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Detection and correction of prescription errors by an emergency department pharmacy service

Published online by Cambridge University Press:  04 March 2015

Philip Stasiak ,
Marc Afilalo ,
Tanya Castelino ,
Xiaoqing Xue ,
Antoinette Colacone ,
Nathalie Soucy  and
Jerrald Dankoff
Philip Stasiak*
Affiliation:
McGill Emergency Medicine Residency Program
Marc Afilalo
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Tanya Castelino
Affiliation:
Faculty of Medicine, McGill University, Montreal, QC
Xiaoqing Xue
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Antoinette Colacone
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Nathalie Soucy
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
Jerrald Dankoff
Affiliation:
Emergency Department, Sir Mortimer B. Davis Jewish General Hospital
*
Emergency Department Room D-027, Jewish General Hospital, 3755 Côte-Sainte-Catherine Road, Montréal, QC H3T 1E2; philip.stasiak@mail.mcgill.ca

Abstract

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Objectives:

Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors.

Methods:

This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists’ recommendations.

Results:

A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5–3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32–4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54–9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18–4.14).

Conclusions:

Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.

Keywords

adverse drug eventsemergency departmentpatient safetypharmacistprescription errors
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 193 - 206
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

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