Search results for "Ordering/Prescribing Errors"

Hypoglycemia is a common and severe adverse drug event among patients with diabetes. This retrospective study of claims data found that Medicare patients with diabetes were less likely to be hospitalized or seen in the emergency department for hypoglycemia if their medications were prescribed electronically, compared to those receiving fewer or no electronic prescriptions. These findings add to the literature demonstrating the benefits of electronic prescribing.

Although certain medication classes pose increased risks to children, well-defined criteria for potentially inappropriate prescribing for pediatric patients have not been established. This study described an iterative consensus-building process which identified 12 indicators of potentially inappropriate medications for children. Future studies will test the validity of these indicators.

Standard term selection tools—like pick lists or drop-down menus—in information technology can create opportunities for user error due to human factors. This publication explores how mistakes such as selecting the wrong drug from an ordering pick list can occur in the ambulatory environment. The report includes recommendations and resources to help enhance medication safety when using these tools.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Prescribing errors are a serious source of patient harm in primary care. This cross-sectional study in the United Kingdom found wide variation in the prevalence of potentially hazardous prescribing ranging from nearly zero to 10%, and for inadequate medication monitoring ranging from 10% to 42% between practices.

Overprescribing can increase risk of dementia, particularly among older patients. This commentary describes an incident involving a patient with moderate dementia that worsened when opioids were prescribed following a fall. After a geriatrician evaluated the patient and suspected polypharmacy, the drugs were stopped, caregivers were educated about how to treat the patient, and the patient improved. Highlighting the importance of environmental interventions in treating this patient, the author reviews strategies to address neuropsychiatric symptoms of dementia.

A key patient safety role of pharmacists involves verifying orders placed by clinicians for accuracy and completeness. This retrospective study from an academic medical center found that pharmacists were more likely to commit errors in the verification process when they had to review more than 400 orders in one 8-hour shift or if they were working the evening shift (compared to the day or night shift).

A 5-year-old boy with transverse myelitis presented to the rehabilitation medicine clinic for scheduled quarterly botulinum toxin injections to his legs for spasticity. Halfway through the course of injections, the patient's mother noted her son was tolerating the procedure "much better than 3 weeks earlier"—the patient had been getting extra injections without the physicians' knowledge. Physicians discussed the risks of too-frequent injections with the family. Fortunately, the patient had no adverse effects from the additional injections.

This analysis of Medicare data found that outpatient practices using electronic prescribing had fewer adverse drug events among their panel of patients with diabetes compared to practices not consistently using electronic prescribing. Although promising, this study does not address the many differences between practices that use electronic prescribing versus those that do not and the patients that select these disparate health care systems.

This direct observation study found that various medication errors related to electronic prescribing occur in community pharmacies. Contributing factors included poor inter-operability between pharmacy and clinic systems, inadequate technology usability, and data entry errors. This finding underscores the growing safety concerns associated with medication prescribing in ambulatory care.

Comparing the accuracy of electronic dosing rules provided by a commercial vendor with traditional clinical dosing rules in pediatrics, this stimulation study found that the electronic rules were accurate only 55% of the time. This finding highlights the possible unintended consequences of health information technology (IT) on patient safety and underscores the specific challenge of pediatric medication prescribing. A recent AHRQ WebM&M commentary examines the complex issues around medication dosing for pediatric patients.

In this retrospective review of pediatric medication alerts, more than 85% of dosing alerts presented to clinicians were inappropriate. Frequent incorrect alerts contribute to alert fatigue and make clinicians more likely to override appropriate warnings.