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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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