Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-28T02:45:31.342Z Has data issue: false hasContentIssue false
  • English
  • Français

Detection and correction of prescription errors by an emergency department pharmacy service

Published online by Cambridge University Press:  04 March 2015

Philip Stasiak ,
Marc Afilalo ,
Tanya Castelino ,
Xiaoqing Xue ,
Antoinette Colacone ,
Nathalie Soucy  and
Jerrald Dankoff
Philip Stasiak*
Affiliation:
McGill Emergency Medicine Residency Program
Marc Afilalo
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Tanya Castelino
Affiliation:
Faculty of Medicine, McGill University, Montreal, QC
Xiaoqing Xue
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Antoinette Colacone
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Nathalie Soucy
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Jerrald Dankoff
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
*
Emergency Department Room D-027, Jewish General Hospital, 3755 Côte-Sainte-Catherine Road, Montréal, QC H3T 1E2; philip.stasiak@mail.mcgill.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors.

Methods:

This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists’ recommendations.

Results:

A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5–3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32–4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54–9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18–4.14).

Conclusions:

Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.

Keywords

adverse drug eventsemergency departmentpatient safetypharmacistprescription errors
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 193 - 206
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Kohn, LT, Corrigan, J, Donaldson, MS, editors. To err is human: building a safer health system. Washington (DC): National Academy Press; 2000.Google Scholar
2. Kulstad, EB, Sikka, R, Sweis, RT, et al. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med 2010;28:304–9, doi:10.1016/j.ajem.2008.12.014.Google Scholar
3. Phillips, DP, Bredder, CC. Morbidity and mortality from medical errors: an increasingly serious public health problem. Annu Rev Public Health 2002;23:135–50, doi:10.1146/annurev.publhealth.23.100201.133505.CrossRefGoogle ScholarPubMed
4. Chisholm, CD, Collison, EK, Nelson, DR, et al. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”? Acad EmergMed 2000;7:1239–43, doi:10.1111/j.1553-2712.2000.tb00469.x.Google Scholar
5. Jenkins, G, Johnston, PE, Patel, NR, et al. The epidemiology of medication prescribing errors in the emergency department. AMIA Annu Symp Proc 2006:968.Google Scholar
6. Croskerry, P, Shapiro, M, Campbell, S, et al. Profiles in patient safety: medication errors in the emergency department. Acad Emerg Med 2004;11:289–99, doi:10.1111/j.1553-2712.2004.tb02214.x.Google Scholar
7. Benjamin, DM. Minimizing medication errors: practical pointers for prescribers. J Clin Pharmacol 2003;43:751–3.Google Scholar
8. Peth, HA. Medication errors in the emergency department, a systems approach to minimizing risk. Emerg Med Clin North Am 2003;21:141–58, doi:10.1016/S0733-8627(02)00085-8.Google Scholar
9. Kozer, E, Scolnik, D, Macpherson, A, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics 2002;110:737–42, doi:10.1542/peds.110.4.737.Google Scholar
10. Bobb, A, Gleason, K, Husch, M, et al. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med 2004;164:785–92, doi:10.1001/archinte.164.7.785.Google Scholar
11. Dean, B, Schachter, M, Vincent, C, et al. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care 2002;11:340–4, doi:10.1136/qhc.11.4.340.Google Scholar
12. Lesar, TS, Briceland, L, Stein, DS. Factors related to errors in medication prescribing. J Am Med Assoc 1997;277:312–7, doi:10.1001/jama.1997.03540280050033.Google Scholar
13. Rothschild, JM, Churchill, W, Erickson, A, et al. Medication errors recovered by emergency department pharmacists. Ann Emerg Med 2010;55:513–21, doi:10.1016/j.annemergmed.2009.10.012.Google Scholar
14. Rinke, ML, Moon, M, Clark, JS, et al. Prescribing errors in a pediatric emergency department. Pediatr Emerg Care 2008;24:1–8.Google Scholar
15. Taylor, BL, Selbst, SM, Shah, AE. Prescription writing errors in the pediatric emergency department. Pediatr Emerg Care 2005;21:822–7, doi:10.1097/01.pec.0000190239.04094.72.CrossRefGoogle ScholarPubMed
16. Vasileff, HM, Whitten, LE, Pink, JA, et al. The effect on medication errors of pharmacists charting medication in an emergency department. Pharm World Sci 2009;31:373–9, doi:10.1007/s11096-008-9271-y.Google Scholar
17. Clancy, CM. Evidence shows cost and patient safety benefits of emergency pharmacists. Am J Med Qual 2008;23:231–3, doi:10.1177/1062860608316108.CrossRefGoogle ScholarPubMed
18. Case, LL, Paparella, S. Safety benefits of a clinical pharmacist in the emergency department. J Emerg Nurs 2007;33:564–6, doi:10.1016/j.jen.2007.06.008.Google Scholar
19. Lada, P, Delgado, G. Documentation of pharmacists’ interventions in an emergency department and associated cost avoidance. Am J Health Syst Pharm 2007;64:63–8, doi:10.2146/ajhp050213.Google Scholar
20. Marconi, GP, Claudius, I. Impact of an emergency department pharmacy on medication omission and delay. Pediatr Emerg Care 2012;28:30–3, doi:10.1097/PEC.0b013e31823f232d.Google Scholar
21. Abu-Ramaileh, AM, Shane, R, Churchill, W, et al. Evaluating and classifying pharmacists’ quality interventions in the emergency department. Am J Health Syst Pharm 2011;68:2271–5, doi:10.2146/ajhp110004.Google Scholar
22. Brown, JN, Barnes, CL, Beasley, B, et al. Effect of pharmacists on medication errors in an emergency department. Am J Health Syst Pharm 2008;65:330–3, doi:10.2146/ajhp070391.Google Scholar
23. Guy, J, Persaud, J, Davies, E, et al. Drug errors: what role do nurses and pharmacists have in minimizing the risk? J Child Health Care 2003;7:277–90, doi:10.1177/13674935030074004.Google Scholar
24. Hendey, GW, Barth, BE, Soliz, T. Overnight and postcall errors in medication orders. Acad Emerg Med 2005;12:629–34, doi:10.1111/j.1553-2712.2005.tb00919.x.Google Scholar
25. Bizovi, KE, Wears, R, Lowe, RA. Researching quality in emergency medicine. Acad Emerg Med 2002;9:1116–23, doi:10.1111/j.1553-2712.2002.tb01565.x.Google Scholar
26. Lam, P, Elliott, RA, George, J. Impact of a self-administration of medications programme on elderly inpatients’ competence to manage medications: a pilot study. J Clin Pharm Ther 2011;36:80–6, doi:10.1111/j.1365-2710.2009.01157.x.Google Scholar
27. Fialová, D, Onder, G. Medication errors in elderly people: contributing factors and future perspectives. Br J Clin Pharmacol 2009;67:641–5, doi:10.1111/j.1365-2125.2009.03419.x.CrossRefGoogle ScholarPubMed
28. Corona-Rojo, JA, Altagracia-Martínez, M, Kravzov-Jinich, J, et al. Potential prescription patterns and errors in elderly adult patients attending public primary health care centers in Mexico City. Clin Intervent Aging 2009;4:343–50.Google ScholarPubMed
29. Patanwala, AE, Warholak, TL, Sanders, AB, et al. A prospective observational study of medication errors in a tertiary care emergency department. Ann Emerg Med 2010;55:522–6, doi:10.1016/j.annemergmed.2009.12.017.Google Scholar
30. Fijn, R, Van den Bemt, PM, Chow, M, et al. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol 2002;53:326–31, doi:10.1046/j.0306-5251.2001.bjcp1558.doc.x.Google Scholar
31. Wakefield, DS, Ward, MM, Groath, D, et al. Complexity of medication-related verbal orders. Am J Med Qual 2008;23:7–17, doi:10.1177/1062860607310922.Google Scholar
32. West, DW, Levine, S, Magram, G, et al. Pediatric medication order error rates related to the mode of order transmission. Arch Pediatr Adolesc Med 1994;148:1322–6, doi:10.1001/archpedi.1994.02170120084016.Google Scholar