Renovation of Prescribing Error Reporting System and Analysis of Inpatient Prescribing Errors in a Medical Center
Date Issued
2009
Date
2009
Author(s)
Yang, Yea-Harn
Abstract
Background:rescribing errors are the most common type of medication errors and are often preventable. Implementation of a new computerized physician order entry (CPOE) system in National Taiwan University Hospital impaired part of the function of the old prescribing error reporting system. The number of prescribing errors reported by pharmacists also declined.bjective:he aim of this study was to renovate an efficient and effective prescribing error reporting system in a medical center and to analyze the errors reported by this system.ethod:his study included a questionnaire survey, implementation of a new prescribing error reporting system and prescribing error analysis. Firstly, a questionnaire survey was conducted to evaluate the current status of prescribing errors reporting, factors that affect prescribing errors reporting and the reasons why reported prescribing errors decreased. Secondly, through collaboration between department of pharmacy and information systems office, a new prescribing reporting system was implemented in the new CPOE system. Finally, the effectiveness of the new system was evaluated through the analysis of the reported prescribing errors, according to the error types, prescribing departments, pharmacy divisions, medication categories, physicians’ acceptance rates, and prescribing report rates.esult:A total of 70 questionnaires were returned for a response rate of 94.6%. After excluding 11 pharmacists who did not use the old reporting system before, 59 questionnaires were included in this study. It took pharmacists 9.6 minutes to report one prescribing error by using the transitional system. Although there were 57.6% of pharmacists willing to report prescribing errors, only 22% of pharmacists were satisfied with the transitional system. Around 28.8% of pharmacists only reported the interventions that were accepted by physicians, and 39.0% pharmacists’ willingness to report prescribing errors declined when physician turned down their suggestions. Multiple logistic regressions showed that pharmacist’s satisfaction toward reporting system was influenced by “the convenience of data entry” and “the helpfulness to the patients”. In addition, the willingness to report errors depended on “the familiarity with the computer system”, “the clearness of the definition” and “potentialities of the reports to improve clinical skill”.here was also some advancement in the new system including database queries, teaching function and the statistical report. Averagely, the new system took pharmacists 3.1 minutes to report one prescribing error, which was 6.5 minutes faster than the transitional system. It took an average of 2.2 days for a chief pharmacist to verify a documented error. Prescribing errors identified in the old system, transitional system and new system were 2289.6, 531.8, and 1319.2 per month respectively. Excluding entry errors, those orders changed due to “pharmacists’ cognitive service” in the old system, transitional system and new system were 682.2 (29.8%), 394.3 (74.2%), and 1006.7 (76.3%) per month respectively. The most common error in the old system was “failure to discontinue the order on computer” (68.5%), while the most common error in the transitional and new system was “pharmacists’ cognitive service” (74.2% and 76.3% respectively). The prescribing error rate reported by the new system was 0.9%. The highest error rate was found in the emergency medicine department (1.4%), followed by the surgery department (1.1%). Of all the inpatient pharmacies, the prescribing error rate of parenteral nutrition pharmacy, oncology pharmacy, inpatient pharmacy in main region, inpatient pharmacy in kung-kuan region and emergency room pharmacy was 4.4%, 1.9%, 1.2%, 1.2%, 0.3%, respectively.he most common medication class among the prescribing errors was antimicrobial agents (423.3 prescriptions/month; 32.1%), followed by gastrointestinal agents (157.5 prescriptions/month; 11.9%), and metabolic and nutrients agents (155.3 prescriptions/month; 11.8%). The physicians’ acceptance rates for pharmacist’s intervention in the old system, transitional system and new system were 94.8%, 92.5% and 89.9%, respectively. The physicians’ acceptance rates of “entry error” were highest (>98%) in all the three systems. The physicians’ acceptance rates of all types of errors in new system were higher than old system and transitional system except for “entry error”.onclusion:he newly implemented prescribing error reporting system successfully replaced the transitional system because of its user-friendly design and novel functions. It facilitated pharmacists’ willingness to report and thus provided information for strategy planning in prescribing errors prevention.he novelty of the new system is that pharmacists can share the prescribing error database. Data can be integrated as a teaching material through database queries. Therefore, prescribing errors can be reduced and patient care quality can be achieved through education symposiums for medical and pharmacy professionals.
Subjects
inpatient
prescribing error
error reporting system
pharmacoinformatics
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