Incomplete Prescription Research Articles

PS-100 Reconciliation errors at Cardiology Unit admission

BackgroundThe reconciliation process detects medicines errors and is a key point in improving patient safety.PurposeTo analyse the incidence, type and seriousness of reconciliation errors at admission to a Cardiology Unit.Materials...

Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia.

BackgroundMedication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients.ObjectiveTo assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia.MethodsA cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval).ResultsOut of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error.ConclusionsMedication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended.

Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems.

BackgroundChemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used.MethodsUp to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale.ResultsEight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome.ConclusionsChemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.

Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain

Medication errors are one of the main causes of morbidity amongst hospital inpatients. More than half of medication errors occur at 'interfaces of care', when patients are discharged or transferred to the care of another physician. Medication reconciliation is the process of reviewing patients' complete previous medication regimen, comparing it with current prescriptions, and analysing and resolving any discrepancies that the pharmacist does not believe to be intentional (unjustified discrepancies). To quantify and analyse reconciliation unjustified discrepancies detected by a pharmacist in patients admitted to an internal medicine unit (IMU) over a 3-year period. The hospital employs a pharmacist who acts as a link between the primary care services and the internal medicine specialist care unit. A retrospective descriptive study on the reconciliation discrepancies found was carried out. Medication reconciliation was performed upon admission in all patients transferred from the Accident and Emergency department (A&E) and admitted to the IMU, and also at the time of discharge. The interventions were categorised based on the consensus document on terminology and medication classification published by the Spanish Society of Hospital Pharmacy. Number of patients with unjustified discrepancies, also known as reconciliation errors. 2,473 patients had their treatment reviewed at the time of admission and 1,150 at discharge. 866 reconciliation discrepancies were detected in 446 patients (1.94 per patient). 807 (93 %) were accepted by the prescribing physician and classified as reconciliation errors. 16.8 % of patients had at least one reconciliation error: 63.8 % of these errors were incomplete prescriptions, 16.6 % were medication omissions and 10.5 % were errors in dosage, administration method and/or frequency. The rate of medication errors found in this study is low compared with other similar studies. The most common error was "incomplete prescriptions", most of them generated by the Accident and Emergency department. A computerised clinical history would help to decrease the number of reconciliation errors. Pharmacist interventions focused on medication reconciliation are well accepted by physicians, improving the quality of clinical histories and decreasing the number of medication errors that occur across transitions in patient care.

Response to Introduction of an N‐acetylcysteine weight‐based dosing chart reduces prescription errors in the treatment of paracetamol poisoning: Reply

Objective Under- or overdosing of N-acetylcysteine (NAC), when used to treat paracetamol toxicity, is associated with significant morbidity and mortality. This study evaluated the effect of a weight-based dosing chart (WBDC) introduced to decrease NAC prescription errors. Methods We undertook a pre- and post-intervention trial in a single ED. The intervention (the NAC WBDC) was introduced in January 2011 and publicised by posters and presentations at medical handovers and education sessions. ED staff were not aware that use of the WBDC was to be evaluated. Data were collected using a retrospective explicit medical record review by a single investigator. The study end-point was the proportion of NAC prescriptions with errors. Results The 81 and 42 patients enrolled in the pre- and post-intervention periods, respectively, did not differ in age, sex or weight (P > 0.05). Post-intervention, there were significant reductions in prescription errors of fluid type/volume (50.6% vs 4.8%, P < 0.001), NAC dosage (13.6% vs 0.0%, P = 0.01) and infusion rate (11.1% vs 0.0%, P = 0.03). The proportion of prescriptions with any errors also decreased (56.8% vs 14.3%, P < 0.001). However, there were no improvements in the documentation of patient weight (65.4% vs 64.3%, respectively, P = 0.90) or the proportion of incomplete prescriptions (4.9% vs 11.9%, P = 0.16). Conclusion The introduction of a WBDC did not produce a clinically significant reduction in major NAC prescription error rates (as pre-defined in this study); however, there was a clear trend towards a reduction. The WBDC significantly reduced total and minor NAC prescription error rates.

Errores de conciliación al ingreso hospitalario en pacientes pluripatológicos mediante metodología estandarizada

ObjectivesTo determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method. Material and methodA prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed. ResultsA total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors. ConclusionsThe percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels.

GRP-156 Reconciliation Errors at Cardiology Unit Admission

BackgroundThe reconciliation process detects medicines errors and is a key point for improving patient safety.PurposeTo analyse the incidence, type and severity of reconciliation errors at Cardiology Unit admission.Materials and MethodsDescriptive...

CPC-057 Evolution of Clinical Trial Prescribing Incidents

BackgroundIt is essential to record incidents in clinical trials (CT) to monitor them appropriately. It is a basic tool to analyse and detect problems.Purpose To analyse the development in prescription...

Introduction of an N‐acetylcysteine weight‐based dosing chart reduces prescription errors in the treatment of paracetamol poisoning

Under- or overdosing of N-acetylcysteine (NAC), when used to treat paracetamol toxicity, is associated with significant morbidity and mortality. This study evaluated the effect of a weight-based dosing chart (WBDC) introduced to decrease NAC prescription errors. We undertook a pre- and post-intervention trial in a single ED. The intervention (the NAC WBDC) was introduced in January 2011 and publicised by posters and presentations at medical handovers and education sessions. ED staff were not aware that use of the WBDC was to be evaluated. Data were collected using a retrospective explicit medical record review by a single investigator. The study end-point was the proportion of NAC prescriptions with errors. The 81 and 42 patients enrolled in the pre- and post-intervention periods, respectively, did not differ in age, sex or weight (P > 0.05). Post-intervention, there were significant reductions in prescription errors of fluid type/volume (50.6% vs 4.8%, P < 0.001), NAC dosage (13.6% vs 0.0%, P = 0.01) and infusion rate (11.1% vs 0.0%, P = 0.03). The proportion of prescriptions with any errors also decreased (56.8% vs 14.3%, P < 0.001). However, there were no improvements in the documentation of patient weight (65.4% vs 64.3%, respectively, P = 0.90) or the proportion of incomplete prescriptions (4.9% vs 11.9%, P = 0.16). The introduction of a WBDC did not produce a clinically significant reduction in major NAC prescription error rates (as pre-defined in this study); however, there was a clear trend towards a reduction. The WBDC significantly reduced total and minor NAC prescription error rates.

Medication reconciliation process in emergency department

BackgroundMedication reconciliation is a key point of security and improvement to patient care process.PurposeTo describe discrepancies in medication reconciliation process during admission and classify drugs involved in reconciliation errors according...

Management of clinical trials by the hospital pharmacy department

BackgroundThe management of errors by the hospital pharmacy department is a critical aspect for the conduct of clinical trials (CT).PurposeTo evaluate early identification and resolution of CT problems in order...

High risk drugsÖ reorganising the European Institute of Oncology

BackgroundJC Standards impose at hospitals organisation to develop a method to improve high risk drugs safety.PurposeEuropean Institute of Oncology (EIO) decided to develop this method improving the safety of high-alert...

Medication errors associated with reconciliation in a hospital with computerised physician order entry system with access to primary care treatment

BackgroundA recently introduced computerised physician order entry system (CPOES) in hospital and a primary care electronic record system help prescribing and provide information about patients' medicines. These tools should improve...

Instantaneous detection of nonadherence: quality, strength, and weakness of an electronic prescription database

The "personal electronic medicine profile" (PEM) is a Web-based tool for electronic prescription and monitoring of purchased medicine. It is based on the National Prescription Database and contains data on all prescriptions in Denmark. It includes information on time of drug purchase, number of tablets, and prescribed daily dosage. This allows calculation of the expected time for new purchases. To study the accuracy of the PEM as a tool for monitoring drug nonadherence as compared with pill counts (PCs). Five hundred eighty-three randomly selected elderly Danish citizens older than 65 years taking more than four drugs were studied. They were visited three times by a nurse who counted their medicine supply. Contingency table analysis was used to compare drug nonadherence calculated from PC with that revealed by PEM. For PC and PEM, an adherence level of at least 80% was defined as acceptable. PEM could not accurately process (non)adherence in 44% of all drugs. The probability of identifying drug nonadherence with PEM was low (negative predictive value 23%). Incomplete prescription information (34%) and inaccurate dosage registration (10%) were the major sources of error. PEM is inferior to PC for accurate monitoring of drug nonadherence. The inaccuracy is due to erroneous prescription information. PEM could be a powerful tool for electronic monitoring of drug nonadherence if prescription information was recorded uniformly and correctly. To increase the accuracy, we recommend informal free-text dosing instruction to be translated into a formal one by use of appropriate software such as library of phrases.

Medication Errors in a Neonatal Intensive Care Unit, Saudi Arabia: a Retrospective Study

Background and Aims: Medication errors (MEs) are important causes of morbidity that may result in death of already sick neonates. We aimed to study the nature of MEs of neonates admitted to level III neonatal intensive care unit (NICU) at Riyadh Military Hospital, Saudi Arabia. Methods: All incident reports (IRs) that were voluntarily reported to the Department of Continuous Quality Improvement and Patient Safety (January 2007 to March 2010) from our NICU were reviewed for MEs. From these reports, we estimated the incidence and nature MEs. In addition, our neonatal database was reviewed for patient characteristics. Results: There were 66 IRs involving MEs with estimated incidence of one per 250 admissions (mean gestational age: 32(SD)& 4.8,wks, birth weight: 1797±1012gm and median age: 19 days). They were more common during day shifts (66.7%). Most prevalent type was dispensing error (91%). Nurses were involved more commonly than pharmacists and physicians (66, 33 and 1%; respectively). The most common type of MEs for nurses: delay/not giving; pharmacists: delay /not dispensing and physicians; incomplete prescriptions. The most common medications involved were antibiotics and TPN. Patient harm that required intervention (category E) occurred in 56% while near-misses occurred in 25% and no harm in 14%. Errors of commission were 61%. Conclusions: In our NICU, the incidence of reported ME was low which could be due to underreporting. We recommend improving reporting system and training all staff involved in medication use about prevention of ME emphasizing on the nature of error in each category.

Validating a Classification Scheme for Medication Errors to be Used in Chemotherapy

ObjectiveTo validate a classification sheet for medication errors associated with antineoplastic medication. MethodProspective study. A data sheet was designed based on ASHP's classification. Two observers reviewed the treatment prescribed for chemotherapy from the Haematology Department during a month and they classified the errors detected. The interobserver concordance was analysed using the kappa index test. The error categories with a moderate or lower concordance were reviewed, and the need to modify them was evaluated. ResultsA total of 23 error categories were analysed and 162 lines of treatment were reviewed. Only one of the categories was assessable in accordance with its error prevalence, which was the category for incomplete or ambiguous prescriptions (kappa index=0.458=moderate concordance). The causes were analysed and subsections within this category itemised. ConclusionOur results proved the need to review error classification. Validated tools need to be made available so as to make progress in characterising this type of medication error.

Detection of prescribing related problems at the community pharmacy

The objective of this study was to detect prescribing-related problems at a community pharmacy in Madrid (Spain) and to analyze these problems from the perspective of their prevention and patient safety. A descriptive study was conducted at a community pharmacy during a 6-month period. The data collection was generated by the pharmacists reviewing all the prescriptions, and dispensed medication. All prescriptions, prescribing-related problems, and pharmacist interventions were recorded. Means, standard deviation, and frequency were calculated. A total of 23,995 prescriptions were evaluated, and 355 prescribing errors were detected. The most common problems were incomplete prescriptions or incorrect information, and prescriptions for unavailable items 70% (247/355). Inappropriate doses were reported in 27 cases (7.61%), followed by inappropriate direction/ instruction in 25 cases (8%). Fifty-four percent (195/355) of the errors were resolved without any contact with the general practices. The incidence of prescribing problems reported by community pharmacy was relatively low compared with other studies. This study has contributed to illustrate the role that community pharmacy has in the detection and rectification of prescribing problems to ensure maximum patient safety at the community setting.

Medication discrepancies at discharge from an internal medicine service

Background Medication errors most commonly occur at the time of medication prescribing and particularly at the moment of the transitions of care. The objectives of this study were to identify and characterize the discrepancies between the physicians' discharge medication orders and the medication lists at admission obtained by an internal medicine specialist physician in a general internal medicine service. Methods This descriptive, retrospective, study was carried out at a tertiary care university teaching hospital in Spain. It was based on the review of non selected, consecutive, hospital discharge reports. Discrepancies were identified, categorized and characterized through the analysis of the information (medication lists, laboratory tests results, diagnosis, and clinical evolution) contained in them. Results We analyzed 954 discharge reports. In the medication reconciliation process, we find discrepancies in 832 (87.2%) of them. Justified discrepancies were found in 828 (86.8%) reports and unjustified discrepancies in 52 (5.4%). Omission of a medication was the most frequent medication error detected in 86.4% of cases, followed by incomplete prescription (9.6%). The number of diagnosis, the length of hospital stay and the number of permanent medications at admission were the characteristics of cases associated with medication discrepancies in multivariate linear regression ( P < 0.01). Conclusions Although considering the limitations in its design, it is remarkable the low number of medication errors detected in our study. Appropriate routines to ensure an accurate medication history collection and a methodical elaboration of the medication list at discharge, when performed by trained internists, are important for an adequate medication reconciliation process.

Validación de una clasificación de errores de medicación para su utilización en quimioterapia

Objective To validate a classification sheet for medication errors associated with antineoplastic medication. Method Prospective study. A data sheet was designed based on ASHP's classification. Two observers reviewed the treatment prescribed for chemotherapy from the Haematology Department during a month and they classified the errors detected. The interobserver concordance was analysed using the kappa index test. The error categories with a moderate or lower concordance were reviewed, and the need to modify them was evaluated. Results A total of 23 error categories were analysed and 162 lines of treatment were reviewed. Only one of the categories was assessable in accordance with its error prevalence, which was the category for incomplete or ambiguous prescriptions (kappa index=0.458=moderate concordance). The causes were analysed and subsections within this category itemised. Conclusion Our results proved the need to review error classification. Validated tools need to be made available so as to make progress in characterising this type of medication error.

Information technology (IT) and chemotherapy (CT) prescribing errors.

6080 Background: The role of IT in preventing CT prescribing errors is unclear. Comparing their frequency across different studies is unworthy, due to inconsistencies in error classification, strategies of detection and functions of the IT system in use. Still, an intraorganizational study of error incidence, type and clinical relevance may reveal existing drawbacks and help to implement system applications. Methods: The study was part of a Health Department safety project. The study setting was the Cancer Unit at the University Hospital in Udine, Italy, where a computerized order entry system is fully operative since the end of 2006. Eligible prescriptions were made between January 2007-July 2008, by staff physicians with at least 2-year experience. Records of pts enrolled in clinical trials were excluded. A maximum of 3 random orders per eligible record were analyzed by trained residents and 2 oncology specialists. Errors were classified as inappropriate, incomplete or incorrect prescriptions and their severity was rated on a 4-point scale. Results: Among 237 eligible records (19% of screened charts), 125 have been analyzed so far, for a total of 305 prescriptions. The error rate was 18% and increased to 22% when considering that each order could contain > 1 error. Excluding a priori errors in the default CT protocol entry, the error rate fell to 7%. Most (62%) wrong prescriptions were incomplete - 95% because the route of administration was missing; 23% were incorrect – all because of under/overdosage; 15% were inappropriate. Inappropriateness was mainly due to errors in drug dose (50%) or treatment (30%) selection with respect to pts' age, organ function or tumor type; one patient was re-exposed to a drug causing a previous adverse reaction; and no CSF prophylaxis was given to a pt at high risk of febrile neutropenia. Among errors having caused injury (3%) or with potential for harm (9%), 25% were classified as minor, 37% as serious, 37% as potentially life-threatening. There was no fatal error. All errors were judged preventable or strongly preventable. Conclusions: CT prescribing errors may arise even in a fully computerized order entry system. Errors detection may help to identify system flaws and to fine-tune and improve its performance and utilization. No significant financial relationships to disclose.