occurred and origin of the error. Results: A total of 1412 reports met the inclusion criteria and were reviewed, of which 4.3% (61/1412) were deemed preventable. Not all errors resulted in patient harm: 29.5% (18/61) were 'no harm' errors but 65.5% (40/61) of errors were deemed to have been associated with some degree of patient harm (preventable adverse drug events [ADEs]). For 5.0% (3/61) of events, the degree of patient harm was unable to be determined as the patient outcome was unknown. The majority of preventable ADEs (62.5% [25/40]) occurred in adults aged 65 years and older. The medication classes most involved in preventable ADEs were antibacterials for systemic use and anti-inflammatory agents, with gastrointestinal and respiratory system disorders the most common adverse events reported. For both preventable ADEs and 'no harm' events, most errors were incorrect dose and drug therapy monitoring problems consisting of failures in detection of significant drug interactions, past allergies or lack of necessary clinical monitoring. Preventable events were mostly related to the prescribing and administration stages of the medication ORIGINAL RESEARCH ARTICLE
BMJ Open, 2013
To evaluate the prevalence, type and severity of prescribing errors observed between grades of prescriber, ward area, admission or discharge and type of medication prescribed. Design: Ward-based clinical pharmacists prospectively documented prescribing errors at the point of clinically checking admission or discharge prescriptions. Error categories and severities were assigned at the point of data collection, and verified independently by the study team. Setting: Prospective study of nine diverse National Health Service hospitals in North West England, including teaching hospitals, district hospitals and specialist services for paediatrics, women and mental health. Results: Of 4238 prescriptions evaluated, one or more error was observed in 1857 (43.8%) prescriptions, with a total of 3011 errors observed. Of these, 1264 (41.9%) were minor, 1629 (54.1%) were significant, 109 (3.6%) were serious and 9 (0.30%) were potentially life threatening. The majority of errors considered to be potentially lethal (n=9) were dosing errors (n=8), mostly relating to overdose (n=7). The rate of error was not significantly different between newly qualified doctors compared with junior, middle grade or senior doctors. Multivariable analyses revealed the strongest predictor of error was the number of items on a prescription (risk of error increased 14% for each additional item). We observed a high rate of error from medication omission, particularly among patients admitted acutely into hospital. Electronic prescribing systems could potentially have prevented up to a quarter of (but not all) errors. Conclusions: In contrast to other studies, prescriber experience did not impact on overall error rate (although there were qualitative differences in error category). Given that multiple drug therapies are now the norm for many medical conditions, health systems should introduce and retain safeguards which detect and prevent error, in addition to continuing training and education, and migration to electronic prescribing systems.
2011
Some adverse drug reactions are due to hypersensitivity reactions. Drug allergy related errors in a handwritten treatment compared with those in an electronic prescribing system, characteristics of reported allergies and economic impact were analyzed. Prospective, observational study was carried out in two phases. 1 st Phase (manual prescriptions), errors due to drug allergy were detected when pharmacists registered allergies and then warned the physician. 2 nd Phase (electronic prescription) physicians registered allergies and entered treatments in a computerized physician order entry. The program warned avoiding prescription error. 3,682 patients were included. In phase 1, the incidence of prescription errors due to drug allergy was 13.7%, while in phase 2, it was 1.5% (p<0.001). The main drugs involved were antimicrobials. 52 reported allergies (29.7%) were confirmed by a positive allergy test. Alternative therapy was needed in 45 cases (22%), of which 44.1% were due to betalactamic allergy. On average, the alternative antimicrobial treatment multiplied costs per day by 4.4 fold. Computerized physician order entry is an effective tool in preventing medication errors associated with drug allergy. It is important to verify the drug allergy, because incorrectly reported allergies lead to less efficient treatments.
Pharmacology, Toxicology and Biomedical Reports
Methods: This is a 9-month cross-sectional study conducted at a 300-bed public hospital to evaluate pharmacist response and prevention of inpatient medication errors in adult and pediatric patients. There is a medication safety officer in the hospital along with a medication safety committee. The following information on medication errors were documented in the form available at the hospital: patient's demographic information, sources of medication errors, time of errors, type of errors, description of errors, causes of errors, recommendation to prevent such errors and the outcome of errors. The form was developed by using the National Coordinating Council (NCC) for Medication Error Reporting and Prevention (MERP) system. Results: According to the results, the pharmacist prevented a total of 3089 medication errors within 805 patients. About 3.8 errors per prescription were prevented. Most of the prevention occurred during prescribing stage (705 (99.2%)). Patient-related errors (1564 (50.63%)) and prescriber-related errors (1435 (46.46%)) were the most type of prevented errors. Allergy was the most prevented subtype of errors (560 (91.4%)) followed by patient's body weight (543 (88.6%)) and prescriber data missing/unclear (347 (56.6%)). Most of the errors that were prevented were near miss (93.3%) followed by 6.3% of the errors that reached the patient but did not cause any harm. The highest percentage with respect to the causes of medication errors was missing clinical information (649 (83.7%)) and miscommunication of drug order (627 (80.9%)). The top 20 medications involved in medication errors were oral and intravenous injections (Paracetamol and enoxaparin injection, respectively). Conclusion: The pharmacist plays a very crucial role in preventing medication errors. In order to prevent medication errors and improve patient outcome, the pharmacist provides education to the healthcare professional about medication safety and establishes the intravenous medication guidelines.
Drug safety, 2015
It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors. This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors. Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors. Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for a...