Baylor University Medical Center Proceedings April 2017 - 145
Table 2. Prescription errors organized by medication class
Errors in Class's % of
Prescriptions Errors class (%) total errors
Class
Antibiotic
154
23
14.9%
17.2%
Analgesic
141
5
3.5%
3.7%
Antiemetic
106
9
8.5%
6.7%
Inhaler
77
5
6.5%
3.7%
Corticosteroid
54
16
29.6%
11.9%
Antihypertensive
42
7
16.7%
5.2%
Topical
30
13
43.3%
9.7%
Proton pump inhibitor
26
11
42.3%
8.2%
Muscle relaxer
24
1
4.2%
0.7%
Nebulized medication
22
14
63.6%
10.4%
Antiplatelet
19
1
5.3%
0.7%
Antiepileptic
18
1
5.6%
0.7%
Supplement
15
4
26.7%
3.0%
Diuretic
15
1
6.7%
0.7%
Ophthalmic
12
3
25.0%
2.2%
Antiviral
10
2
20.0%
1.5%
Benzodiazepine
10
1
10.0%
0.7%
Laxative
7
1
14.3%
0.7%
Insulin
5
3
60.0%
2.2%
Antipsychotic
5
2
40.0%
1.5%
Anticoagulant
5
1
20.0%
0.7%
Nasal
5
1
20.0%
0.7%
Anticholinergic
3
1
33.3%
0.7%
Otic
3
1
33.3%
0.7%
Antianginal
2
2
100.0%
1.5%
Antiparasitic
2
2
100.0%
1.5%
Antacid
1
1
100.0%
0.7%
Appetite stimulant
1
1
100.0%
0.7%
Probiotic
1
1
100.0%
0.7%
Table 3. Prescription errors organized by provider type
Physician type
Rx
written
Percentage
Percentage Percentage
of total
of total
of Rx
Rx written Errors
errors
with errors
EM attending
180
18%
11
8.2%
6.1%
EM resident
467
46.7%
43
32.1%
9.2%
Non-EM attending
13
1.3%
9
6.7%
69.2%
Non-EM resident
340
34%
71
53.0%
20.9%
EM indicates emergency medicine; Rx, prescriptions.
April 2017
information were prone to errors. If a specific medication regimen was incorrect in a prepopulated "favorite prescriptions"
list, then it may have been incorrect for all of the prescriptions
printed for that medication by that physician. Also, the lack
of directly available dosage calculators and decision support
aids may have contributed to a greater chance for inaccurate
dosing, especially for weight-based medications. Errors were
also observed when the dose and frequency of liquid solutions
or suspensions were included but the quantity to be dispensed
was "1 bottle" instead of the specific bottle size needed. Also
seen were prescriptions where the package size was left in the
dose category, such as a 30 g tube of hydrocortisone 1% cream
printed as "Hydrocortisone 1% cream 30 g, 30 applications TP
daily #1 tube." Dose and package size interchange may lead to
patient confusion, supratherapeutic doses, and adverse events.
In the ED, analgesics, muscle relaxers, antiepileptics,
and inhalers are often prescribed in acute care patient visits,
supporting the low within-class error rate seen in this study.
Seventeen percent of all prescription errors were written for
antibiotics, paralleling other medication error identification
studies (8, 12). Other classes of drugs that demonstrated high
levels of prescription errors were nebulized, topical, and steroid
medications. These are all medications that require special instructions, and counseling should be given both verbally and
via the prescription label to maximize patient understanding.
Medications less frequently prescribed, such as antiparasitics, antianginals, nebulized medications, and appetite stimulants, may be less familiar to physicians, and therefore may be
more prone to errors. Knowing the classes of medications that
have high within-class error rates as well as high total error
rates may help determine appropriate educational and quality
improvement interventions.
The error rate for EM residents was higher than that for EM
attending physicians. The prescription error rates were highest
for off-service resident and attending physicians. Medication
regimens used by off-service disciplines can be significantly different from those prescribed in the ED setting. This suggests
a potential need for better orientation of these residents to the
types of prescriptions written in the ED and potentially more
oversight and input from attending physicians, pharmacists,
and nurses.
Unsurprisingly, the greatest amount of prescription errors occurred during the busiest time of day for an ED, from
10:00 am to 6:00 pm. There were 641 prescriptions written
during this time frame, 104 of which contained an error. This
result is proportional to the number of patients roomed in the
ED at the time of prescription printing, increasing the demand
on providers and expectedly dividing their focus.
Dedicating more ED pharmacist, pharmacy resident, or
student time to prescription review during peak hours of patient
care could help minimize errors. EM pharmacists have the advanced knowledge and skill set to help reduce patient harm
through minimization of prescription medication errors. The
data showing that pharmacists improve the error rates for medications is robust, showing a positive impact on medication errors
(12), decreasing unintended medications being continued from
Emergency department discharge prescription errors in an academic medical center
145
Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017
No label
Baylor University Medical Center Proceedings April 2017 - No label
Baylor University Medical Center Proceedings April 2017 - Cover2
Baylor University Medical Center Proceedings April 2017 - 137
Baylor University Medical Center Proceedings April 2017 - 138
Baylor University Medical Center Proceedings April 2017 - 139
Baylor University Medical Center Proceedings April 2017 - 140
Baylor University Medical Center Proceedings April 2017 - 141
Baylor University Medical Center Proceedings April 2017 - 142
Baylor University Medical Center Proceedings April 2017 - 143
Baylor University Medical Center Proceedings April 2017 - 144
Baylor University Medical Center Proceedings April 2017 - 145
Baylor University Medical Center Proceedings April 2017 - 146
Baylor University Medical Center Proceedings April 2017 - 147
Baylor University Medical Center Proceedings April 2017 - 148
Baylor University Medical Center Proceedings April 2017 - 149
Baylor University Medical Center Proceedings April 2017 - 150
Baylor University Medical Center Proceedings April 2017 - 151
Baylor University Medical Center Proceedings April 2017 - 152
Baylor University Medical Center Proceedings April 2017 - 153
Baylor University Medical Center Proceedings April 2017 - 154
Baylor University Medical Center Proceedings April 2017 - 155
Baylor University Medical Center Proceedings April 2017 - 156
Baylor University Medical Center Proceedings April 2017 - 157
Baylor University Medical Center Proceedings April 2017 - 158
Baylor University Medical Center Proceedings April 2017 - 159
Baylor University Medical Center Proceedings April 2017 - 160
Baylor University Medical Center Proceedings April 2017 - 161
Baylor University Medical Center Proceedings April 2017 - 162
Baylor University Medical Center Proceedings April 2017 - 163
Baylor University Medical Center Proceedings April 2017 - 164
Baylor University Medical Center Proceedings April 2017 - 165
Baylor University Medical Center Proceedings April 2017 - 166
Baylor University Medical Center Proceedings April 2017 - 167
Baylor University Medical Center Proceedings April 2017 - 168
Baylor University Medical Center Proceedings April 2017 - 169
Baylor University Medical Center Proceedings April 2017 - 170
Baylor University Medical Center Proceedings April 2017 - 171
Baylor University Medical Center Proceedings April 2017 - 172
Baylor University Medical Center Proceedings April 2017 - 173
Baylor University Medical Center Proceedings April 2017 - 174
Baylor University Medical Center Proceedings April 2017 - 175
Baylor University Medical Center Proceedings April 2017 - 176
Baylor University Medical Center Proceedings April 2017 - 177
Baylor University Medical Center Proceedings April 2017 - 178
Baylor University Medical Center Proceedings April 2017 - 179
Baylor University Medical Center Proceedings April 2017 - 180
Baylor University Medical Center Proceedings April 2017 - 181
Baylor University Medical Center Proceedings April 2017 - 182
Baylor University Medical Center Proceedings April 2017 - 183
Baylor University Medical Center Proceedings April 2017 - 184
Baylor University Medical Center Proceedings April 2017 - 185
Baylor University Medical Center Proceedings April 2017 - 186
Baylor University Medical Center Proceedings April 2017 - 187
Baylor University Medical Center Proceedings April 2017 - 188
Baylor University Medical Center Proceedings April 2017 - 189
Baylor University Medical Center Proceedings April 2017 - 190
Baylor University Medical Center Proceedings April 2017 - 191
Baylor University Medical Center Proceedings April 2017 - 192
Baylor University Medical Center Proceedings April 2017 - 193
Baylor University Medical Center Proceedings April 2017 - 194
Baylor University Medical Center Proceedings April 2017 - 195
Baylor University Medical Center Proceedings April 2017 - 196
Baylor University Medical Center Proceedings April 2017 - 197
Baylor University Medical Center Proceedings April 2017 - 198
Baylor University Medical Center Proceedings April 2017 - 199
Baylor University Medical Center Proceedings April 2017 - 200
Baylor University Medical Center Proceedings April 2017 - 201
Baylor University Medical Center Proceedings April 2017 - 202
Baylor University Medical Center Proceedings April 2017 - 203
Baylor University Medical Center Proceedings April 2017 - 204
Baylor University Medical Center Proceedings April 2017 - 205
Baylor University Medical Center Proceedings April 2017 - 206
Baylor University Medical Center Proceedings April 2017 - 207
Baylor University Medical Center Proceedings April 2017 - 208
Baylor University Medical Center Proceedings April 2017 - 209
Baylor University Medical Center Proceedings April 2017 - 210
Baylor University Medical Center Proceedings April 2017 - 211
Baylor University Medical Center Proceedings April 2017 - 212
Baylor University Medical Center Proceedings April 2017 - 213
Baylor University Medical Center Proceedings April 2017 - 214
Baylor University Medical Center Proceedings April 2017 - 215
Baylor University Medical Center Proceedings April 2017 - 216
Baylor University Medical Center Proceedings April 2017 - 217
Baylor University Medical Center Proceedings April 2017 - 218
Baylor University Medical Center Proceedings April 2017 - 219
Baylor University Medical Center Proceedings April 2017 - 220
Baylor University Medical Center Proceedings April 2017 - 221
Baylor University Medical Center Proceedings April 2017 - 222
Baylor University Medical Center Proceedings April 2017 - 223
Baylor University Medical Center Proceedings April 2017 - 224
Baylor University Medical Center Proceedings April 2017 - 225
Baylor University Medical Center Proceedings April 2017 - 226
Baylor University Medical Center Proceedings April 2017 - 227
Baylor University Medical Center Proceedings April 2017 - 228
Baylor University Medical Center Proceedings April 2017 - 229
Baylor University Medical Center Proceedings April 2017 - 230
Baylor University Medical Center Proceedings April 2017 - 231
Baylor University Medical Center Proceedings April 2017 - 232
Baylor University Medical Center Proceedings April 2017 - 233
Baylor University Medical Center Proceedings April 2017 - 234
Baylor University Medical Center Proceedings April 2017 - 235
Baylor University Medical Center Proceedings April 2017 - 236
Baylor University Medical Center Proceedings April 2017 - 237
Baylor University Medical Center Proceedings April 2017 - 238
Baylor University Medical Center Proceedings April 2017 - 239
Baylor University Medical Center Proceedings April 2017 - 240
Baylor University Medical Center Proceedings April 2017 - 241
Baylor University Medical Center Proceedings April 2017 - 242
Baylor University Medical Center Proceedings April 2017 - 243
Baylor University Medical Center Proceedings April 2017 - 244
Baylor University Medical Center Proceedings April 2017 - 245
Baylor University Medical Center Proceedings April 2017 - 246
Baylor University Medical Center Proceedings April 2017 - 247
Baylor University Medical Center Proceedings April 2017 - 248
Baylor University Medical Center Proceedings April 2017 - 249
Baylor University Medical Center Proceedings April 2017 - 250
Baylor University Medical Center Proceedings April 2017 - 251
Baylor University Medical Center Proceedings April 2017 - 252
Baylor University Medical Center Proceedings April 2017 - Cover3
Baylor University Medical Center Proceedings April 2017 - Cover4
http://www.brightcopy.net/allen/bapr/30-4
http://www.brightcopy.net/allen/bapr/30-3
http://www.brightcopy.net/allen/bapr/30-2
http://www.brightcopy.net/allen/bapr/30-1
http://www.brightcopy.net/allen/bapr/29-4
http://www.brightcopy.net/allen/bapr/29-3
http://www.brightcopy.net/allen/bapr/29-2
http://www.brightcopy.net/allen/bapr/29-1
http://www.brightcopy.net/allen/bapr/28-04
https://www.nxtbook.com/allen/bapr/28-3
https://www.nxtbook.com/allen/bapr/28-2
https://www.nxtbook.com/allen/bapr/28-1
https://www.nxtbook.com/allen/bapr/27-4
https://www.nxtbook.com/allen/bapr/27-3
https://www.nxtbookmedia.com