Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis

Abstract

BackgroundDrug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (i.e. override the alert).MethodsWe prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (i.e. prescribing error repeated).Results12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (i.e error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist's alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error.ConclusionsSince 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts.

Junior doctors prescribing: enhancing their learning in practice

“…However, initiatives such as e-prescribing for doctors are not yet in full use and one could argue that prescribers cannot rely solely upon such decision support aids. Doctors must still have a certain amount of background knowledge and recognition to be able to understand if an incorrect answer has been given and to know when to override an alert [2,36].…”

“…In the United Kingdom (UK), this is at the beginning of the 2 year Foundation Programme which immediately follows basic medical education.Prescribing is one of the biggest steps in practice in the transition from being a medical student to being a Foundation Year 1 (F1) doctor. From being unable to prescribe by law as medical students, new doctors have the responsibility for prescribing powerful,potentially high risk drugs [1].Often it is junior doctors who prescribe most drugs in hospital [2] and their ability to do this safely and effectively is a concern both in the UK [3] and internationally [4]. A number of previous studies have found that new doctors are not as well prepared for prescribing as they might be [4][5][6][7][8][9][10][11][12][13].…”

Emergency Pharmacist-A Safety Valve In Hospital Emergency

“…New developments in information technology and the advent of electronic medical records with computerized physician order entry, ward-based clinical pharmacists, and standardized bar codes promise substantial reductions in the incidence of medication errors and adverse drug events. ED patients expect and deserve nothing less than the safest possible emergency medicine service 12 .…”

Interventions des pharmaciens sur les prescriptions ambulatoires dans le cadre de l’activité de rétrocession d’un centre hospitalier universitaire

“…Il existe de nombreuses études concernant les problèmes médicamenteux détectés par les pharmaciens sur les prescriptions hospitalières [3,[5][6][7][8][9][10] et qui évaluent l'impact clinique [7][8][9] ou économique [10] mais de telles études spé-cifiques à l'activité de rétrocession n'ont pas été publiées en France. L'objectif de ce travail est de décrire, d'une part, les principaux problèmes médicamenteux détectés lors de l'analyse des prescriptions et, d'autre part, présenter les interventions pharmaceutiques formulées par les pharmaciens au sein de trois sites de rétrocession des HCL.…”