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Medication Errors in Surgery: A Classification Taxonomy and a Pilot Study in Postcall Residents.

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Surgery residents make more medication errors when post-call. This study found a higher proportion of prescription errors in the post-call state, highlighting a need for interventions.

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Area of Science:

  • Medical Education
  • Patient Safety
  • Surgical Residency

Background:

  • Post-call fatigue in medical trainees is linked to impaired decision-making and increased medical errors.
  • The specific impact of the post-call state on medication prescription errors among surgery residents remains under-investigated.

Purpose of the Study:

  • To determine if the post-call state is associated with a higher proportion of medication prescription errors made by surgery residents.
  • To investigate this association in an academic hospital setting lacking a computerized physician order entry (CPOE) system.

Main Methods:

  • A prospective observational study was conducted at a tertiary academic hospital.
  • Medication prescription errors were compared between surgery residents in post-call (PC) and no-call (NC) states.
  • A novel taxonomy was utilized for classifying medication prescription errors.

Main Results:

  • Surgery residents in the post-call state committed a significantly higher proportion of medication prescription errors (9.2%) compared to the no-call state (3.2%) (p=0.04).
  • Participants in the post-call state reported significantly less sleep (2 hours) than those in the no-call state (6 hours).
  • Decision-making errors accounted for 33% and prescription-writing errors for 67% of the observed errors.

Conclusions:

  • The post-call state is significantly associated with an increased proportion of medication prescription errors among surgery residents in hospitals without CPOE.
  • Educational interventions targeting decision-making and prescription-writing errors may help mitigate risks associated with resident fatigue.