Prescription Errors Research Articles

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool.

The purpose of the Ambulatory Electronic Health Record (EHR) Evaluation Tool is to provide outpatient clinics with an assessment that they can use to measure the ability of the EHR system to detect and prevent common prescriber errors. The tool consists of a medication safety test and a medication reconciliation module. The goal of this study was to perform a broad evaluation of outpatient medication-related decision support using the Ambulatory EHR Evaluation Tool. We performed a cross-sectional study with 10 outpatient clinics using the Ambulatory EHR Evaluation Tool. For the medication safety test, clinics were provided test patients and associated medication test orders to enter in their EHR, where they recorded any advice or information they received. Once finished, clinics received an overall percentage score of unsafe orders detected and individual order category scores. For the medication reconciliation module, clinics were asked to electronically reconcile two medication lists, where modifications were made by adding and removing medications and changing the dosage of select medications. For the medication safety test, the mean overall score was 57%, with the highest score being 70%, and the lowest score being 40%. Clinics performed well in the drug allergy (100%), drug dose daily (85%), and inappropriate medication combinations (74%) order categories. Order categories with the lowest performance were drug laboratory (10%) and drug monitoring (3%). Most clinics (90%) scored a 0% in at least one order category. For the medication reconciliation module, only one clinic (10%) could reconcile medication lists electronically; however, there was no clinical decision support available that checked for drug interactions. We evaluated a sample of ambulatory practices around their medication-related decision support and found that advanced capabilities within these systems have yet to be widely implemented. The tool was practical to use and identified substantial opportunities for improvement in outpatient medication safety.

Mitigation of IMRT/SBRT Treatment Planning Errors on the First Biology-Guided Radiotherapy System Using FMEA within Six Sigma Framework

Utilize the Six Sigma methodology and Failure Mode and Effect Analysis (FMEA) to prevent and mitigate errors in IMRT/SBRT treatment planning with the first clinical installation of biology-guided radiotherapy (BgRT) system. The Six Sigma approach consisted of five phases: Define-Measure-Analyze-Improve-Control. The Define-Measure-Analyze phases consisted of process mapping and an FMEA of the IMRT/SBRT treatment planning process on the BgRT system. The multidisciplinary team outlined the workflow process and identified the failure modes associated with the plan check items using AAPM TG-100 recommendations. Items with the highest average risk priority numbers (RPN) and Severity ≥7 were prioritized for automation using the treatment planning system scripting API (ESAPI). The Improve phase consisted of developing ESAPI scripts prior to the launch of the BgRT system to improve efficiency and safety. In the Control phase, the FMEA ranking was re-evaluated 1-year post-clinical launch. Overall, 100 plan check items were identified where the RPN values ranged from 10.2 to 429.0. Fifty of these items (50%) were suitable for automation within ESAPI. Of the 10 highest-risk items (Table 1), 8 were suitable for automation. Based on the results of the FMEA, two scripts were developed: Planning Assistant used by the planner during preparation for planning and the Automated Plan Check used by the planner and the plan checker during plan preparation for treatment. At 1-year post-clinical launch, the scripts were used for 80 patients successfully treated in 1747 fractions. During this period only 3 errors were reported: omitted bolus during treatment, nomenclature error in the BgRT system plan prescription, and dose tracking plan not approved following physics plan check. The average RPN pre-scripts was 138.0 compared to the average post-scripts RPN of 47.8 (p < 0.05) signifying a safer process. Implementing new technology into the clinic can be an error-prone process where the likelihood of errors increases with increasing pressure to implement the technology quickly. To limit errors in the clinical implementation of the first BgRT system, the Six Sigma methodology was utilized to identify failure modes, establish quality control checks, and re-evaluate these checks 1-year post-clinical launch.

Pharmacologic Stewardship in a Rural Community Pharmacy.

Pharmacotherapy is an essential part of patient care. In order to achieve optimal health outcomes, safe and effective prescribing and administering of medications is crucial, especially since the process of pharmacotherapy can cause serious problems, mainly adverse events and/or interactions, that often pass undetected. To investigate the feasibility of using community pharmacies as checkpoints to detect errors and failures in prescribing, as well as patients' compliance with pharmacotherapy. To this end, analysis and recording of the prescribing process was carried out and error-prone points were identified. Patients and caregivers filling prescriptions during the first 4 weeks of November 2017 and February 2018 answered questions in order to evaluate their attendance of regular checkups and their compliance with prescribing instructions. All prescriptions filled at the pharmacy were examined for detection of prescription errors and drug-drug interactions. Statistical analyses, including calculations of the correlation coefficient phi (φ), chi-square, and confidence intervals, were carried out. Detected errors and failures were evaluated by application of the Health Failure Mode Effect Analysis (HFMEA) quality tool. A significant number of patients (16.7%) failed to regularly attend checkups regarding known health problems (95% CI: 10.6-22.7%), a corresponding percentage (16%, 95% CI: 10.1-21.9%) did not comply with prescribed pharmacotherapy, and a significant proportion of patients self-medicated regularly (32%, 95% CI: 24.5-39.5%). A total of 8.6% of prescriptions included medication combinations with a potential for severe drug-drug interactions (95% CI: 7.1-10.2%) while 58.7% of the prescriptions included combinations that could lead to moderate ones (95% CI: 56.1-61.4). The HFMEA indicated that all problems recorded required immediate interventions, except for prescribing errors. Community pharmacies can be potential checkpoints for the detection and evaluation of prescribing errors and pharmacotherapy failures.

Determining Medication Errors in an Adult Intensive Care Unit.

Research addressing the costs of Medication errors (MEs) is still scarce despite issues related to patient safety having significant economic and health impacts, making it imperative to analyze the costs and adverse events related to MEs for a better patient, professional, and institutional safety. To identify the number of medication errors and verify whether this number was associated with increased hospitalization costs for patients in an Intensive Care Unit (ICU). This retrospective cross-sectional cohort study evaluated secondary data from patients' electronic medical records to compile variables, create a model, and survey hospitalization costs. The statistical analysis included calculating medication error rates, descriptive analysis, and simple and multivariate regression. The omission error rate showed the highest number of errors per drug dose (59.8%) and total errors observed in the sample (55.31%), followed by the time error rate (26.97%; 24.95%). The omission error had the highest average when analyzing the entire hospitalization (170.40) and day of hospitalization (13.79). Hospitalization costs were significantly and positively correlated with scheduling errors, with an increase of BRL 121.92 (about USD $25.00) (95% CI 43.09; 200.74), and to prescription errors, with an increase of BRL 63.51 (about USD $3.00) (95% CI 29.93; 97.09). We observed an association between two types of medication errors and increased hospitalization costs in an adult ICU (scheduling and prescription errors).

330 Evaluating anticoagulant prescribing errors in older adults in a rehabilitation setting

Abstract Background Anticoagulant use is common in older adults for the prevention or treatment of a number of conditions, most commonly Venous Thrombo-Embolism (VTE) or to prevent stroke in atrial fibrillation. Our audit aimed to review anticoagulation prescribing practices, identify errors and areas for improvement. Methods The initial retrospective audit of all inpatients in a medical gerontology ward took place from 15/11/2022–30/12/22. Data collected included age, sex, weight, renal profile, anticoagulation type, dose and indication. Information was collected from medication records, clinical notes and online laboratory system. After initial audit, multiple education sessions were conducted with the medical team. Re-audit of all inpatients occurred from 05/04/2023–25/04/2023. The guidelines used were the HSE Prescribing Tips for Anticoagulation and local Hospital Guidelines on VTE prophylaxis. Results The initial audit of 73 patients showed 15% (11) rate of prescribing error with 7 subtherapeutic and 4 supratherapeutic doses. Of these 11 errors, 4 doses were corrected recently prior to audit. Average age was 82.6 (64–100) and 55% (40) were female. The re-audit of 51 patients showed the rate of error improved to 7.84%(4) with 4 supratherapeutic doses. 1 dose was corrected on admission and 5.88%(3) required dose adjustment due to fluctuations in weight and renal function throughout admission. Average age was 83.1(66–103) and 69%(35) were female. Conclusion The re-audit demonstrated ongoing education sessions reduces prescribing error with a 48% reduction. However ongoing monitoring throughout admission is required to account for fluctuations in weight and renal function. Suggestions for further improvements include ongoing regular education sessions with the medical team. Further sessions are planned with the wider multidisciplinary team members to highlight importance of regularly monitoring weight and renal function and medication dosages. This audit also reinforces the importance of the role of pharmacist in the multidisciplinary team in Rehabilitation Units and would support regular pharmacist input on an regular basis.

253 An audit of the inpatient management of Parkinson’s Disease medication in a level four hospital in 2019

Abstract Background Parkinson’s Disease (PD) is a progressive, complex neurodegenerative disease characterised by both motor and non-motor symptoms. PD medications are time sensitive, and their correct prescription and administration are crucial in optimal management strategies. Previous work presented at the Irish Gerontological Society showed a lack of knowledge regarding PD and its medications among healthcare staff in a level four hospital. Methods Data were collected from a retrospective chart analysis of PD admissions in 2019. 115 admissions coded PD were identified from HIPE data. Subsequently, 10 patients were randomly selected from medical, surgical, and orthopaedic admissions respectively (39 admissions). Patients were excluded if they were not on PD-specific medications or if their drug Kardex was not available. 28 patient Kardex’s were reviewed. Data was collected using a predetermined spreadsheet and analysed using Microsoft Excel. Results 100% of patients were on levodopa medication. 86% of patients did not receive their appropriate PD medications in the Emergency department. 21% had errors in medication prescription (omitted drug [n = 4, 14%], incorrect timings [n = 2, 7%]) on admission. 75% missed at least one dose of levodopa. 83 doses of levodopa were missed across the 28 admissions. 40% were because the patient was nil by mouth (NPO), while 21% had no reason documented. 64% of patients had doses of levodopa delayed by more than 1 hour, with over 80% of these in the perioperative period. 5 patients (18%) received antidopaminergic drugs. Conclusion This review highlighted multiple shortcomings in PD medication management during acute admissions. We introduced hospital guidelines for the management of patients with PD while NPO. This guideline includes information on alternatives to oral route, advice regarding the perioperative period, and medications to avoid. It has been approved by the Medications and Therapeutics committee and will be introduced with education sessions at the changeover. We will reaudit practices after 6 months.

Tackling Drug-Resistant Tuberculosis: New Challenges from the Old Pathogen Mycobacterium tuberculosis.

Antibiotics have played a crucial role in the reduction in the incidence of TB globally as evidenced by the fact that before the mid-20th century, the mortality rate within five years of the onset of the disease was 50%. The use of antibiotics has eliminated TB as a devastating disease, but the challenge of resistance to anti-TB drugs, which had already been described at the time of the introduction of streptomycin, has become a major global issue in disease management. Mismanagement of multidrug-resistant tuberculosis (MDR-TB) cases, resulting from intermittent drug use, prescription errors, and non-compliance of patients, has been identified as a critical risk factor for the development of extensively drug-resistant tuberculosis (XDR-TB). Antimicrobial resistance (AMR) in TB is a multi-factorial, complex problem of microbes evolving to escape antibiotics, the gradual decline in antibiotic development, and different economic and social conditions. In this review, we summarize recent advances in our understanding of how Mycobacterium tuberculosis evolves drug resistance. We also highlight the importance of developing shorter regimens that rapidly reach bacteria in diverse host environments, eradicating all mycobacterial populations and preventing the evolution of drug resistance. Lastly, we also emphasize that the current burden of this ancient disease is driven by a combination of complex interactions between mycobacterial and host factors, and that only a holistic approach that effectively addresses all the critical issues associated with drug resistance will limit the further spread of drug-resistant strains throughout the community.

Are Physician Assistants Able to Correctly Identify Prescribing Errors? A Cross-Sectional Study

Purpose (1) To describe how often physician assistant (PA) students correctly identify prescribing errors and (2) examine between-cohort differences on ability to correctly identify prescribing errors. Methods This was a cross-sectional study of 2 cohorts of PA students at one institution. Students were presented with 3 hypothetical prescriptions, 2 of which contained a prescribing error. For each prescription, students were asked to (1) identify whether an error occurred and (2) indicate the type of error. A simple Poisson regression model analyzed the data. Results We received responses from 130 students (72.6% response rate). Approximately 12% (12.3%, n = 16) correctly identified whether all 3 prescriptions were correct. The median number of correctly identified prescriptions was 1 (interquartile range = 1). There was not a statistically significant between-cohort difference identifying the correct number of prescriptions (β = 0.27, P = .10). Conclusion Physician assistant students' prescribing error identification was similar to previous research in medical and nursing students. Efforts to improve prescribing training are critical to ensure patient safety.

The Digital Hospital: A Scoping Review of How Technology Is Transforming Cardiopulmonary Care.

Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings. The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings. Scoping review. Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias. Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool. While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes. Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU).

Do junior doctors make more prescribing errors than experienced doctors when prescribing electronically using a computerised physician order entry system combined with a clinical decision support system? A cross-sectional study

ObjectivesPrescribing errors can lead to inconvenience, morbidity and mortality. It is therefore crucial to educate doctors to prescribe safely, efficiently and effectively. To create an effective educational programme, it is...

Prescription Error

Objective: This research study aimed to investigate prescription errors and their intervention outcomes at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, during the year 2023. The study assessed the prevalence of prescription errors, identified contributing factors, evaluated the effectiveness of medication safety interventions, and examined the impact of adverse drug events on patient outcomes and healthcare costs. Methods: A cross-sectional study design was employed, and data were collected from the hospital's prescription files. Prescription errors were classified into various categories, and the frequency and proportion of errors were calculated. The study also evaluated different medication safety interventions' effectiveness in reducing prescription errors and assessed healthcare professionals' adherence to medication safety protocols. Additionally, the study conducted a cost analysis of adverse drug events to assess their financial implications. Results: The study revealed a prescription error rate of 25.1%, with wrong dosage, drug omission, drug-drug interactions, and illegible prescriptions being the most common error categories. Adverse drug events resulting from prescription errors affected 12.2% of patients, leading to patient harm and increased healthcare utilization. The electronic prescribing system emerged as the most effective intervention, reducing prescription errors by 60.1%. High adherence rates were observed for double-checking high-risk medications and conducting medication safety huddles. However, there was room for improvement in implementing barcoding technology and tall man lettering. Conclusion: Prescription errors and adverse drug events pose significant challenges to medication safety at Zewditu Memorial Hospital. Implementing electronic prescribing systems and enhancing medication reconciliation processes can significantly reduce prescription errors and improve patient outcomes. Furthermore, fostering a culture of safety, promoting interprofessional collaboration, and investing in education and training programs are essential to enhance medication safety practices. Continuous quality improvement initiatives and regular audits should be conducted to address medication safety challenges and support a culture of learning from errors. Policymakers should be engaged to support medication safety initiatives, and multi-center studies are recommended to enhance generalizability.

SP9.17 Adherence to fluid guidelines in surgical patients and impact on complication rate

Abstract Aims Up to 95% of intravenous fluid prescription requests for surgical patients are executed by Foundation Year-1(FY1) doctors. This, notwithstanding the plethora of studies suggesting FY1 doctors are inadequately equipped to be prescribing fluids unsupervised. Poor intravenous fluid therapy is associated with an approximate 20% complication rate, including electrolyte abnormalities, dysrhythmia and fluid overload. Methods A closed-loop audit was performed at a large teaching hospital to examine compliance with fluid prescribing guidelines and associated complications. This involved a 4-week retrospective review of drug prescription charts against NICE guidelines followed by a targeted intervention that involved a dedicated teaching session on fluid management in the surgical patient, alongside posters and crib sheets of fluid management on surgical wards. The re-audit using the same criteria compared proportion of prescription errors, over- or under-hydration, and total complications before and after intervention. Results 308 patient records were reviewed (pre-intervention n=185; post-intervention n=123). Documentation of fluids indication (31% vs 46%(p&amp;lt;0.0414)), contingency plans (3% vs 38%(p&amp;lt;0.0001)) and glucose prescription for nil per os patients on maintenance fluids (10% vs 25% (p=0.0029)) improved post-intervention. Fluid balance monitoring (29% vs 9%(p=0.0001)) worsened. The proportion of patients receiving insufficient potassium (91% both rounds), excess sodium (90% vs 92% (p=0.6212)), and the average rate of complications (1 in 1.67 vs 1 in 1.54, p=0.4652) remained unchanged. Conclusion Didactic educational intervention for FY1 doctors on fluid therapy improved documentation on fluids indication, but failed to resolve significant prescription failures and resulted in similar complication rates pre-and post-intervention.

Improving Clinician Confidence in Insulin Prescriptions at Discharge for Individuals With Newly Diagnosed Type 1 Diabetes.

Background In a questionnaire, we found that pediatric clinicians at Basildon and Thurrock University Hospital (BTUH) have low confidence levels in prescribing multiple daily injections (MDI) for newly diagnosed pediatric patients with type 1 diabetes mellitus. We designed and evaluated locally tailored prescription guidance to improve confidence in MDI discharge prescriptions for pediatric doctors of all grades. Methods We designed a prescription guidance tool by adapting existing local guidelines to improve clinician familiarity with MDI prescriptions and prevent prescription errors. The intervention was delivered in a single pediatric unit to doctors of all levels. Feedback was collected, and the clinicians' confidence in their MDI prescriptions was evaluated before and after the intervention. Questionnaires were distributed to all pediatric doctors within the unit to assess their confidence in prescribing MDIs using a five-point Likert Scale. Furthermore, the questionnaires aimed to determine whether clinicians regularly consulted the existing local guidelines. Local guidelines were adapted in consultation with the local pediatric diabetic multidisciplinary team (MDT) and with reference to the East of England Pediatric Diabetes Network to present MDI guidance in a more concise format, which includes an example MDI discharge medication checklist. Following approval by the local guidelines management group, additional changes were made to enhance the practicality and accessibility of the discharge prescription guidance for clinicians. These guidelines were distributed to the pediatric MDT via email and displayed in visible areas of the department. Results Out of the 13 doctors surveyed, 10 provided pre- and post-intervention feedback (77%). Statistical significance was calculated using unpaired t-tests. Ninety percent of pediatric doctors routinely refer to local guidelines for guidance on MDI prescriptions. However, 50% of respondents felt that existing local guidelines were not easily accessible, given the time and effort required to locate them. The mean confidence score for completing MDI prescriptions at discharge before the intervention was 1.9 (SD: 0.83). After the intervention, it increased to 4 (SD: 0.63) (95% CI: 2.79-1.41, p<0.0001). Ninety percent of pediatric doctors felt that the design and display of the MDI guidelines optimized patient care. Conclusions Following the presentation of the project at a local audit and quality improvement (QI) meeting, the adapted guidelines were included in the junior doctor induction program at BTUH and made accessible on the local intranet. The production of locally tailored prescription guidance for MDI prescriptions at discharge has led to an increase in the confidence of pediatric doctors when writing their prescriptions. We aimed to continue updating this guidance as necessary and making further developments to enhance clinician confidence.

Introduction of Supervisor-Type Pediatric Hospitalists in a Tertiary Children's Hospital: Experiences in a Hematology/Oncology Ward.

(1) Background: Hospitalists are healthcare providers who focus on hospitalized patients, but research on the roles of pediatric hospitalists is lacking. This study investigates the role of a supervisor-type hospitalist in a pediatric hematology/oncology ward at a tertiary children's hospital, assessing the impact on satisfaction levels among patient caregivers, resident physicians, and nurses. (2) Methods: A retrospective analysis and online surveys were conducted to assess satisfaction levels before and after the introduction of hospitalists in the Department of Pediatric Hematology/Oncology at Seoul National University Children's Hospital in the Republic of Korea. (3) Results: The introduction of hospitalists led to a 19.3% reduction in prescription error interventions over six months. Unexpected transfers to the intensive care unit decreased from 1.4% to 0.7% (p = 0.229). Patient caregivers reported elevated satisfaction levels with physicians (rated 8.47/10), and there was a significant enhancement in overall satisfaction among nurses (increasing from 3.23 to 4.23/5, p < 0.001). The majority of resident physicians (83.3%) expressed contentment with the hospitalist system, with 77% indicating an interest in transitioning to a hospitalist role. However, these resident physicians also expressed concerns regarding job stability. (4) Conclusions: Supervisor-type pediatric hospitalists have the potential to elevate satisfaction levels not only among patient caregivers but also among nurses and resident physicians, showing promise in improving medical care quality. Nonetheless, ensuring favorable perception and securing job stability within the hospitalist system are pivotal for achieving successful implementation.

Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms.

Potential medication errors and related adverse drug events (ADE) pose major challenges in clinical medicine. Clinical decision support systems (CDSSs) help identify preventable prescription errors leading to ADEs but are typically characterized by high sensitivity and low specificity, resulting in poor acceptance and alert-overriding. With this cross-sectional study we aimed to analyze CDSS performance, and to identify factors that may increase CDSS specificity. Clinical pharmacology services evaluated current pharmacotherapy of 314 patients during hospitalization across three units of two Swiss tertiary care hospitals. We used two CDSSs (pharmaVISTA and MediQ), primarily for the evaluation of drug-drug interactions (DDI). Additionally, we evaluated potential drug-disease, drug-age, drug-food, and drug-gene interactions. Recommendations for change of therapy were forwarded without delay to treating physicians. Among 314 patients, automated analyses by both CDSSs produced an average of 15.5 alerts per patient. In contrast, additional expert evaluation resulted in only 0.8 recommendations per patient to change pharmacotherapy. For clinical pharmacology experts, co-factors such as comorbidities and laboratory results were decisive for the classification of CDSS alerts as clinically relevant in individual patients in about 70% of all decisions. Such co-factors should therefore be used for the development of multidimensional CDSS alert algorithms with improved specificity. In combination with local expert services, this poses a promising approach to improve drug safety in clinical practice.

The impact of transition to a digital hospital on medication errors (TIME study)

Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors.

An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study.

Background: Inappropriate medication in older patients with multimorbidity results in a greater risk of adverse drug events. Clinical decision support systems (CDSSs) are intended to improve medication appropriateness. One approach to improving CDSSs is to use ontologies instead of relational databases. Previously, we developed OntoPharma-an ontology-based CDSS for reducing medication prescribing errors. Objective: The primary aim was to model a domain for improving medication appropriateness in older patients (chronic patient domain). The secondary aim was to implement the version of OntoPharma containing the chronic patient domain in a hospital setting. Methods: A 4-step process was proposed. The first step was defining the domain scope. The chronic patient domain focused on improving medication appropriateness in older patients. A group of experts selected the following three use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events. The second step was domain model representation. The implementation was conducted by medical informatics specialists and clinical pharmacists using Protégé-OWL (Stanford Center for Biomedical Informatics Research). The third step was OntoPharma-driven alert module adaptation. We reused the existing framework based on SPARQL to query ontologies. The fourth step was implementing the version of OntoPharma containing the chronic patient domain in a hospital setting. Alerts generated from July to September 2022 were analyzed. Results: We proposed 6 new classes and 5 new properties, introducing the necessary changes in the ontologies previously created. An alert is shown if the Medication Regimen Complexity Index is ≥40, if the Drug Burden Index is ≥1, or if there is a trigger based on an abnormal laboratory value. A total of 364 alerts were generated for 107 patients; 154 (42.3%) alerts were accepted. Conclusions: We proposed an ontology-based approach to provide support for improving medication appropriateness in older patients with multimorbidity in a scalable, sustainable, and reusable way. The chronic patient domain was built based on our previous research, reusing the existing framework. OntoPharma has been implemented in clinical practice and generates alerts, considering the following use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events.

Drug Prescribing Pattern among the Inpatients in the Surgery Department of Tertiary Hospital of Eastern Nepal

Background: Prescription is a written instruction by a health care personnel to pharmacist to dispense drug(s). Irrational drug prescribing is a global problem, particularly in developing and transitional countries. This study was conducted to see the status of World Health Organization (WHO) core prescription indicators, complementary indices and prescription errors. Methods: It was a quantitative cross-sectional descriptive study carried out among inpatients of general surgery of tertiary hospital in eastern Nepal. Ethical approval for the study was obtained from the Institutional Review Committee. It was a convenience sampling. Calculated Sample size was 224. Enrollment of patients started on 16 May 2018 with the last case being enrolled on 1 Oct 2019 after obtaining informed consent. Relevant data was entered in a semi-structured proforma. Microsoft excel 2016 and IBM Statistical Package for the Social Sciences (SPSS) v. 21 were used for descriptive statistics. Results: Median age of inpatients was 40 (24 - 54) years with male: female ratio being 1.05. Total 1492 drugs were prescribed in 224 prescriptions. Mean number of drugs prescribed was 6.66 ± 2.33. Percentage of drugs prescribed by generic name was 25.60%. Prescriptions with at least one antimicrobial agent was 89.3%. Prescriptions with at least one injection was 92.9%. Percentage of drugs prescribed from the WHO Essential Medicine List was 66.48%. Other complementary prescribing indicators and prescription errors were also calculated. Conclusions: Most prescription indicators were inadvertently deviated away from WHO standards. Prescription errors were comparable to other studies.

Traduction et adaptation au contexte hospitalier français d’un outil de codification des erreurs de prescription liées aux logiciels

Prescribing errors related to computerized physician order entry are current and may have serious consequences for patients. They can be detected by pharmacists during prescriptions analysis and lead to pharmacist's interventions. In France, few monocentric studies have studied Pharmacist Interventions triggered by prescribing errors identified as System-Related Errors (PISREs) in French hospitals. However, their respective analysis method prevent any comparison between computerized physician order entry systems in order to identify the safest and rule out the most dangerous. A computerized physician prescribing error related to the software is characterized by its causes, consequences and mechanism of occurrence. US researchers have developed and validated a tool to classify and illustrate these three characteristics. The objectives of this article are to present this tool, to propose a French adaptation and to describe the perspectives analyze and understand prescription errors related to computerized physician order entry based on data of Act-IP©. The adaptation was performed using PISREs extracted from the Act-IP© observatory of the French Society of Clinical Pharmacy. Each item of the codification is illustrated with an example of PI. We are considering a training plan in order to allow wide use of this tool. Once adopted this tool, the next step will be to organize a prospective multicenter study including as many computerized prescription order entry systems as possible. The aim of this study will be identifying the safest systems. Consequently, it will then be possible to have arguments to qualify the most dangerous and thus propose their withdrawal from the market.

Potential drug-drug interactions and prescription errors in COVID-19 infected patients

Potential drug-drug interactions and prescription errors in COVID-19 infected patients