The incidence and severity of errors in pharmacist-written discharge medication orders

Abstract

Background Errors in discharge prescriptions are problematic. When hospital pharmacists write discharge prescriptions improvements are seen in the quality and efficiency of discharge. There is limited information on the incidence of errors in pharmacists’ medication orders. Objective To investigate the extent and clinical significance of errors in pharmacist-written discharge medication orders. Setting 1000-bed teaching hospital in London, UK. Method Pharmacists in this London hospital routinely write discharge medication orders as part of the clinical pharmacy service. Convenient days, based on researcher availability, between October 2013 and January 2014 were selected. Pre-registration pharmacists reviewed all discharge medication orders written by pharmacists on these days and identified discrepancies between the medication history, inpatient chart, patient records and discharge summary. A senior clinical pharmacist confirmed the presence of an error. Each error was assigned a potential clinical significance rating (based on the NCCMERP scale) by a physician and an independent senior clinical pharmacist, working separately. Main outcome measure Incidence of errors in pharmacist-written discharge medication orders. Results 509 prescriptions, written by 51 pharmacists, containing 4258 discharge medication orders were assessed (8.4 orders per prescription). Ten prescriptions (2%), contained a total of ten erroneous orders (order error rate—0.2%). The pharmacist considered that one error had the potential to cause temporary harm (0.02% of all orders). The physician did not rate any of the errors with the potential to cause harm. Conclusion The incidence of errors in pharmacists’ discharge medication orders was low. The quality, safety and policy implications of pharmacists routinely writing discharge medication orders should be further explored.

Comparison of pharmacy technicians’ and doctors’ medication transcribing errors at hospital discharge

“…However, the technician TTO error rate was lower than doctors both in this audit, and average discharge error rates reported elsewhere (6.4%) 1. Similarly, the reported error rate for pharmacy technicians was higher than that (0.2%) reported for transcribed TTOs by pharmacists in a recent study 13. Such differences possibly reflect heterogeneity in prescribing error definitions with further research required to assess any difference that could inform future service design.…”

“…Full electronic prescribing provides considerable promise to improve prescribing errors although benefits are not consistent21 and omission or commission errors can still occur on discharge for example. While the role of pharmacy technicians in TTO transcribing with full electronic systems is unknown, and is likely to vary or become redundant depending on the system used, a recent study reported low error rates from pharmacists transcribing discharge medications using full electronic systems 13. This demonstrates appetite, at least with some electronic systems, for non-medical transcribing of TTOs and provides possible future research avenues to compare error rates and the cost effectiveness of different staff groups undertaking this role.…”

“…While the incidence of pharmacist discharge transcribing error rates have been reported,13 14 there are no known studies describing the impact of pharmacy technicians in undertaking this role and their impact on discharge transcribing error rates, severity of error or error type.…”

Are Incident Reporting Systems in Healthcare Systems a Requirement for Improving Patient Safety? A Review

“…It has been reported that the preventable adverse events are a leading cause of death in the United State and at least 44,000 to 98,000 Americans are dying in the hospitals each year as a result of medical errors. National cost has been estimated to be between $37.6 billion and $50 billion for adverse events and between $17 billion and $29 billion for preventable adverse events in the USA (62). These estimations could always be lower than the actual figures due to under reporting of the incidents due to the fear of disciplinary actions (63)(64)(65)(66).…”

A review of the effectiveness of interventions to reduce medication errors among older adults in Singapore

“…Globally, it has been shown that pharmacists can prescribe safely but despite this the longstanding practice, in most healthcare settings, has been to let the physician play the central role in prescribing. 39 In Australia, recent studies have shown that pharmacist-led interventions which include a partnered doctor-pharmacist prescribing have not only produced lower rates of medication errors but a reduced length of hospital stay (4.7 versus 4.2 days with p < 0.001) which in turn will lead to reduced healthcare costs. 40 In another Australian geriatric service, a collaborative pharmacist-led prescribing model for discharge prescriptions had fewer patients with MEs than the usual prescribing model in both handwritten and digital prescriptions.…”