Aims and objectives. To examine the incidence of
prescribing errors in a main public hospital in Pakistan and to assess the
impact of introducing electronic prescribing system on the reduction of their
incidence.
Background. Medication errors are persistent in today’s healthcare
system. The impact of electronic prescribing on reducing errors has not been
tested in developing world.
Design. Prospective review of medication and discharge medication
charts before and after the introduction of an electronic inpatient record and
prescribing system.
Methods. Inpatient records (n = 3300) and 1100
discharge medication sheets were reviewed for prescribing errors before and
after the installation of electronic prescribing system in 11 wards. Results.
Medications (13,328 and 14,064) were prescribed for inpatients, among which
3008 and 1147 prescribing errors were identified, giving an overall error rate
of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively.
Medications (2480 and 2790) were prescribed for discharge patients, among which
418 and 123 errors were detected, giving an overall error rate of 16·9% and
4·4% during paper-based and electronic prescribing, respectively.
Conclusion. Electronic prescribing has a significant effect on the
reduction of prescribing errors. Relevance to clinical practice.Prescribing
errors are commonplace in Pakistan public hospitals. The study evaluated the
impact of introducing electronic inpatient records and electronic prescribing
in the reduction of prescribing errors in a public hospital in Pakistan.
AIMS AND OBJECTIVES: To
investigate the prevalence of transcription errors in a main public hospital in
Pakistan and to test the impact of medication name and dose writing styles and
the nurse duty duration on the occurrence of transcription errors.
BACKGROUND: Medication errors
occur frequently in public hospitals. Errors occurring at the transcription
stage have not been sufficiently investigated.
DESIGN: Medications transcripts
and dispensed item labels were prospectively reviewed. In the second stage,
nurses (n=25) transcribed medication charts in a double-blind randomised
cross-over design administered at one, six and 10 hours after the commencement
of their duty.
METHODS. Inpatient (n=1000), discharge patient (n=1000) medication transcripts
and labels of dispensed items for (n=1000) transcripts were reviewed. On
medication charts, orthographically similar medications (n=20) were written in
lowercase and Tall Man, decimal doses were written covered and uncovered, and
metric doses were written with and without trailing zeros.
RESULTS: Of the 6583 and 5329
medications transcribed from inpatient and discharge patient charts, error
rates were 16·9 and 13·8%, respectively. Labels for 6734 dispensed items were
reviewed, and error rate was 6·1%. Tall Man, covered decimal points and
avoiding trailing zeros with decimal units significantly reduced transcription
errors.
CONCLUSION: Errors increased with
increasing nurse duty duration. Highlighting orthographically similar
medications and the use of proper decimal and metric units reduce errors.
RELEVANCE TO CLINICAL PRACTICE: Transcription
errors are highly prevalent in Pakistan public hospitals; therefore,
elimination of transcription stage is encouraged.
Background: The prescription of contraindicated drugs is a preventable medication error, which can cause morbidity and mortality. Recent data on the factors associated with drug contraindications (DCIs) is limited world-wide, especially in Malaysia.
Aims: The objectives of this study are 1) to quantify the prevalence of DCIs in a primary care setting at a Malaysian University; 2) to identify patient characteristics associated with increased DCI episodes, and 3) to identify associated factors for these DCIs.
Methods: We retrospectively collected data from 1 academic year using computerized databases at the Universiti Sains Malaysia (USM) from patients of USM’s primary care. Descriptive and comparative statistics were used to characterize DCIs. Results: There were 1,317 DCIs during the study period. These were observed in a cohort of 923 patients, out of a total of 17,288 patients, representing 5,339 DCIs per 100,000 patients, or 5.3% of all patients over a 1-year period. Of the 923 exposed patients, 745 (80.7%) were exposed to 1 DCI event, 92 (10%) to 2 DCI events, 35 (3.8%) to 3 DCI events, 18 (2%) to 4 DCI events, and 33 patients (3.6%) were exposed to 5 or more DCI events. The average age of the exposed patients was 30.7 ± 15 y, and 51.5% were male. Multivariate logistic regression analysis revealed that being male (OR = 1.3; 95% CI = 1.1 – 1.5; p < 0.001), being a member of the staff (OR = 3; 95% CI = 2.5 – 3.7; p < 0.001), having 4 or more prescribers (OR = 2.8; 95% CI = 2.2 – 3.6; p < 0.001), and having 4 or more longterm therapeutic groups (OR = 2.3; 95%CI = 1.7 – 3.1; p < 0.001), were significantly associated with increased chance of exposure to DCIs. Discussion and
conclusions: This is the first study in Malaysia that presents data on the prevalence of DCIs. The prescription of contraindicated drugs was found to be frequent in this primary care setting. Exposure to DCI events was associated with specific socio-demographic and health status factors. Further research is needed to evaluate the relationship between health outcomes and the exposure to DCIs.