Impact of a standard medication chart on prescribing errors: a before-and-after audit

Area of Science:

• Health Services Research
• Patient Safety
• Medication Management

Background:

• Medication errors and adverse drug reactions pose significant risks in hospital settings.
• Lack of standardized medication charts can contribute to prescribing and administration errors.
• Effective medication management is crucial for patient safety and quality of care.

Purpose of the Study:

• To develop and implement a standard medication chart in Queensland public hospitals.
• To evaluate the impact of the standard chart on prescribing errors, adverse drug reaction documentation, and warfarin safety.
• To utilize the chart for facilitating standardized medication management training.

Main Methods:

• A multidisciplinary collaborative developed the standard medication chart using incident analysis and work practice mapping.
• Observational audits of prescriptions were conducted before and after chart implementation across five hospital sites.
• Nurse and pharmacist pairs performed audits of all available prescriptions.

Main Results:

• The prescribing error rate decreased from 20.0% to 15.8% after chart implementation (p = 0.03).
• Documentation of previous adverse drug reactions improved, with rates decreasing from 19.5% to 11.2% (p = 0.032).
• Prescribing errors related to adverse drug reactions decreased from 11.3% to 4.6% (p = 0.021), and warfarin-related risks (INRs >5) also reduced (p = 0.004).

Conclusions:

• The standard medication chart significantly reduced prescribing errors and improved adverse drug reaction documentation.
• The chart enhanced the safety of warfarin management and facilitated uniform medication management training.
• The developed chart served as the foundation for the National Inpatient Medication Chart, promoting wider adoption of safe practices.