Advantages of the Introduction of Electronic Healthcare Prescriptions before COVID Era Experiences in Pioneer Countries Estonia and Finland and the Status in Germany

As pointed out by previous studies, fragmentation of health information based on medical prescription is a prevalent health crisis across the globe. Several countries such as Finland, Estonia, and Germany have adopted the electronic health system to eradicate these medical errors1 . As suggested by the health professionals, the major health concerns in modern healthcare are prescription error elimination and patients' safety. So, eprescription is proposed as the most effective health approach to provide long-term solutions by replacing manually written prescriptions2 . Electronic health is a computerized medical system with an expansive database of patients' information. Despite its speculated benefits on the health industry, e-prescription implementation has experienced various challenges such as patients and pharmacists resistance3 . Therefore, this paper explores the health benefits of e-prescriptions in Estonia and Finland and their status in Germany.

Medication Errors: Reported Prescription Faults and Prescription Error

The present study aimed to evaluate the trends of prescription errors that did not caused any harm to the patients and the prescription errors that were identified before reaching to the patients in the year 2017 at a tertiary care hospital in Kingdom Saudi Arabia. Simple random sampling and sampling based on prescription errors that were identified, documented, and reported before reaching the patients in the first three quarters of 2017 were performed in present observational retrospective study. Descriptive analysis with D’Agostino & Pearson omnibus were applied for normality testing at 95% CI through one-sample t-test to compare the prescription errors that did not cause harm to the patients and were identified before reaching the patient in the first quarter (Q1), the second quarter (Q2), and the third quarter (Q3) of 2017. Total number of prescription errors that did not caused harm to the patients were 1,601 in Quarter 1 further decreased to 1,422 in Quarter 2 and then increased to 1,710 in Quarter 3 of 2017. Furthermore, the total number of prescription errors that did not cause harm to the patients were 1,601 in Quarter 1 further decreased to 1,422 in Quarter 2 and then increased to 1,710 in Quarter 3 of 2017. The current study revealed that prescription errors were common in the tertiary Hospital, Taif, Saudi Arabia. Therefore, educating the prescribers to reduce prescription errors through seminars, conferences, and workshops is essential. Also, a joint training exercise for the pharmacist and doctors would minimize the prescribing errors.

The Use of Intravenous Lidocaine in the Setting of Chronic Dofetilide Overdose: A Case Report

Managing the risks and consequences of long QT syndrome can be challenging. Multiple factors contribute to the prolongation of the heart-rate corrected QT (QTc) interval including many drug-drug and drug-disease state interactions. Current literature is often focused on avoiding dysrhythmias with limited guidance on acute management strategies. Here we describe a case of QTc prolongation to 616 msec (Bazett’s formula) in the setting of chronic dofetilide overdose due to a possible prescription error. Our case was complicated by alcohol withdrawal and electrolyte disturbances that progressed to patient cardiac arrest in the emergency department. Dofetilide overdose was identified through pharmacist-initiated medication reconciliation and lidocaine was recommended as an alternative to amiodarone during advanced cardiac life support (ACLS). This case highlights the importance of reviewing outpatient medication records as well as avoiding drug-drug interactions during ACLS. Due to the potential for additive QTc prolongation, we recommend using lidocaine as the preferred antiarrhythmic in ACLS algorithms where drug induced QTc prolongation is suspected.

Prescribing error reporting in primary care: a narrative synthesis systematic review

Prescribing errors can cause avoidable harm to patients. Most prescriptions originate in primary care, where medications tend to be self-administered and errors have the most potential to cause harm. Reporting prescribing errors can identify trends and reduce the risk of the reoccurrence of incidents; however, under-reporting is common. The organisation of care and the movement of prescriptions from general practice to community pharmacy may create difficulties for professionals to effectively report errors.This review aims specifically to identify primary research studies that examine barriers and facilitators to prescription error reporting across primary care. A systematic research of the literature was completed in July 2019. Four databases (PubMed/Medline, Cochrane, CINAHL and Web of Science) were searched for relevant studies. No date or language limits were applied. Eligible studies were critically appraised using the Mixed Methods Appraisal Tool, and data were descriptively and narratively synthesised.Ten articles were included in the final analysis. Seven studies considered prescription errors and error reporting within general practice and three within a community pharmacy setting. Findings from the included studies are presented across five themes, including definition of an error, prescribing error reporting culture, reporting processes, communication and capacity.Healthcare professionals appreciate the value of prescription error reporting, but there are key barriers to implementation, including time, fear of reprisal and organisation separation within primary care.

Prescribing errors involving antineoplastics and others drug centre of preparation of injectable drugs

Objective: To describe the prescribing errors involving antineoplastics and others drugs in a centre for the preparation of injectable drugs at a university hospital. Method: A retrospective descriptive study was carried out based on the records of a drug preparation center with prescribing errors identified in the pharmaceutical validation phase prior to drug preparation in the period from 2016 to 2017.Results: A total of 1516 prescriptions/month were evaluated and 562 prescribing errors were identified and the prescription error rate involving medications was 1.5%. Of the drugs most involved in errors are cisplatin (37.5%), etoposide (14.1%), carboplatin (8.9%), cyclophosphamide (5.7%) and oxaliplatin (4.1%). Most of the errors were related to the diluents associated with the preparations, either in the absence of this information or in the prescription of volumes outside the concentration range required by the preparation of the drug with 56% and 22.6% respectively. In 94.3% of the prescriptions identified with errors, pharmaceutical interventions were necessary for its correction before preparation with adhesion in 99.6% of the cases. Conclusion: Although prescribing errors are described in the literature, the study presents the fragility of the prescriber system, even when it is computerized, and the importance of organized barriers or processes to avoid errors of prescription and manipulation in a centre for the preparation of injectable drugs

STUDENTS’ KNOWLEDGE AND RISK OF COMMITTING MEDICATION ERRORS IN TWO SCHOOLS OF PHARMACY IN NIGERIA

Objective: The aim of this study was to determine the knowledge of prescription errors, the certainty of such knowledge, and the risk of committing medication errors among pharmacy students in two universities in Nigeria. Methods: This study was a cross-sectional comparative survey between pharmacy students of two universities in Nigeria: University of Nigeria, Nsukka (UNN) and Nnamdi Azikiwe University (NAU), Awka. Study variables were measured using four simulated prescriptions and questionnaires. Chi-square test, independent t-test, and ordinal regression analyses were used to assess study outcomes. Results: A total of 339 pharmacy students (239 in UNN and 100 in NAU), with a mean age of 24 (2.8) years and 57.2% (n=194) male students, participated in this study. Their accurate knowledge of each of the prescriptions were 294 (86.72%), 166 (48.97%), 199 (58.70%), and 248 (73.16%) for prescriptions with error of drug allergy, error of drug interaction, no error, and wrong dose of a drug, respectively. Students from UNN were more likely to commit a statistically significant high risk of error compared to NAU students in prescriptions with a drug allergy and wrong dose, while students in the 4th year class had a statistically significant higher odds of committing a drug interaction prescription error compared to final year students. Conclusion: Pharmacy students evaluated in this study had good knowledge of medication error detection. The risk of these pharmacy students committing a prescription error was evident in nearly all prescriptions tested and the students’ school was the major predictor of these risks.

AB1292-HPR NUMBER OF DRUGS IN THE PRESCRIPTION, A PREDISPOSING FACTOR FOR MEDICATION ERRORS IN RHEUMATOLOGY

Background:Medication error can be defined as a failure in the treatment process that leads to or has the potential to lead to harm to the patient, this fault can happen in two different phases: prescribing and prescription.Prescribing is the process of deciding what to prescribe and naming it. Various types of faults can occur in the decision-making process: underprescribing, overprescribing, irrational, inappropriate and ineffective prescribing. All these covers one type of errors, but these are different kind of errors that those that occur in the act of writing a prescription. This leads to the distinct concepts of ‘prescribing faults’ and ‘prescription errors’A prescription is ‘a written order, which includes detailed instructions of what medicine should be given, to whom, in what formulation and dose, by what route, when, how frequently, and for how long’. Thus, a prescription error can be defined as ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the patient, the identity of the drug, the formulation and dose, and the route, timing, frequency, and duration of administration. (1)It is not record about the rate of medication errors in rheumatology consultation.Objectives:To evaluate whether there is a relationship between prescribing errors and the number of drugs in the prescription.Methods:A descriptive, observational, and retrospective study was made.It was carried out a random search of medical prescriptions, generated by the electronic records (REPAIR®) of the rheumatology consultation of the Hospital Universitario “Dr. José Eleuterio González” during 2019, in which the prescriptions that contained any error were identifiedT student test was performed to see the difference in the prescription error based on the number of medications. P <0.05 was taken as statistically significant.Results:A review of 867 medical prescriptions was performed, among which 5503 medications were indicated with an average of 6.34 medications per prescription, a total of 30 (6.9%) prescriptions were found with error, where a total of 71 (3.9%) medications had errors. In the prescriptions with medication error, all the errors were prescription type; 68 (95.7%) had a mistake in the duration of administration and 3 (4.22%) in the identity of the drug.In the prescriptions with medical errors the average number of prescription drugs was 7.50, only 2/30 (0.6%) had less than 7 indicated medications (4 and 6), meanwhile the prescriptions in which no error was found had a mean of 6.30 indicated medications. P < 0.001.Conclusion:According to the study findings, it could be established that when the number of prescribed medications is greater than 7, there is an increased risk of making a prescription error. Further studies should carry out to look for other factors that influence medical errors in rheumatology clinics.References:[1]Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67(6):599-604.AcknowledgmentsDisclosure of Interests:None declared

Level of clinical competence in junior medical residents and its correlation with antibiotic prescription errors: a cross-sectional study

BackgroundA large portion of prescribing errors can be attributed to medication knowledge deficiency. They are preventable and most often occur in the stage of ordering. Antimicrobials are the drug class most commonly related to prescribing errors.ObjectivesThe study main objective was to describe the relationship between clinical competence and antibiotic prescription errors. Secondary objectives were to measure clinical competence of junior medical residents with an Objective Structured Clinical Examination (OSCE), to describe the frequency and severity of antibiotic prescription errors and to find items and attributes of clinical competence that are correlated with the antibiotic prescription error ratio.MethodsA cross-sectional study was designed to assess the clinical competence of junior medical residents, from National Institute of Pediatrics and “Manuel Gea Gonzalez” General Hospital in Mexico City, through an infectious disease OSCE and measure the frequency and severity of antibiotic prescription errors. Statistical analysis included generalizability theory and internal consistency Cronbach’s alpha, a partial correlation controlling sex and time of degree, simple linear regression and item’s exploratory factorial analysis.ResultsThe mean OSCE score was 0.692 ± 0.073. The inter-item Cronbach’s alpha was 0.927 and inter-station Cronbach’s alpha was 0.774. The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The severity of antibiotic prescription errors was: category C (errors that do not cause patient harm) = 56 cases, 15.5%; category D (monitoring required to confirm that errors resulted in no harm to the patient or intervention required to preclude harm) = 51 cases, 14.1%; category E (errors that may contribute to or result in temporary harm to the patient and require intervention) = 235, 65.2%; category F (errors that may contribute to or resulted in temporary harm to the patient and require initial or prolonged hospitalization) = 18 cases, 5%. The correlation between clinical competence and antibiotic prescription errors was established with Pearson correlation (r=-0.33, p<0.05, CI95% -0.57 to -0.07), and partial correlation controlling effect of gender and time since graduation (r=-0.39, p<0.01, CI95% -0.625 to -0.118).ConclusionsWe found a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent mistakes in antibiotic prescriptions errors would need a second intervention.