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The MOWER (middle of the week everyone gets a re-chart) pilot study: reducing in-hospital charting error with a
Tony Floyd1, Siri Mårtensson2, Jannine Bailey3
1NSW Department of Health, Sydney, NSW, Australia.
Background:
Medication charting errors occur often and can be harmful for patients. Interventions to improve charting errors have demonstrated some success particularly if the intervention uses multiple approaches including an education component. The aim of this pilot study was to determine whether a multi-faceted intervention, including education of junior doctors and weekday re-charting could reduce in-hospital charting error.
Methods:
Medication charts (n = 579) of all patients admitted to the medical ward of a medium sized regionally-based hospital in Australia over nine months (baseline and during intervention) were inspected for errors. The intervention ran for three months and involved implementation of a National Inpatient Medication Chart targeted error tool with eight targeted charting requirements which was used for visual reminders in the ward and training of junior doctors. In addition, mid-weekly re-charting (MOWER) was performed by a senior and junior doctor team.
Results:
The mean number of charting requirement errors significantly reduced during the intervention by 26% from 4.6 ± 1.3 to 3.4 ± 1.7 per chart (p < 0.001). Re-chart errors reduced on average by 50% (4.4 ± 1.4 to 2.2 ± 1.7 per chart, p < 0.001) and primary (initial) charts by 20% (4.6 ± 1.3 to 3.7 ± 1.5 per chart, p < 0.001) during the intervention. Failing to provide indication information for a drug, prescriber name, and failing to use generic rather than brand names were the categories with the most errors at baseline and also showed the largest error reductions during the intervention.
Conclusions:
A multi-intervention including education of junior doctors, visual reminders and midweek re-charting are effective in reducing the rate of charting errors. We advise that a larger study is now conducted using the same multi-intervention strategy in different ward settings to evaluate feasibility and sustainability of this intervention.
Insights
A multi-faceted intervention significantly reduced medication charting errors by 26%. This strategy combined junior doctor education, visual reminders, and midweek re-charting to improve patient safety.
Area of Science:
- Medical error reduction strategies
- Patient safety in healthcare settings
- Clinical pharmacology and therapeutics
Background:
- Medication charting errors are frequent and pose risks to patient safety.
- Multi-component interventions, especially those including education, show promise in mitigating these errors.
- This pilot study investigated a novel intervention to decrease in-hospital medication charting errors.
Purpose of the Study:
- To evaluate the effectiveness of a multi-faceted intervention in reducing in-hospital medication charting errors.
- To assess the impact of junior doctor education and regular re-charting on charting accuracy.
- To determine the feasibility of implementing a targeted error reduction strategy.
Main Methods:
- A pilot study involving 579 medication charts over nine months in an Australian regional hospital.
- Implementation of a National Inpatient Medication Chart targeted error tool with visual reminders and junior doctor training.
- Mid-weekly re-charting (MOWER) conducted by a senior and junior doctor team.
Main Results:
- A significant 26% reduction in mean charting requirement errors per chart (4.6 to 3.4).
- Re-chart errors decreased by 50%, and primary chart errors by 20%.
- Largest error reductions were observed in categories: drug indication, prescriber name, and generic vs. brand naming.
Conclusions:
- A multi-intervention strategy incorporating education, visual aids, and regular re-charting effectively reduces medication charting errors.
- The findings support the need for a larger study to assess the feasibility and sustainability of this intervention in diverse clinical settings.
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