"Chart First"-A targeted initiative to reduce medication errors associated with verbal orders in the emergency...

Verbal orders for administration of medications have been associated with errors. A multidisciplinary education campaign (the "Chart First" campaign) was developed to champion safe medication practices by encouraging medication prescribing prior to administration. The aim of this study was to assess whether the campaign was associated with a reduction in errors resulting from verbal medication orders in the emergency department (ED) setting.

A retrospective pre-post cohort study of an education campaign carried out in 2 EDs was performed. The intervention included education by clinical champions, multidisciplinary education sessions, and visual cues displayed across the EDs. All errors related to verbal medication orders were extracted from the hospital Risk Management Solutions (RiskMan) system over 12 months before the intervention (February 7, 2021, to February 6, 2022) and after the intervention (February 7, 2022, to February 7, 2023). An expert panel of clinicians, blinded to the intervention period, classified the severity of errors.

A total of 295,107 medications were administered in the preintervention period and 297,421 in the postintervention period. Following expert panel review, it was determined that there were 21 medication errors during the overall study period: 16 errors in the preintervention period and 5 errors in the postintervention period (odds ratio [OR], 0.31; 95% CI, 0.12-0.81; P = 0.016). There were 3 verbal order medication errors in the preintervention period classified as "major" or "catastrophic," while in the postintervention period there were none.

A simple multidisciplinary approach encouraging medication prescribing prior to administration to patients may be an effective intervention to reduce medication errors associated with verbal orders. Ongoing initiatives are indicated for prevention of medication-related errors in the ED.