Abstract
BackgroundMedication charting errors occur often and can be harmful for patients. Interventions to improve charting errors have demonstrated some success particularly if the intervention uses multiple approaches including an education component. The aim of this pilot study was to determine whether a multi-faceted intervention, including education of junior doctors and weekday re-charting could reduce in-hospital charting error.MethodsMedication charts (n = 579) of all patients admitted to the medical ward of a medium sized regionally-based hospital in Australia over nine months (baseline and during intervention) were inspected for errors. The intervention ran for three months and involved implementation of a National Inpatient Medication Chart targeted error tool with eight targeted charting requirements which was used for visual reminders in the ward and training of junior doctors. In addition, mid-weekly re-charting (MOWER) was performed by a senior and junior doctor team.ResultsThe mean number of charting requirement errors significantly reduced during the intervention by 26% from 4.6 ± 1.3 to 3.4 ± 1.7 per chart (p < 0.001). Re-chart errors reduced on average by 50% (4.4 ± 1.4 to 2.2 ± 1.7 per chart, p < 0.001) and primary (initial) charts by 20% (4.6 ± 1.3 to 3.7 ± 1.5 per chart, p < 0.001) during the intervention. Failing to provide indication information for a drug, prescriber name, and failing to use generic rather than brand names were the categories with the most errors at baseline and also showed the largest error reductions during the intervention.ConclusionsA multi-intervention including education of junior doctors, visual reminders and midweek re-charting are effective in reducing the rate of charting errors. We advise that a larger study is now conducted using the same multi-intervention strategy in different ward settings to evaluate feasibility and sustainability of this intervention.
Highlights
Medication charting errors occur often and can be harmful for patients
The focus of this study is the National Inpatient Medication Chart (NIMC) that is implemented by the Australian Commission on Safety and Quality in Health Care for mandatory use in all hospitals in Australia, for both paper and electronic charting [19]
The multi-intervention significantly reduced the overall error rate by 26%, 1.2 (95%CI 0.9, 1.5) errors per chart during the intervention
Summary
Interventions to improve charting errors have demonstrated some success if the intervention uses multiple approaches including an education component. The aim of this pilot study was to determine whether a multi-faceted intervention, including education of junior doctors and weekday re-charting could reduce in-hospital charting error. Single factor interventions that have shown success when combined with education interventions include: audit and feedback [14], manual reminders such as posters with checklists for correct prescribing [14, 15] and involving pharmacists in medication charting and medical reconciliation [16]
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