Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study

Medication errors in emergency departments: a systematic review and meta-analysis of prevalence and severity

BACKGROUND

Medication errors significantly compromise patient safety in emergency departments. Although previous studies have investigated the prevalence of these errors in this setting, results have varied widely.

AIM

The aim was to report pooled data on the prevalence and severity of medication errors in emergency departments, as well as the proportion of patients affected by these errors.

METHOD

Systematic searches were conducted in Embase, PubMed, and the Cochrane Library from database inception until June 2023. Studies provided numerical data on medication errors within emergency departments were eligible for inclusion. Random-effects meta-analysis was employed to pool the prevalence of medication errors, the proportion of patients experiencing these errors, and the error severity levels. Heterogeneity among studies was assessed using the I2 statistic and Cochran's Q test.

RESULTS

Twenty-four studies met the inclusion criteria. The meta-analysis gave a pooled prevalence of medication errors in emergency departments of 22.6% (95% Confidence Interval [CI] 19.2-25.9%, I2 = 99.9%, p < 0.001). The estimated proportion of patients experiencing medication errors was 36.3% (95% CI 28.3-44.3%, I2 = 99.8%, p < 0.001). Of these errors, 42.6% (95% CI 5.0-80.1%) were potentially harmful but not life-threatening, while no-harm errors accounted for 57.3% (95% CI 14.1-100.0%).

CONCLUSION

The prevalence of medication errors, particularly those potentially harmful, underscores potential safety issues in emergency departments. It is imperative to develop and implement effective interventions aimed at reducing medication errors and enhancing patient safety in this setting.

Incidence of Medication-Related Problems Following Pediatric Epilepsy Admissions

BACKGROUND

An estimated 26% to 33% of pediatric patients have at least one medication error at hospital discharge. Pediatric patients with epilepsy may be at greater risk due to complex medication regimens and frequent hospitalizations. This study aims to quantify the proportion of pediatric patients with epilepsy experiencing medication problems after discharge and determine if medication education decreases these problems.

METHODS

This was a retrospective cohort study including pediatric patients with epilepsy-related hospital admissions. Cohort 1 consisted of a control group, and cohort 2 consisted of patients who received discharge medication education, enrolled in a 2:1 ratio. The medical record was reviewed from hospital discharge to outpatient neurology follow-up to identify medication problems that occurred. The primary outcome was the difference in proportion of medication problems between the cohorts. Secondary outcomes were incidence of medication problems with harm potential, overall incidence of medication problems, and 30-day epilepsy-related readmissions.

RESULTS

A total of 221 patients were included (163 in the control cohort and 58 in the discharge education cohort) with balanced demographics. The incidence of medication problems was 29.4% in the control cohort and 24.1% in the discharge education cohort (P = 0.44). The most common problems were mismatched dose or direction. Medication problems with harm potential were 54.2% in the control group and 28.6% in the discharge education cohort (P = 0.131).

CONCLUSION

Medication problems and their harm potential were lower in the discharge education cohort, but the difference was not significant. This demonstrates education alone may not be enough to impact medication error rates.

Impact of Partnered Pharmacist Medication Charting (PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign

Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies' clinical significance, with 'unintentional' discrepancies deemed 'errors'. Fewer patients in the PPMC group had at least one error (3.5%; 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4%; 95% CI: 42.5% to 56.3%) and usual care group (61.4%; 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.

Current views of community and hospital pharmacists on pharmaceutical care services in the United Arab Emirates: A mixed methodological study

Background: The profession of pharmacy has evolved significantly in recent years in terms of professional service delivery. The aim of this study was to explore the current views of pharmacists in the United Arab Emirates (UAE) on pharmaceutical care services and the nature of barriers encountered in practice using qualitative and quantitative assessment methods. Methods: A cross-sectional study was conducted among hospital and community pharmacists (n = 305) between March and May 2021, using qualitative and quantitative assessment methods. In the qualitative phase, 15 interviews were conducted to explore five main criteria: patient information, inadequate patient counseling, prescribing errors prevention and identifying drug-related problems, lack of participation in health awareness programs, and barriers to pharmaceutical care implementation. In the quantitative phase, 305 consenting pharmacists completed a questionnaire on seven criteria: demographic profile, pharmacist-physician interaction, patient counseling assessment, patient reports of adverse drug events, pharmacist participation in health awareness programs, perceptions of reducing prescribing errors and identifying drug-related problems, and barriers to appropriate pharmaceutical care implementation. Results: The results of both the qualitative and quantitative phases of the study revealed that pharmacists' influence on practice in the UAE is limited due to many factors, mainly lack of time and patients' ignorance of the pharmacist's role in the medical field. The mean responses regarding pharmacists' approach to patient counseling and patients' knowledge of pharmacists' role in managing adverse drug reactions were 77.1% and 59.7%, respectively. Active participation in health awareness programs was 64.8%. The mean positive response of participants in reducing prescribing errors and recognizing drug-related problems was 9.2%. Pharmacists' age and number of years in practice were the most important factors influencing the pharmaceutical care services implementation. Conclusion: The study has shown the need to shed light on the proper implementation of pharmaceutical care while maintaining a trusting relationship with physicians.

Initiation of a discharge pharmacy within a busy urban emergency department: The first year

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

Discharge prescriptions represent an important aspect of care for patients seen in the emergency department (ED) setting and are used by providers to continue therapy for acute illness once patients leave the ED or to prevent future exacerbations of chronic conditions. The success of an ED discharge and the medications prescribed rely on patient compliance. Compliance depends on patients' ability to obtain prescriptions, which can be hindered by limited access to pharmacies and cost.

SUMMARY

In order to address issues traditionally associated with medication noncompliance, a discharge pharmacy was implemented within a busy urban ED. The pharmacy began processing prescriptions on December 18, 2019, using a formulary aimed towards providing commonly prescribed and high-risk medications. The pharmacy accepts insurance plans in addition to utilizing 340B Drug Pricing Program pricing to offer affordable medications to patients. During the first year of operation 10,230 prescriptions were filled for 5,703 patients, representing 13% of all patients discharged during that time. Of the prescriptions filled, 35.4% were for products considered high-risk medications, including epinephrine auto-injectors, insulin, and antibiotics. Over 50% of these high-risk medications were provided to patients through reduced cash pricing. Pharmacist interventions were made on 4.3% of prescriptions to address incorrect dosing, avoid use of inappropriate antibiotics, and recommend alternative therapies.

CONCLUSION

The implementation of a discharge pharmacy within the ED allowed over 5,700 patients to be discharged with medications and represents a potential solution to issues surrounding medication noncompliance. Similar initiatives have the opportunity to improve medication access for a larger ED population.

Meta-analysis of differences in sleep quality based on actigraphs between day and night shift workers and the moderating effect of age

OBJECTIVES

This study was to conduct a meta-analysis of studies that used actigraphs to compare the influence of day and night shifts on the sleep quality of workers as well as examine the moderating effect of age.

METHODS

Databases including PubMed, CINAHL, the Cochrane Library, MEDLINE, and EBSCOhost were searched for relevant studies published in English between January 1st, 2000 and April 30st, 2021. Our main targets were studies that used actigraphs to assess the sleep quality of night shift workers. This meta-analysis included 12 papers and was performed using Comprehensive Meta-Analysis (CMA) Version 3.0. Effect sizes were displayed in a forest plot using standardized mean difference (SMD) and 95% confidence intervals (CI).

RESULTS

Among the sleep quality indices of the day and night shift workers, no significant difference existed in terms of sleep efficiency (SE) (SMD = 0.27, 95% CI: -0.03-0.57), whereas night shift workers presented longer sleep-onset latency (SOL) (SMD = 0.62, 95% CI: 0.15-1.08), greater wake after sleep onset (WASO) (SMD = 0.41, 95% CI: 0.12-0.70), and longer total sleep time (TST) (SMD = 0.85, 95% CI: 0.32-1.39) than did day shift workers. The differences between the day and night shift workers in SOL, WASO, and TST did not vary with age.

CONCLUSIONS

Among the sleep quality indices, night shift workers presented longer SOL and greater WASO than did day shift workers. However, night shift workers could regulate their rest time and had adequate TST; thus, their SE was not different from that of day shift workers.