Patient Safety and Quality

Medication errors are common among patients in psychiatric hospitals

Despite the movement of mental health patients out of psychiatric hospitals, more than a quarter of all hospital admissions are for psychiatric hospitalizations. Adverse drug events (ADEs) and medication errors (MEs) involving psychiatric medications are common among patients at psychiatric hospitals, according to a new study. Of 1,559 patients admitted at 1 psychiatric hospital in 2004 and 2005, mostly for mood disorders and schizophrenia, the rate of ADEs and serious MEs were 10 and 6.3 per 1,000 patient days, respectively. Preventable ADEs accounted for 13 percent of the 191 ADEs. Atypical antipsychotics accounted for over one-third of ADEs (37 percent).

Two-thirds of ADEs were significantly harmful, 31 percent were considered serious, and 2 percent were considered life-threatening events. There were no fatal ADEs. Nonpsychiatric drugs accounted for only 4 percent of nonpreventable ADEs, but were associated with nearly one-third of all preventable ADEs and near misses.

The most common types of MEs were wrong dose (24.6 percent), drug-drug interaction (17.2 percent), and omitted medication (13.8 percent). MEs were most frequently associated with physician orders (68 percent), but 20 percent were attributed to nursing transcription errors and 10 percent to administration errors.

Medication orders were paper-based. Serious MEs in this study could have been prevented by computerized physician order entry (CPOE) with decision support such as drug-drug interaction, and drug-dose checking (44 percent). MEs could have also been prevented by basic CPOE alone to ensure prescription legibility and completeness (16.7 percent) and bar-coded medication administration (15.2 percent).

The researchers identified MEs and ADEs from medical charts, progress notes, and test results; nursing and physician reports; and pharmacy intervention reports. The study was supported by the Agency for Healthcare Research and Quality (HS11534).

See "Medication safety in a psychiatric hospital," by Jeffrey M. Rothschild, M.D., M.P.H., Klaus Mann, M.D., Carol A. Keohane, B.S.N., R.N., and others in the March/April 2007 General Hospital Psychiatry 29, pp. 156-162.

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