Prescription Errors Detected and Corrected by Pharmacy Service in by rt3463df

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									PRESCRIPTION ERRORS DETECTED
AND CORRECTED BY PHARMACY
      SERVICE IN THE ED
Philip Stasiak, BSc, M3 (presenting)
Xiaoqing Xue, MSc
Tanya Castelino, BSc, M1
Marc Afilalo, MD, MCFP(EM), FACEP, FRCP, CSPQ
Antoinette Colacone, BSC-CCRA
Nathalie Soucy, PhD
Jerrald Dankoff, MD, CSPQ
  Sponsorship

                      Jewish General Hospital




                    Canadian Patient Safety Institute


I do not have an affiliation (financial or otherwise) with
   any commercial organization that may have a direct or
   indirect connection to the content of my presentation.
Introduction
   Emergency Departments (ED) recognized as high risk
    areas for prescription errors
   ED Pharmacy Services is an important resource that
    aids in reviewing, identifying, and correcting
    prescribing errors
                                               Medical decision
                                                prescription

                                                transcription

                                                  dispensing

                                                administration
                        Medical   Medication
                         errors     errors        monitoring
Our Study
   Goals:

     Describe the frequency and type of prescription errors
      detected and corrected by the pharmacy service in the
      ED

     Identify   factors that are related to prescription errors in
      the ED
Site characteristics
   Tertiary teaching hospital ED in Montreal
   ED Pharmacy Service operates during weekday day
    shift (8 am – 4 pm)
   Every in-hospital ED prescription is reviewed by
    Pharmacy Service
   Prescription errors are corrected if possible
Methodology
   Prospective observational study
   25 consecutive weekdays
   All in-hospital prescriptions written in ED
   Errors were flagged and described by Pharmacy
    Service
Methodology
Data collected:
 Patient characteristics

       Age, LOS, triage category, CC, diagnosis, mode of arrival
   Date and time/shift
   Number of medications on prescription
   Doctor “type”
       EM staff, EM resident, consultant staff, consultant resident
Methodology
   If error:
     Error type: wrong drug
                      wrong dose
                      wrong frequency
                      wrong route
                      incomplete prescription
                      other
     Name of medication
     Description of error
     Error corrected
Results
   3137 prescriptions collected (containing a total of
    11534 medication orders) with 102 errors detected.
   Error rate: 3.5%
Results
  Results
Most common drugs
      with errors

   Name          %

  Diltiazem      7

acetylcysteine   4
Fluticasone/
                 3
 salmeterol
Carbidopa/
                 3
 levodopa
  Results

                         Day   Evening   Night

   Distribution of
written prescriptions
                         34%    40%      26%

Distribution of errors
      identified
                         19%    54%      27%


  Errors corrected       73%    83%      50%
    Results
Multiple logistic regression analysis: risk of prescription error


                 Variable                   Odds Ratio    95% CI

             Emergency residents               2.8        1.5-5.1

                  Age >65                      2.3       1.07-4.8
      # medication orders on prescription
       (per each additional medication)        1.2       1.16-1.24
Results
No errors were found in verbal order prescriptions
Most common VO prescriptions:     (total=142)
     IV fluids (33/142, 23%)
     Tylenol (23/142, 16%)     50%
     Morphine (15/142, 11%)



Most VO prescriptions were ordered by ER staff
Limitations
   Relied on pharmacy for confirmation of error – some
    errors may have been undetected

   Single ED with exclusively adult clientele, teaching
    hospital

   Weekends were not included

   Limited time period – unable to study seasonal
    effects
Concluding Statements
   Most common prescription errors were wrong dose,
    wrong frequency and incomplete prescription
   ED Pharmacy Services corrected most of the
    prescription errors
   Prescriptions with errors were more likely to contain
    many medication orders, written for patients older
    than 65, written by emergency residents
Future Research

   Cause of errors
   Adverse outcomes, impact on patient care
   Prevention of errors
   Electronic prescribing systems / computerized
    physician order entries
Questions?

								
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