Reducing medication prescribing errors in a teaching hospital.
BACKGROUND
Medication errors occur frequently, result in significant morbidity and mortality, and are often preventable. A multifaceted intervention was conducted to reduce prescribing errors in handwritten medication orders written by house staff.


METHODS
A before-and-after design was used to evaluate the intervention--which included grand rounds, an interactive presentation for house staff, and reminders (a checklist, chart inserts, and requests for clarification)--and targeted 20 safe prescribing behaviors.


RESULTS
At baseline, prescribing errors were more common among surgical house staff than medical house staff (1.08 errors/order versus 0.76 errors/order, p < .001). Only 1% of orders contained an overt error, but 49% were incomplete, 27% contained dangerous dose and frequency abbreviations, and 17% were illegible. Postintervention, the mean number of prescribing errors per order decreased for surgical house staff from 1.08 (standard deviation [SD], 0.23) to 0.85 (SD, 0.11; p < .001), with a more marked effect for house staff who attended the didactic portion of the intervention. In addition, the mean number of the more significant errors per order decreased from 0.65 (SD, 0.19) to 0.45 (SD, 0.13; p < .001), and significant decreases occurred in the proportion of orders that were incomplete, were illegible, and contained an overt error. However, prescribing errors per order increased in orders written by medical house staff from 0.76 (SD, 0.14) to 0.98 (SD, 0.11; p < .001).


CONCLUSIONS
The intervention was associated with a modest improvement in the quality of medication orders written by surgical house staff. To reduce prescribing errors, multilevel interventions are needed, including training in safe prescribing for all physicians. Such training may need to be started in medical school and augmented and reinforced throughout residency.
Garbutt
Jane
J
Division of General Medical Sciences, Washington University School of Medicine, St. Louis, USA. jgarbutt@im.wustl.edu
Milligan
Paul E
PE
McNaughton
Candace
C
Highstein
Gabrielle
G
Waterman
Brian M
BM
Dunagan
W Claiborne
WC
Fraser
Victoria J
VJ
D001521:Behavior Therapy; D006784:Hospitals, Teaching; D006801:Humans; D007318:Inservice Training; D007396:Internship and Residency; D008508:Medication Errors / Q000517:prevention & control*