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Search results for "Ordering/Prescribing Errors"

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  • Ordering/Prescribing Errors
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Journal Article > Study

Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old.

Wauters M, Elseviers M, Vaes B, et al. Br J Clin Pharmacol. 2016;82:1382-1392.

Older patients are particularly vulnerable to adverse drug events. This study examined the prevalence of appropriate prescribing in community-dwelling adults age 80 and older. Consistent with prior research, this study found that inappropriate prescribing was common. The authors also determined that underuse had a higher association with mortality and hospitalization than misuse.

Journal Article > Study

Hospital prescribing of opioids to Medicare beneficiaries.

Jena AB, Goldman D, Karaca-Mandic P. JAMA Intern Med. 2016;176:990-997.

Misuse of prescription opioids represents a serious patient safety issue. In this study, investigators examined opioid prescribing to Medicare beneficiaries upon hospital discharge. They found that new opioid use was common after discharge and that prescribing rates varied widely across hospitals.

Journal Article > Study

Risk factors for i.v. compounding errors when using an automated workflow management system.

Deng Y, Lin AC, Hingl J, et al. Am J Health Syst Pharm. 2016;73:887-893.

Mistakes during preparation of intravenous (IV) medications can lead to dosing errors and adverse drug events. Analyzing data collected over 12 months in a hospital's automated IV compounding workflow management system, this study found that IV compounding errors occurred in less than 1% of cases and were usually intercepted through the automated system. These results suggest that existing processes do support safe medication use.

Journal Article > Review

Interventions to address potentially inappropriate prescribing in community-dwelling older adults: a systematic review of randomized controlled trials.

Clyne B, Fitzgerald C, Quinlan A, et al. J Am Geriatr Soc. 2016;64:1210-1222.

Older patients are more vulnerable to adverse drug events, and a key safety strategy is to avoid prescribing high-risk medications to these patients. This systematic review found that pharmacist medication review and clinical decision support, as well as combined approaches, were modestly effective at reducing high-risk prescribing for older patients. The authors suggest that further studies are needed to identify more effective means of promoting safe prescribing for this vulnerable population.

Journal Article > Study

Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011.

Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. JAMA. 2016;315:1864-1873.

More than 12% of all outpatient visits in the United States in 2010–2011 resulted in an antibiotic prescription, of which approximately 30% were inappropriate, according to this population-based analysis. Inappropriate antibiotic prescribing increases the risk of antibiotic-resistant infections and is a recognized patient safety risk. A WebM&M commentary discusses catastrophic complications resulting from an inappropriate antibiotic prescription for sinusitis.

Book/Report

Antibiotic Stewardship in Acute Care: A Practical Playbook.

National Quality Partners. Washington, DC: National Quality Forum; 2016.

Antimicrobial stewardship has been promoted as a strategy to improve patient safety by reducing overuse of antibiotics to prevent hospital-acquired infections. This report draws from the experience of existing programs to summarize practical strategies for implementing initiatives. Core elements include engaging leadership, monitoring effectiveness, and reporting benchmarks.

Journal Article > Study

Discrepancies between prescribed and actual pediatric home parenteral nutrition solutions.

Raphael BP, Murphy M, Gura KM, et al. Nutr Clin Pract. 2016;31:654-658.

Medication compounding is prone to dosing errors. This study found that the majority of reviewed home parenteral nutrition preparations, which must be individually compounded based on caloric and nutrient needs, had at least one discrepancy between the formulation prescribed and dispensed. The authors recommend routine reconciliation of home parenteral nutrition compounds with prescriptions to prevent errors.

Web Resource > Government Resource

Injury Prevention & Control: Opioid Overdose.

Centers for Disease Control and Prevention.

Concerns about patient harm from prescription opioid misuse are increasing in the United States. This website provides guidelines for use of opioid medications and information to raise awareness about the need to improve physicians' prescribing decisions and patients' medication use.

Journal Article > Review

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review.

Bannan DF, Tully MP. J Clin Pharm Ther. 2016;41:246-255.

Many successful patient safety programs involve the use of bundled interventions. For example, the seminal Keystone ICU project combined a checklist with regular data audit and feedback and efforts to improve safety culture. This systematic review of bundled interventions to prevent prescribing errors and medication administration errors in hospitalized children characterized several types of approaches. The authors ultimately determined that the poor quality of existing literature precludes conclusions about effectiveness.

Journal Article > Review

Improving feedback on junior doctors' prescribing errors: mixed-methods evaluation of a quality improvement project.

Reynolds M, Jheeta S, Benn J, et al. BMJ Qual Saf. BMJ Qual Saf 2017;26:240-247.

Prescribing errors are a common source of harm for hospitalized patients. This study describes a multifaceted intervention to improve feedback and prevent resident physician prescribing errors. Despite improvements in numerous process measures, rates of errors did not significantly change.

Journal Article > Study

Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England.

  • Classic

Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. BMJ Qual Saf. 2017;26:530-541.

Electronic prescribing is an important component of health information technology–related patient safety efforts. Some health care systems have invested in hospital-wide integrated programs that include prescribing modules, whereas others have linked standalone systems through interfacing mechanisms. This intensive study integrated data from six hospitals (including multiple interviews, observations, implementation documents, and expert round-table discussions) to explore the tradeoffs between these technologic strategies. The authors describe various integration and interfacing issues with both standalone and multimodular systems, such as increased workloads due to lack of timely information and insufficient information transfer necessitating manual data entry between modules. A recent PSNet perspective focused on the many advances and remaining challenges of electronic prescribing.

Journal Article > Study

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.

Her QL, Amato MG, Seger DL, et al. J Am Med Inform Assoc. 2016;23:924-933.

Users often bypass alerts meant to enhance the safety of medication ordering and dispensing technologies. This observational study at a large academic medical center found approximately one in five nonformulary medication alerts are inappropriately overridden. The authors suggest strategies that future research should examine for improving the design of nonformulary alerts.

Journal Article > Study

A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.

  • Classic

Slight SP, Beeler PE, Seger DL, et al. BMJ Qual Saf. BMJ Qual Saf 2017;26:217-225.

Clinical decision support systems are intended to improve safety by providing clinicians with information about potential harms—principally harmful drug interactions and allergies—at the point of care. Analyzing more than 150,000 drug allergy warnings in the inpatient and outpatient settings within a single health care system, this study examined how often the warnings were overridden and the appropriateness of prescribers' reasons for doing so. Clinicians overrode 81% of warnings in hospitalized patients and 77% of alerts in outpatients. More than 96% of the overrides were judged appropriate by independent clinical reviewers. These proportions are similar to prior studies. A common appropriate reason for overriding was that the patient had actually tolerated the drug in question, leading the authors to call for improving the accuracy of allergy documentation in electronic medical records. A few classes of drugs accounted for a large proportion of overridden alerts, suggesting that enhancing the accuracy of allergy warnings for these drugs could significantly reduce the overall burden of alerts. Given that alert fatigue is an increasingly recognized patient safety hazard, creating tailored alerts could help clinical decision support systems achieve their potential to improve safety.

Journal Article > Study

Safer prescribing—a trial of education, informatics, and financial incentives.

  • Classic

Dreischulte T, Donnan P, Grant A, Hapca A, McCowan C, Guthrie B. N Engl J Med. 2016;374:1053-1064.

Adverse drug events among outpatients are common and can lead to preventable complications. Conducted in primary care practices, this cluster-randomized trial found that a combination of professional education, electronic health record alerts, and financial incentives for practices to review potentially inappropriate prescribing decreased high-risk medication prescriptions. Investigators also observed a decrease in two of the three medication-related complications associated with use of high-risk medications, suggesting a clinical benefit to this intervention. The success of this study argues for similar larger-scale, multi-modal patient safety studies to detect modest but significant improvements.

Journal Article > Study

Analysis of prescribers' notes in electronic prescriptions in ambulatory practice.

  • Classic

Dhavle AA, Yang Y, Rupp MT, Singh H, Ward-Charlerie S, Ruiz J. JAMA Intern Med. 2016;176:463-470.

Many ambulatory practices have recently introduced electronic prescribing, which has the potential to improve medication safety. In this large cross-sectional study, researchers analyzed more than 26,000 electronic prescriptions that included free-text notes sent to community pharmacies. Two-thirds of free-text notes contained inappropriate content, despite the availability of a standard data field. Nearly 1 in 5 of these notes included conflicting administration instructions from the designated structured field, creating an important source of potential medication errors. In addition, approximately 5% of notes contained irrelevant information, which may distract or confuse pharmacy staff. The authors outline recommended solutions based on the information most commonly included in prescription free-text notes.

Journal Article > Study

Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers.

Sacarny A, Yokum D, Finkelstein A, Agrawal S. Health Aff (Millwood). 2016;35:471-479.

Overprescribing of opioids is a serious and worsening problem. In the United States, deaths from opioid overdoses have more than quadrupled over the past decade. Providing peer comparisons has been shown to reduce other instances of medical care overuse, such as inappropriate antibiotic prescriptions. In this study, health care providers who very frequently prescribed Schedule II controlled substances (the highest risk category for which a prescription is still legal) were randomized to receive a letter showing their prescription practices compared to their peers. There was no evidence that the letters had any impact on prescribing behaviors. The authors describe ongoing efforts to redesign the letters with the hope to enhance their influence on physicians. A past WebM&M commentary discussed best practices for opioid prescribing.

Journal Article > Commentary

Automatic errors: a case series on the errors inherent in electronic prescribing.

Lourenco LM, Bursua A, Groo VL. J Gen Intern Med. 2016;31:808-811.

Inadvertent dispensing of discontinued medications can result in patient harm. Examining incidents involving such medication errors, this commentary spotlights the need for enhanced electronic medical records to reduce risks related to discontinuation orders.

Journal Article > Study

Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial.

Meeker D, Linder JA, Fox CR, et al. JAMA. 2016;315:562-570.

In this cluster randomized trial among 47 primary care practices, prompting clinicians to enter justifications for prescribing antibiotics in patients with antibiotic-inappropriate diagnoses or providing peer comparisons through emails decreased mean antibiotic prescribing rates compared to controls. Antibiotics are a significant source of medical care overuse and inappropriate prescriptions can lead to avoidable harms.

Journal Article > Study

US poison control center calls for infants 6 months of age and younger.

  • Classic

Kang AM, Brooks DE. Pediatrics. 2016;137:1-7.

Pediatricians commonly advise parents to keep medications and chemicals inaccessible to their young children to avoid accidental ingestions. With the assumption that infants will not be mobile enough to access potentially harmful substances, providers typically begin these conversations with parents when children are age 6 months. This retrospective study reviewed 10 years of calls to poison control centers for infants younger than 6 months. Nearly 97% of the 271,513 exposures were unintentional. Half were coded as "general unintentional," which includes exploratory exposures and other scenarios leading to access, such as a sibling providing a substance to the child. Therapeutic errors, such as dosing mistakes, accounted for another 37% of exposures. Some parents self-triaged to a health care facility prior to speaking to poison control, which may be due to unawareness among parents of young infants about the availability of poison control consultation. The authors suggest this study may help guide future poison education and prevention efforts.

Journal Article > Study

Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin.

Berthe-Aucejo A, Girard D, Lorrot M, et al. Arch Dis Child. 2016;101:359-364.

This prospective observational study demonstrated that caregivers of pediatric patients experienced difficulties in reconstituting and dosing liquid medications, consistent with prior studies. Family education and enhanced instructions are needed to improve safety of pediatric medication use.

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