Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.
BACKGROUND
The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors.


METHODS
The point prevalence survey, carried out in May 26-30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered.


RESULTS
Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD +/- 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions.


CONCLUSIONS
The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections.Nevertheless the overall illegibility and incompleteness (above 20%) are unacceptably high. Values need to be improved by enhancing the safety culture and in particular the awareness of the professionals on the consequences that a bad prescription writing can produce.
Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy.
Laura
L
Calligaris
Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy.
Angela
A
Panzera
Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy.
Luca
L
Arnoldo
Risk Management Unit, University Hospital of Udine, 33100 Udine, Italy.
Carla
C
Londero
Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy.
Rosanna
R
Quattrin
Pharmacy Unit, University Hospital of Udine, 33100 Udine, Italy.
Maria G
MG
Troncon
Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy.|Risk Management Unit, University Hospital of Udine, 33100 Udine, Italy.
Silvio
S
Brusaferro
D002648:Child; D003625:Data Collection; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004608:Eligibility Determination; D006801:Humans; D007880:Legislation, Drug; D019300:Medical Errors; D008508:Medication Errors; D010607:Pharmacy Service, Hospital; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000008:administration & dosage; D055656:Prescriptions; D017749:Total Quality Management
D055553:Prescription Drugs