The Impact of a Pharmacy Resident Led Educational Sessions on Electronic Prescribing Errors on Surgical Wards

2016 ◽  
Vol 04 (02) ◽  
Author(s):  
Abrar Al Subhi ◽  
Mohammed Aseeri
Keyword(s):  
Electronic Prescribing ◽  
Prescribing Errors ◽  
The Impact

scholarly journals Impact of Electronic Prescription on Prescribing Errors

2021 ◽  
pp. 212-220
Author(s):  
Ameen M. Almohammadi ◽  
Huda M. Al-Dhahri ◽  
Shroug H. Al-Harbi
Keyword(s):  
Study Design ◽  
Intervention Study ◽  
Dosage Forms ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Post Intervention ◽  
Electronic Prescription ◽  
Prescription Errors ◽  
Trade Names ◽  
The Impact

Aims: There are series of medical errors that can be prevented by taking precautions.             Therefore, the study evaluates the impact of the electronic prescribing system on prescription errors. Study Design:  A pre-post study design was conducted. Place and Duration of Study: The study was conducted at outpatient pharmacy services of a teaching hospital in Jeddah city. Methodology: Prescriptions were evaluated for the presence of the essential prescription elements such as patient information, drug name, dose, frequency, strength, and other prescription completeness parameters. Results: In the pre-intervention study, 1182 handwritten prescriptions were evaluated, and 6627 errors were detected from these prescriptions. The length of the pre-and post-intervention period was two weeks each. The most prevalent prescribing errors were that of medications written without defined dosage forms were recorded 1653 (55.90%) time followed by prescriptions written by trade names 1493 (22.5%), without route of administration 1266 (19.1%), and without specified duration 1009 (15.2%). However, 1512 prescriptions were evaluated in the post-intervention study, among which 339 errors were detected. The errors included prescriptions written without diagnosis (5.09%), or without doctor’s name or stamp (1.52%), written by trade names (4.49%), without defined dosage forms (4.29%), and without specified duration (2.84%). Conclusion: The study concluded that E-prescribing eliminated prescription errors that resulted from handwritten prescriptions.

scholarly journals P047 Evaluating the impact of pre-prepared neonatal intubation premedication kits on a level 3 neonatal unit (Project NIK)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.52-e2
Author(s):  
Suzannah Hibberd ◽  
Alok Sharma ◽  
Marhamat Chavoshzadeh
Keyword(s):  
Nursing Staff ◽  
Response Rate ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
Prescribing Errors ◽  
Before And After ◽  
Level 3 ◽  
Perceived Impact ◽  
Set Up ◽  
The Impact

BackgroundIn January 2018, neonatal intubation premedication kits containing atropine, suxamethonium and fentanyl were introduced alongside the implementation of dose- banding for these medicines according to patient’s weight and regardless of the patient’s gestation. A prescribing bundle on the electronic prescribing system was also created to automatically populate the doses based on the patient’s weight. Seven kits are produced each week by the Pharmacy Technical Services Unit.AimTo assess the staff perceived impact of pre-prepared intubation drug kits with associated dose-banding of the medication.MethodsThree months after the kits were implemented, a survey was sent to all nursing and medical staff to establish their thoughts on the intubation process before and after the introduction of pre-made intubation drug kits.Results78 staff responded, 45.5% were doctors and 54.5% were nursing staff. The response rate was 53.8%. 78% of respondents reported being part of a difficult intubation over the last 5 years. The main problems identified, prior to the implementation of the neonatal intubation drug kits, included the intubation process (51.5%), preparation and communication prior to intubation, (13.6%), time drawing up intubation drugs (10.6%) and the patient having a difficult airway (9%). 87.2% found the premade intubation kits very useful, none of the respondents thought the kits were not useful. Four themes were found irrespective of whether the respondent was a doctor or member of nursing staff. The themes were: they made the process easier; quicker; reduced risk of error and helped provide better patient care. When asked if any complications had arisen, 4% reported that they had run out of kits and 2.7% said there was confusion when signing the kits out of the controlled drug (CD) register.Three weeks out of 25 saw all the kits being used, average usage is 4 intubation kits per week. 97.4% reported the doses used were effective in sedating and paralysing the baby prior to intubation, 2.6% commented that they were somewhat effective but that in one occasion the paralysis had not been optimal, however they questioned whether the cannula had been functioning properly.ConclusionThe implementation of ready to use intubation drug kits has made the process of preparing for an intubation easier and quicker for all involved in the process. Having the dose banding set up on the electronic prescribing system has reduced the chance of prescribing errors and the pre- filled kits have reduced the chances of calculation errors during drug preparation. When the kits run out there are instructions in the guideline detailing how to make the required concentrations. As a result of this study standardised teaching videos were introduced from the beginning of July 18. Further simulations have been completed to ensure that all staff follow a standardised process. Next steps are to ensure that the documentation in the CD register includes all necessary information without any need for amendments. To overcome this, a stamp is being designed to use in the book each time a patient requires a kit, thereby providing a prompt for the nurses.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

scholarly journals What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital

2019 ◽  
Vol 26 (4) ◽  
pp. 3152-3162 ◽  
Author(s):  
Bryony Dean Franklin ◽  
Seetal Puaar
Keyword(s):  
Logistic Regression ◽  
Study Design ◽  
Teaching Hospital ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Stepped Wedge ◽  
Future Studies ◽  
Before And After ◽  
Study Designs ◽  
The Impact

Most studies evaluating the impact of electronic prescribing on prescribing safety have used comparatively weak study designs such as uncontrolled before-and-after studies. This study aimed to apply a more robust naturalistic stepped wedge study design to compare the prevalence and types of prescribing errors for electronic prescribing and paper prescribing. Data were collected weekly during a phased electronic prescribing implementation across 20 wards in a large English hospital. We identified 511 (7.8%) erroneous orders in 6523 paper medication orders, and 312 (6.0%) in 5237 electronic prescribing orders. Logistic regression suggested no statistically significant effect of electronic prescribing use or of study week; patient and ward had significant effects. Errors involving incorrect doses and illegible or incomplete orders were less common with electronic prescribing; those involving duplication, omission, incorrect drug and incorrect formulation were more common. Actions are needed to mitigate these error types; future studies should give more consideration to the effects of patient and ward.

RATES AND TYPES OF PRESCRIBING ERRORS AND RELATED INTERVENTIONS IN PAEDIATRIC ONCOLOGY

2016 ◽  
Vol 101 (9) ◽  
pp. e2.32-e2 ◽  
Author(s):  
Claire Fosbrook
Keyword(s):  
Error Rate ◽  
Paediatric Oncology ◽  
Electronic Prescribing ◽  
Clear Correlation ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Start Date ◽  
Pharmacy Intervention ◽  
Type Data ◽  
The Impact

AimThe aim of the pharmacy intervention audit was to prospectively record the number and type of interventions made to paediatric oncology chemotherapy prescriptions. This baseline data will be used in the future to assess the impact of electronic prescribing (EP) on prescribing error or intervention rates.Independently from the EP project research, I interrogated the data to establish if there was a correlation between prescribing workload and rate of errors or interventions. I predicted that an ‘overworked’ prescriber would make more mistakes due to the volume of the workload and a less frequent prescriber would make more mistakes due to scarce use of these skills.Intervention rates have been found to be as high as 66% for chemotherapy prescriptions, including interventions for missed information, wrong doses and protocol breach1. This intervention rate demonstrates the importance of pharmacy verification. Another source demonstrated that 80% of errors were due to poor prescription writing.2 MethodAn audit tool was created to collect the data, included fields for date, prescriber type, number of drugs prescribed, number of interventions made and intervention type. Data was collected from 5 Jan 2015 to 12 Jun 15.ResultsThe most common interventions required were addition of diluent volume, addition of start date and dose amendments to ensure doses could be accurately measured.The staff grade doctor prescribed on average 75% of the prescriptions each week, with an intervention rate of 19%. The registrar was responsible for 23% each week and had an error rate pf 24%. Consultants were responsible for only 2% of the weekly prescription workload and had the lowest rate of interventions at 7%. There was no clear correlation between percentage of chemotherapy prescribed per week and rate of errors.ConclusionThe most common types of errors expected from the background reading are demonstrated by this audit, as the three common interventions are related to poor prescribing. EP should eliminate all three of these interventions as all these are either mandatory fields for a prescription to be ordered or measurable dose rounding will be in inbuilt into each drug field, and therefore calculated automatically by our prescribing system.There was no clear correlation between error rate and proportion of prescribing. Errors are therefore independent of prescribing workload. Alternative reasons for errors could include external factors such as environment or bad habits of the prescriber. I believe the low rate of errors from the consultants is due to the types of prescriptions they often prescribe. Which were more frequently for single agents such as intrathecals. This suggests further data interrogation could identify whether there is a relationship between prescription complexity (or length) and error rate.

ASSESSING THE IMPACT OF A NEWLY INTRODUCED ELECTRONIC PRESCRIBING SYSTEM ACROSS A PAEDIATRIC DEPARTMENT – LESSONS LEARNED

2016 ◽  
Vol 101 (9) ◽  
pp. e2.13-e2 ◽  
Author(s):  
Anastasia Tsyben ◽  
Nigel Gooding ◽  
Wilf Kelsall
Keyword(s):  
Good Practice ◽  
Electronic System ◽  
Daily Basis ◽  
Error Rates ◽  
Lessons Learned ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
New Challenges ◽  
The Impact

AimPrescribing audits have shown that the Women's and Children's Directorate reported higher number of prescription errors on the paediatric and neonatal wards compared to other areas in the Trust. Over the last three years a multidisciplinary prescribing team (PT), which included senior clinicians, pharmacists and trainees introduced a number of initiatives to improve the quality of prescribing. Strategies included structured departmental inductions, setting up of designated prescribing areas and reviewing errors with the prescriber. Year on year there were fewer prescribing errors.1 With the introduction of a new electronic prescribing system in October 2014 prescribing error rates were expected to decrease further, eradicating omissions around allergy recording, ward location and drug names. The aim of this abstract is to highlight the impact of the new system and describe lessons learned.MethodIn the summer of 2014, all inpatient drug charts across the department were reviewed on three non-consecutive days over a period of three weeks. Prescribing errors were identified by the ward pharmacist. Errors were grouped according to type and further analyzed by the PT. Errors deemed to have no clinical significance were excluded. Error rates were compared to the previous audits performed with identical methodology. Following the introduction of the electronic prescribing system, the ward pharmacists continued to review prescription charts on daily basis and generate regular error reports to notify the staff of new challenges.ResultsThere were 174 (14%) errors out of 1225 prescriptions on 181 drug charts. The most commonly made mistakes included drug name errors, strength of preparation, allergies and ward documentation, prescriber's signature omissions, and antibiotic review and end dates. The introduction of an electronic system has eliminated drug name, strength of preparation, allergy recording and ward errors. However, serious challenges have been identified: entering of an incorrect weight resulted in all drug dosages being inaccurate; the timing of drug levels for Vancomycin and Gentamicin and the administration of subsequent doses have been problematic. Communication difficulties between all staff groups has led to dosage omission, duplicate administration and confusion around start and stop dates. The ability to prescribe away from the bedside and indeed the ward has compounded some of these problems.ConclusionThe implementation of a new electronic system has reduced prescribing errors but has also resulted in new challenges, some with significant patient safety implications. The lessons learned and good practice introduced following previous audits of “traditional paper based” prescribing are equally important with electronic prescribing. Communication between staff groups is crucial. It is likely that the full benefits of the system will be realized a year after its introduction. On-going audit is required to assess the impact and safety of the electronic prescribing and lessons learned.

scholarly journals A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 53
Author(s):  
Amandeep Setra ◽  
Yogini Jani
Keyword(s):  
Care Setting ◽  
Electronic Prescribing ◽  
Longitudinal Assessment ◽  
Prescribing Practices ◽  
Record System ◽  
Audit Data ◽  
Core Components ◽  
Secondary Care Setting ◽  
The Impact

Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

Prescribing errors on medical wards and the impact of clinical pharmacists

2003 ◽  
Vol 11 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Alison Dale ◽  
Richard Copeland ◽  
Roger Barton
Keyword(s):  
Prescribing Errors ◽  
Clinical Pharmacists ◽  
Medical Wards ◽  
The Impact
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