1. Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis
- Author
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Vanida Bruni, Florence Gillaizeau, Thibaut Caruba, Brigitte Sabatier, Patrice Prognon, Virginie Korb, Dominique Bégué, Isabelle Colombet, Pierre Durieux, Service de pharmacie, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Laboratoire Interdisciplinaire de Recherche en Economie de Santé, Informatique Hospitalière, Evaluation et Santé Publique, Centre D'investigation Épidémiologique 4, Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Risque Thrombotique et Mecanismes de l'Hemostase ( U765 ), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement ( IFR71 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de pharmacie [CHU HEGP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Risque Thrombotique et Mécanismes de l'Hémostase (U765), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut de Recherche pour le Développement (IRD)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Risque Thrombotique et Mecanismes de l'Hemostase (U765), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and BMC, Ed.
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MESH: Pharmacists ,MESH: Drug Interactions ,MESH : Drug Prescriptions ,MESH : Prospective Studies ,MESH : Pharmacists ,MESH: Medication Errors ,MESH: Hospitalization ,Pharmacists ,030226 pharmacology & pharmacy ,Health informatics ,MESH: Regression Analysis ,MESH: Length of Stay ,Health administration ,Hospitals, University ,0302 clinical medicine ,MESH: Drug Prescriptions ,Computerized physician order entry ,MESH : Regression Analysis ,Medication Errors ,Drug Interactions ,030212 general & internal medicine ,Prospective Studies ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Regression analysis ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,3. Good health ,MESH: Medical Order Entry Systems ,[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences ,Hospitalization ,MESH : Length of Stay ,Regression Analysis ,MESH : Hospitalization ,MESH : Medical Staff, Hospital ,France ,medicine.medical_specialty ,MESH : Interprofessional Relations ,MESH : Medication Errors ,Interprofessional Relations ,Pharmacist ,MESH: Medical Staff, Hospital ,Drug Prescriptions ,Medical Order Entry Systems ,03 medical and health sciences ,[ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology ,MESH: Interprofessional Relations ,Research article ,medicine ,Medical Staff, Hospital ,Humans ,Medical prescription ,MESH : France ,MESH : Hospitals, University ,MESH: Hospitals, University ,MESH: Humans ,business.industry ,MESH : Humans ,lcsh:RA1-1270 ,Length of Stay ,MESH: Prospective Studies ,MESH : Drug Interactions ,MESH: France ,MESH : Medical Order Entry Systems ,[ SDV.SP ] Life Sciences [q-bio]/Pharmaceutical sciences ,Emergency medicine ,Prescribing error ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background: Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient’s stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist’s alert (i.e. override the alert). Methods: We prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards’ using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (i.e. prescribing error repeated). Results: 12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (i.e error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist’s alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error. Conclusions: Since 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts. Background Drug prescribing errors are defined as a prescribing decision or prescription writing process that results in an unintentional, significant reduction in the probability of treatment being timely and effective or increase in the risk of harm, when compared with generally accepted practice. High rates of inpatient prescribing errors have been reported: 1.5-5.3 per 100 drug orders, or 1.4 errors per admission [1,2].
- Published
- 2010