Reducing medication prescribing errors in a teaching hospital.

Area of Science:

• Medical error reduction
• Healthcare quality improvement
• Physician education

Background:

• Medication errors are frequent, leading to significant patient harm and mortality.
• Many medication errors are preventable through targeted interventions.
• Handwritten medication orders by house staff are a common source of prescribing errors.

Purpose of the Study:

• To evaluate a multifaceted intervention aimed at reducing prescribing errors in handwritten medication orders.
• To assess the impact of the intervention on specific safe prescribing behaviors.
• To compare the effectiveness of the intervention between surgical and medical house staff.

Main Methods:

• A before-and-after study design was employed.
• The intervention included grand rounds, interactive presentations, and various reminders (e.g., checklists, chart inserts).
• The intervention targeted 20 specific safe prescribing behaviors.

Main Results:

• Prescribing errors were initially higher in surgical house staff compared to medical house staff.
• Post-intervention, surgical house staff showed a decrease in overall and significant prescribing errors per order.
• Medical house staff experienced an increase in prescribing errors per order following the intervention.

Conclusions:

• The intervention demonstrated a modest improvement in medication order quality for surgical residents.
• Multilevel interventions, including comprehensive safe prescribing training, are necessary to reduce prescribing errors.
• Training in safe prescribing should be integrated early in medical education and reinforced throughout residency.