Therapeutic duplication on the general surgical wards

Area of Science:

• Medical Safety
• Pharmacology
• Quality Improvement

Background:

• Therapeutic duplication, prescribing multiple medications for the same indication, is a common issue in healthcare settings.
• Electronic prescribing records (EPR) can contribute to this problem if medication charts are not thoroughly reviewed.
• Unmanaged therapeutic duplication poses a risk to patient safety and can lead to adverse events.

Purpose of the Study:

• To implement a Quality Improvement Project (QIP) aimed at reducing therapeutic duplication to 0% within a general surgical team.
• To assess the effectiveness of educational interventions in preventing prescribing errors related to therapeutic duplication.
• To identify the need for enhanced system-level solutions beyond manual review and team education.

Main Methods:

• A daily audit of general surgical patient prescriptions was conducted over one month.
• Electronic prescribing records were reviewed for drug duplications or prescriptions of drugs within the same class.
• Patient documentation was scrutinized, and clinical teams were consulted to clarify any ambiguous prescribing decisions.

Main Results:

• The baseline rate of therapeutic duplication was 9%.
• Following initial education, the average rate decreased to 8.77%, with a temporary spike to 22%.
• Subsequent educational cycles and reminders led to a reduction in therapeutic duplication to 5.29% and then 3.12%.

Conclusions:

• Educational interventions and regular reminders can significantly reduce therapeutic duplication rates in surgical wards.
• While education is beneficial, it is not sufficient to eliminate therapeutic duplication entirely, as evidenced by persistent errors.
• Implementing automated alerts within the electronic prescribing system is recommended as a more sustainable solution to prevent patient harm from therapeutic duplication.