Medication safety in a psychiatric hospital.
OBJECTIVE
We sought to assess the epidemiology of medication errors (MEs) and adverse drug events (ADEs) in a psychiatric hospital.


METHODS
We conducted a 6-month prospective observational study in a 172-bed academic psychiatric hospital. Errors and ADEs were found by way of chart review, staff reports and pharmacy intervention reports. Physicians rated incidents as to the presence of injury, preventability and severity of an injury. Serious MEs were nonintercepted MEs with potential for harm (near misses) and preventable ADEs.


RESULTS
We studied 1871 admissions with 19,180 patient-days. The rate of ADEs and serious MEs were 10 and 6.3 per 1000 patient-days, respectively. Preventable ADEs accounted for 13% of all ADEs (25/191). The most common classes of drugs associated with ADEs were atypical antipsychotics (37%). Nonpsychiatric drugs accounted for only 4% of nonpreventable ADEs but were associated with nearly one third of all preventable ADEs and near misses. MEs were most frequently associated with physician orders (68%), but there was also a high rate of nursing transcription errors (20%).


CONCLUSIONS
ADEs and serious MEs were common among psychiatric inpatients and similar to rates in studies of general hospital inpatients. Medication safety interventions targeting psychiatric care need further study.
Rothschild
Jeffrey M
JM
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120-1613, USA. jrothschild@partners.org
Mann
Klaus
K
Keohane
Carol A
CA
Williams
Deborah H
DH
Foskett
Cathy
C
Rosen
Stanley L
SL
Flaherty
Linda
L
Chu
James A
JA
Bates
David W
DW
D000328:Adult; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007902:Length of Stay; D008297:Male; D008508:Medication Errors; D011446:Prospective Studies