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Overnight and postcall errors in medication orders.

Gregory W Hendey1, Bradley E Barth, Tricia Soliz

  • 1Department of Emergency Medicine, UCSF Fresno Medical Education Program, USA. hendey@ucsfresno.edu <hendey@ucsfresno.edu>

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|July 5, 2005
PubMed
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Physician fatigue increases medication errors. Overnight and postcall physicians, especially first-year residents on general medical/surgical wards, show higher error rates, impacting patient safety.

Area of Science:

  • Medical error analysis
  • Physician work hours and patient safety
  • Healthcare quality improvement

Background:

  • Physician fatigue is a significant concern in healthcare.
  • Work hour regulations aim to mitigate fatigue-related errors.
  • The impact of on-call status on medication order accuracy requires further investigation.

Purpose of the Study:

  • To compare medication order error rates among physicians based on their call status: off call, on overnight call, and postcall.
  • To identify specific physician groups and clinical settings with elevated medication ordering errors.

Main Methods:

  • Retrospective review of inpatient medication orders, pharmacy records, and resident physician work schedules.
  • Analysis conducted at a university-affiliated community teaching hospital.

Related Experiment Videos

  • Calculation of error rates, odds ratios (ORs), and 95% confidence intervals (95% CIs) for April 2000.

    • Main Results:

    • Overall medication order error rate was 2.16% (177 errors in 8,195 orders).
    • Increased error rates observed for overnight and postcall orders (2.71%) compared to off-call orders (1.90%).
    • Significantly higher error rates occurred on medical/surgical wards during overnight (3.91%) and postcall (3.41%) periods, with first-year residents (PGY1) showing the highest overnight error rate (4.23%).

    Conclusions:

    • Medication ordering error rates are elevated for physicians on overnight and postcall duty.
    • General medical/surgical wards and PGY1 physicians during overnight shifts are particularly high-risk periods.
    • Findings underscore the need for strategies to mitigate fatigue-related medication errors in resident physicians.