Patient Safety and Quality

Multiple approaches are needed to reduce hospital prescribing errors

A new study found a link between use of grand rounds, an interactive presentation for hospital staff, reminders that targeted 20 safe prescribing behaviors, and modest improvement in the quality of medication orders written by hospital surgical staff. Such training may need to be started in medical school and augmented and reinforced throughout residency, recommend the study authors. They identified prescribing errors in handwritten medication orders written by hospital staff both before and after the intervention in order to evaluate the intervention's impact on these errors.

Prior to the intervention, prescribing errors were more common among surgical hospital staff than medical house staff (1.08 vs. 0.76 errors per order). Only 1 percent of orders contained an overt error, but 49 percent were incomplete, 27 percent contained dangerous dose and frequency abbreviations, and 17 percent were illegible. After the intervention, the mean number of prescribing errors per order decreased for surgical house staff from 1.08 to 0.85, with a more marked effect for house staff who attended the didactic portion of the intervention.

In addition, significant errors per order decreased from a mean of 0.65 to 0.45. The proportion of orders that were incomplete, illegible, or contained an overt error also declined substantially. However, prescribing errors per order increased in orders written by medical house staff from 0.76 to 0.98. The study was supported by the Agency for Healthcare Research and Quality (HS11898).

See "Reducing medication prescribing errors in a teaching hospital," by Jane Garbutt, M.B., Ch.B., Paul E. Milligan, R.Ph., Candace McNaughton, M.D., and others, in the September 2008 Joint Commission Journal on Quality and Patient Safety 34(9), pp. 528-536.

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