Risk factors for wrong-patient medication orders in the emergency department.

Area of Science:

• Health Informatics
• Patient Safety
• Emergency Medicine

Background:

• Wrong-patient medication errors pose a significant risk in emergency departments (EDs).
• The "retract-and-reorder" (RaR) metric identifies intercepted ordering errors, providing a basis for studying contributing factors.

Purpose of the Study:

• To investigate risk factors associated with wrong-patient medication orders in an ED.
• To identify specific elements within the electronic medical record (EMR) and patient demographics that correlate with ordering errors.

Main Methods:

• Analysis of medication ordering data from an academic ED over a 5-year period (2017-2021).
• Identification and evaluation of "retract-and-reorder" (RaR) events.
• Statistical assessment of associations between RaR events and factors including patient name similarity, birthdates, sex, age, time of day, shift start proximity, and EMR exam room layout.

Main Results:

• A total of 1031 RaR events were identified, with a proportional incidence of 184 per 100,000 ED orders.
• RaR events were significantly associated with closer proximity of exam rooms in the EMR interface (OR 0.62, P < .001) and patients of the same sex (OR 1.26, P = .001).
• Factors such as similarity in patient names, birthdates, and age showed no significant association with RaR events.

Conclusions:

• Exam room proximity within the EMR and patients' shared sex are identified as significant risk factors for wrong-patient medication orders.
• Findings suggest that EMR interface design and patient demographic matching play crucial roles in preventing medication ordering errors.
• Further research into user interface optimization and alert systems may enhance patient safety in ED medication ordering.