Investigation of correlation between house-staff work hours and prescribing errors

Area of Science:

• Medical error analysis
• Healthcare quality improvement
• Internal medicine residency

Background:

• Prescribing errors pose a significant risk to patient safety in hospital settings.
• Understanding factors influencing prescribing errors, such as resident work hours, is crucial for developing effective interventions.

Purpose of the Study:

• To investigate the correlation between the number of hours worked by hospital house staff during a 24-hour shift and the frequency and significance of prescribing errors.
• To determine if extended work hours contribute to an increased likelihood or severity of prescribing mistakes.

Main Methods:

• A prospective observational study was conducted in internal medicine units at an academic medical center.
• Prescribing errors in orders written by medical house staff were collected and evaluated for type, significance, and the resident's work hours at the time of the error.
• Data were collected over a defined period (January 8 to March 10, 2001).

Main Results:

• A total of 45,366 orders were reviewed, identifying 498 erroneous prescribing orders.
• A significant majority (77%) of identified errors had the potential to cause substantial patient harm (morbidity or mortality).
• The most frequent errors included incorrect dosage (18%), wrong dosage frequency (15%), and duplicate orders (15%).
• No statistically significant correlation was found between the number of hours worked and the frequency or significance of prescribing errors.

Conclusions:

• The duration of work hours for medical house staff during a 24-hour shift did not demonstrate a significant impact on the occurrence or severity of prescribing errors.
• Findings suggest that factors other than work hours may be more influential in contributing to prescribing errors in this population.