Baylor University Medical Center Proceedings April 2017 - 143

Emergency department discharge prescription errors
in an academic medical center
Kelly A. Murray, PharmD, April Belanger, PharmD, Lauren T. Devine, PharmD, Aaron Lane, DO,
and Michelle E. Condren, PharmD

This study described discharge prescription medication errors written
for emergency department patients. This study used content analysis in
a cross-sectional design to systematically categorize prescription errors
found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members
reviewed the discharge prescription list for errors. Open-ended data were
coded by an additional rater for agreement on coding categories. Coding
was based upon majority rule. Descriptive statistics were used to address
the study objective. Categories evaluated were patient age, provider type,
drug class, and type and time of error. The discharge prescription error
rate out of 1000 prescriptions was 13.4%, with "incomplete or inadequate prescription" being the most commonly detected error (58.2%).
The adult and pediatric error rates were 11.7% and 22.7%, respectively.
The antibiotics reviewed had the highest number of errors. The highest
within-class error rates were with antianginal medications, antiparasitic
medications, antacids, appetite stimulants, and probiotics. Emergency
medicine residents wrote the highest percentage of prescriptions (46.7%)
and had an error rate of 9.2%. Residents of other specialties wrote 340
prescriptions and had an error rate of 20.9%. Errors occurred most often
between 10:00 AM and 6:00 PM.

ccording to the Food and Drug Administration, there
have been over 95,000 reports of medication errors to
MedWatch since 2000, with the number of actual errors
estimated as even higher (1). The National Electronic
Injury Surveillance System-Cooperative Adverse Drug Event
Surveillance project showed that nearly 17% of 700,000 US patients treated annually for adverse drug events in the emergency
department (ED) require hospitalization (2, 3). The ED's increasing patient volumes, pressure to see more patients in shorter
amounts of time, lack of continuity of care, and unfamiliar
patients all play a role in the development of medication errors
(4, 5). Despite computerized provider order entry and decision
support tools in place to prevent prescribing errors in the ED,
high error rates of 10% to 21% persist (5-9). Cesarz et al found
that out of 674 ED discharge prescriptions reviewed, 68 prescriptions required intervention to prevent errors and optimize
therapy (54% and 46%, respectively) (6). This study provided
evidence to support pharmacist prescription review in the ED,
but it lacked the description of what prescriptions required
Proc (Bayl Univ Med Cent) 2017;30(2):143-146

interventions most often and for what reason, the time of day
the interventions occurred most frequently, and what providers
were most likely to need intervention. The current study aimed
to describe those speciﬁcs regarding discharge prescription errors
in an academic medical center ED.
METHODS
This study was approved by the study site's institutional
review board. This study was a retrospective chart review that
used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report capturing
a convenience sample of the ﬁrst 1000 discharge prescriptions
written and submitted in the electronic medical record (Meditech 6.8) in February 2015. Providers for these visits included
emergency medicine (EM) attending physicians, EM residents,
attending physicians from other specialties, and resident physicians from other specialties. All prescriptions written during this
timeframe were included in the analysis.
The study site is an urban academic medical center with
an annual ED volume of approximately 48,000 patients. The
ED has 48 hours of EM faculty physician coverage daily (four
12-hour shifts: 7:00 am-7:00 pm, 9:00 am-9:00 pm, 1:00 pm-
1:00 am, and 7:00 pm-7:00 am). An EM clinical pharmacist
is available on site from 8:00 am to 4:30 pm and is physically
present in the ED from 11:00 am to 4:30 pm focusing on drug
information questions, drug dosing, and medication reconciliation. Numerous EM, oﬀ-service, and pharmacy residents also
are present in the department.
The primary objective of this study was to identify the percentage of prescription errors in a sample of discharge prescriptions from an academic medical ED. The secondary objectives
were to describe errors based on 1) patient age, 2) type of error
From Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
(Murray, Lane); Choctaw Nation Healthcare Center, Talihina, Oklahoma (Belanger);
The University of North Carolina Hospitals, Chapel Hill, North Carolina (Devine);
and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
(Condren).
Corresponding author: Kelly A. Murray, PharmD, Clinical Assistant Professor
of Clinical Pharmacy, Oklahoma State University Center for Health Sciences,
Department of Emergency Medicine, 744 W. 9th Street, Tulsa, OK 74127 (e-mail:
Kelly.Murray@okstate.edu).
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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017