Risk factors for medication errors in the electronic and manual prescription

A refined management system focusing on medication dispensing errors: A 14-year retrospective study of a hospital outpatient pharmacy

Objectives

This study aimed to evaluate the efficiency of a 14-year refined management system for the reduction of dispensing errors in a large-scale hospital outpatient pharmacy and to determine the effects of person-related and environment-related factors on the occurrence of dispensing errors.

Methods

A retrospective study was performed. Data on dispensing errors, inventory and account management from 2008 to 2021 were collected from the electronic system and evaluated using the direct observation method and the Plan-Do-Check-Act (PDCA) cycle.

Results

The consistency of the inventory and accounts increased substantially (from 86.93 % to 99.75 %) with the implementation of the refined management program. From 2008 to 2021, the total number of dispensing errors was reduced by approximately 96.1 %. The number of dispensing errors in quantity and name was reduced by approximately 98.2 % and 95.07 %, respectively. A remarkable reduction in the error rate was achieved (from 0.014 % to 0.00002 %), and the rate of dispensing errors was significantly reduced (0.019 % vs. 0.0003 %, p < 0.001). Across all medication dispensing errors, human-related errors decreased substantially (208 vs. 7, p < 0.05), as did non-human-related errors also (202 vs. 9, p < 0.05). There was a correlation between the occurrence of errors and pharmacists' sex (females generally made fewer errors than males), age (more errors were made by those aged 31-40 years), and working years (more errors were made by those with more than 11 years of work experience) from 2016 to 2021. The technicians improved during this procedure.

Conclusions

Refined management using the PDCA cycle was helpful in preventing dispensing errors and improving medication safety for patients.

Written communication about the use of medications in medical records in a Brazilian hospital

BACKGROUND

Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated.

AIM

To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge.

METHOD

A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe.

RESULTS

This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified.

CONCLUSION

Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.

The impact of computerised physician order entry on prescribing in general paediatric units in Hong Kong

OBJECTIVES

This study aimed to evaluate the effect of a closed-loop computerised physician order entry (CPOE) system on prescribing in a general paediatric unit in Hong Kong. We studied the effect of the CPOE system on medication prescribing error and the characteristics of these errors before and after the implementation of the system.

METHODS

This was a single-site, prospective, observational study at a public hospital's general paediatric unit in Hong Kong, conducted during the pre- and post-implementation of the system from March to April 2019 and 2020, respectively. Collected data included the number of medication orders processed, the number of prescribing errors identified, and the characteristics of errors, such as the severity, children's age group, drug formulation, and drug class.

KEY FINDINGS

The prescribing error rate was significantly reduced from 6.7% to 3.9% after CPOE implementation. The causes of prescribing errors were found to be significantly different, as the implementation eradicated handwriting-related errors and reduced dosage selection-related errors. However, we found that CPOE increased other causes of error, such as missing entry of patient information that might affect the dispensing process, thus delaying patients in receiving their medications on time.

CONCLUSION

The CPOE system significantly reduced prescribing errors and altered some of the characteristics of these errors. Poor system design or inadequate user training could result in the creation of new causes of error.

Proposed model to determine satisfaction with computerised provider order entry systems in a long-stay hospital

Objectives

Computerised provider order entry (CPOE) systems reduce medication errors, but are not without dangers. Knowing satisfaction with the CPOE helps to improve its implementation. Our objective was to determine the satisfaction of healthcare professionals with the CPOE in a long-stay hospital and to propose a single model.

Methods

A cross-sectional study in a long-stay hospital. Two questionnaires were distributed to determine satisfaction with CPOE, one for medical personnel (MP) and another for nursing personnel (NP). Data collected were: sex, age and work aspects. A strategy for item refinement and creation of a single scale was designed.

Results

The overall participation rate was 63.6%, with 68 responses from the target population of 107. Overall, 72.2% (13 of 18) of MP and 40% (20 of 50) of NP were satisfied with CPOE. Regarding the specific questions on satisfaction in the questionnaires, 88.9% (n=16) of MP were very satisfied but only 56.0% (n=28) of NP. The median of each question was 4, with the exception of those for NP referring to a faster process and improved coordination, which were 3 and 3.5, respectively. The items weighing more in the second component were eliminated and the questions merged. After refining the items, a final six-item model was obtained with a single component of high reliability (Cronbach's α=0.896), which accounts for 67% of total variance.

Conclusion

The degree of satisfaction with CPOE in a long-stay hospital was high, though lower in NP than MP. Obtaining a single questionnaire can facilitate this process.