Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis.

Thibaut Caruba,Vanida Bruni,Florence Gillaizeau,Patrice Prognon,Brigitte Sabatier,Dominique Bégué,Pierre Durieux,Isabelle Colombet,Virginie Korb

doi:10.1186/1472-6963-10-13

Abstract

BackgroundDrug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (i.e. override the alert).MethodsWe prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (i.e. prescribing error repeated).Results12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (i.e error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist's alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error.ConclusionsSince 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts.

Highlights

Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors
Drug prescribing errors are defined as a prescribing decision or prescription writing process that results in an unintentional, significant reduction in the probability of treatment being timely and effective or increase in the risk of harm, when compared with generally accepted practice
We modelled the risk of an error on ith day of stay with a Generalized Estimating Equation (GEE) regression model taking account for dependency between repeated measurements in a stay

Summary

Introduction

Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient’s stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the day despite pharmacist’s alert (i.e. override the alert). High rates of inpatient prescribing errors have been reported: 1.5-5.3 per 100 drug orders, or 1.4 errors per admission [1,2]. Clinical Decision Support Systems [3,4,5,6,7] and the review of drug orders by pharmacists (hereafter referred to as ‘pharmacy validation’) [8,9,10], can reduce the rate of errors. The prevention of prescribing errors implies that the physician captures his/her prescriptions in the CPOE and a pharmacist analyses them the same day to detect a prescribing error. We showed in a previous study that prescribers override 70% of pharmacists’ alerts [11]

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