title: Medication prescribing errors in the prehospital setting and in the ED.
abstract: BACKGROUND
  Medication errors are a common cause of iatrogenic adverse drug events. The incidence and nature of medication errors during prehospital treatment have not been fully described.
  
  
  OBJECTIVE
  The objectives of this study are to describe the incidence and characteristics of medication errors in adults during prehospital emergency treatment and in the emergency department (ED) and to identify risk factors for medication errors in those settings.
  
  
  METHODS
  This is a retrospective study of adult patients transferred by emergency medical services to the ED of a university-affiliated hospital in Israel. The drugs administered in the mobile intensive care unit and in the ED were reviewed by 2 reviewers, who independently decided whether an error had occurred. The primary outcome was the number of drug errors per patient. Secondary outcomes were the type and severity of the errors and variables associated with increased incidence of drug errors.
  
  
  RESULTS
  During the study period, 1837 patients were brought to the ED by mobile intensive care unit vehicles. Five hundred thirty-six patient charts (29%) were randomly selected for review; 65 charts (12.12%) could not be found; thus, 471 charts were reviewed. In the emergency vehicle, 188 patients (45.63%) received medications; of those, 12.76% (24 patients) were subject to a medication error. The number of drugs administered and long evacuation times were associated with higher risk for an error (P<.01 and P=.011, respectively). The presence of a physician in the emergency vehicle did not alter the risk of an error (P=.95). In the ED, 332 patients (72.6%) received medications. Of those, medication errors occurred in 120 patients (36.1%). The more medications administered, the higher the risk of error (P<.01). Less errors occurred in trauma patients (P=.041).
  
  
  CONCLUSIONS
  More medication errors occur in the ED than in the emergency vehicles. Patients treated with multiple medications are more prone to medication errors.
authors: Emergency Department and The Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
authors: Adi Einan
authors: AE
authors: Lifshitz
authors: Lee Hilary
authors: LH
authors: Goldstein
authors: Moshe
authors: M
authors: Sharist
authors: Refael
authors: R
authors: Strugo
authors: Einav
authors: E
authors: Asulin
authors: Shmuael
authors: S
authors: Bar Haim
authors: Zvi
authors: Z
authors: Feigenberg
authors: Matitiahu
authors: M
authors: Berkovitch
authors: Eran
authors: E
authors: Kozer
mesh_terms: D016009:Chi-Square Distribution; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors