Search results for "Ordering/Prescribing 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.

This monthly selection of error reports shares examples of topical anesthetic error, methotrexate overdose, and child-proof medicine cap dangers.

Computerized provider order entry (CPOE) continues to be hailed as a solution to preventing medication errors. While past research demonstrates its benefits in reducing serious medication errors, debate exists about its clinical benefits and unintended consequences. This systematic review builds on the existing literature by examining the impact of CPOE in pediatric and intensive care settings. Investigators analyzed data from twelve studies and discovered that medication prescription errors are in fact reduced after CPOE adoption. However, evidence of clinical benefit remains lacking, and the authors conclude that the quality of the implementation process is the key factor in success.

This article analyzed reports of medication errors due to patient allergies and found that lack of patient or drug information contributed to many of these errors.

This population-based study examined how adverse bleeding events associated with warfarin affected physicians' prescribing the drug to other patients.

The authors studied error reports from the Medmarx database and found that 3% of the antiretroviral product errors reported were harmful and that wrong dose and wrong medication delivery errors were the most frequent failures.

The Joint Commission on Accreditation of Healthcare Organization's (JCAHO) National Patient Safety Goals advocate for hospitals to ensure medication reconciliation as part of their safety strategy. This article shares the views of a single institution in its efforts to construct reconciliation forms, design processes for use, and then audit the forms after put into practice. The authors offer a series of lessons learned from their implementation experience and suggest that future success relies on a team-oriented approach with consistent communication.

A woman given is found cyanotic on morning rounds. Her methemoglobinemia is determined to be from a roughly 7-fold overdose of dapsone.

This commentary describes a framework to help prevent inappropriate prescribing for elderly patients.

Elderly patients with dementia who were prescribed more than five medications were at greater risk of long-term functional decline. However, prescribing potentially inappropriate medications (as determined by the Beers criteria) was not correlated with worsened functional status. Other studies have also called the utility of Beers criteria into question.

This piece highlights conservative prescribing as a strategy to prevent overuse of medication.

In contrast to most hospitals and clinics, the Veterans Affairs (VA) health care system has had a fully electronic health record with computerized provider order entry for several years. In this survey, VA physicians generally had positive impressions of the system, with nearly 90% feeling the system improved drug safety and nearly half reporting that serious drug interaction warnings were "very useful." However, the accuracy of drug–drug interaction and allergy warnings within this system are partially dependent upon clinicians manually entering medications prescribed by non-VA providers. As more than one quarter of respondents admitted to not always entering this data, this study highlights the importance of medication reconciliation in establishing accurate medication lists in the ambulatory care setting.

A multidisciplinary collaborative process was used to develop a standardized medication chart. Implementation of the chart resulted in a reduction in medication errors, particularly those arising from prescription of medications to which the patient was allergic.

Alerts within a computerized provider order entry system were not able to prevent medication errors resulting from drug–drug interactions. The authors hypothesize that the inadequacy of the alerts themselves was responsible for this failure, with problems including an excessive number of false-positive alerts and unclear instructions for preventing drug interactions.

Prescribing of potentially inappropriate medications was common, especially in elderly patients, at a Croatian hospital.

This study found that Epocrates, a commercially available drug interaction database, was an efficient tool to highlight potential adverse drug events in the ambulatory setting.

This article describes a computerized drug ordering and dispensing system at a Florida hospital.

The investigators surveyed 882 elderly outpatients in order to determine if the Beers criteria can predict adverse drug reactions (ADRs). They found a positive relationship between potentially inappropriate drug prescribing, as defined by the criteria, and ADRs.