title: Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project.
abstract: OBJECTIVE
  Results of a study of medication "quality-related events" (QREs) at critical access hospitals (CAHs) participating in a telepharmacy project are reported.
  
  
  METHODS
  Rates and types of medication QREs (i.e., all types of drug therapy problems requiring pharmacist intervention) were evaluated at 17 CAHs receiving telepharmacy services from a central order-entry site in the North Dakota Telepharmacy Project (NDTP). During the 17-month study, remote pharmacists used telepharmacy technology to review medication orders prepared at the CAH sites, identify and address QREs, and code clinical interventions. The collected data were analyzed via chi-square testing.
  
  
  RESULTS
  Cumulative monthly medication orders at the CAH study sites ranged from a low of 12,535 in the first month of the study to a high of 18,257. Monthly rates of visual medication verification and clinical intervention ranged from 8.0% to 14.2% and from 1.3% to 3.1%, respectively. Overall, the most frequently identified QREs were transcription errors, which accounted for 2,389 interventions (43.3%); 2,078 interventions (37.7%) targeted prescribing-related QREs. The most frequently cited intervention codes were for dosage adjustments (n = 547), deep venous thrombosis prophylaxis (n = 437), pharmacokinetic consultation (n = 268), renal dosing (n = 182), and the prevention of minor (n = 148) and major (n = 94) adverse drug events.
  
  
  CONCLUSIONS
  The study results indicate that the NDTP telepharmacy model is effective in identifying and resolving QREs in CAHs. The use of the telepharmacy services increased over the study period, suggesting that CAH practitioners became more comfortable using the technology on a regular basis to enhance patient safety.
authors.affiliation: David M. Scott, M.P.H., Ph.D., B.S.Pharm., is Professor; Daniel L. Friesner, Ph.D., is Professor and Associate Dean of Student Affairs and Faculty Development; and Ann M. Rathke, M.A., M.Ed., is Co-ordinator, North Dakota Telepharmacy Project, College of Pharmacy, Nursing, and Allied Sciences, North Dakota State University, Fargo. Shelley Doherty-Johnsen, B.S.Pharm., is Director, ePharmacist Direct, Catholic Health Initiatives, Fargo.
authors.forename: David M
authors.initials: DM
authors.lastname: Scott
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Friesner
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rathke
authors.forename: Shelly
authors.initials: S
authors.lastname: Doherty-Johnsen
mesh_terms: D004346:Drug Information Services; D011307:Drug Prescriptions / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions; D006780:Hospitals, Rural / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data*; D009658:North Dakota; D061214:Patient Safety; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D012017:Referral and Consultation; D012308:Risk Management; D017216:Telemedicine / Q000379:methods*