Ring Justine, Maracle Jesse, Zhang Shannon, Methot Michelle, Zevin Boris
Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
School of Medicine, Queen's University, Kingston, Ontario, Canada.
J Med Educ Curric Dev. 2024 Jan 22;11:23821205241226819. doi: 10.1177/23821205241226819. eCollection 2024 Jan-Dec.
Educational interventions with proven effectiveness to reduce medication prescribing errors are currently lacking. Our objective was to implement and assess the effectiveness of a curriculum to reduce medication prescribing errors on a surgery service.
This was a prospective observational cohort study at a Canadian academic hospital without an electronic order entry system. A pharmacist-led medication prescribing curriculum for surgery residents was developed and implemented over 2 days (2 h/day) in July 2019. Thirteen (76%) out of 17 surgery residents contributed pre-implementation data, while 13 (81%) out of 16 surgery residents contributed post-implementation data. Medication prescribing errors were tracked for 12 months pre-implementation and 6 months post-implementation. Errors were classified as prescription writing (PW) or decision making (DM).
There were a total of 1050 medication prescribing errors made in the pre-implementation period with 615 (59%) PW errors and 435 (41%) DM. There were a mean of 87.5 (SD = 14.6) total medication prescribing errors per month in the pre-implementation period with 51.3 (11.9) PW and 36.3 (6.0) DM errors. There were a total of 472 medication prescribing errors made in the post-implementation period with 260 (55%) PW and 212 (45%) DM errors. There were a mean of 78.7 (10.3) total medication prescribing errors per month in the post-implementation period with 43.3 (9.5) PW and 35.3 (4.2) DM errors. In the first quarter of the academic year, there were significantly fewer mean total errors per month post-implementation versus pre-implementation (77.7(12.7) versus 107.3(8.1); = .035), with significantly fewer PW errors per month (40.7(13.2) versus 68.7(9.3); = .046) and no difference in DM errors per month (37.0(2.0) versus 38.7(5.7); = .671). There were no differences noted in the second quarter of the academic year.
Medication prescribing errors occurred from PW and DM. Medication prescribing curriculum decreased PW errors; however, a continued education program is warranted as the effect diminished over time.
目前缺乏经证实能有效减少用药处方错误的教育干预措施。我们的目标是实施并评估一项旨在减少外科服务中用药处方错误的课程的有效性。
这是一项在加拿大一所没有电子医嘱录入系统的学术医院进行的前瞻性观察队列研究。2019年7月，制定并实施了一项由药剂师主导的针对外科住院医师的用药处方课程，为期2天（每天2小时）。17名外科住院医师中有13名（76%）提供了实施前的数据，16名外科住院医师中有13名（81%）提供了实施后的数据。在实施前的12个月和实施后的6个月对用药处方错误进行跟踪。错误分为处方书写（PW）或决策（DM）两类。
实施前期共发生1050例用药处方错误，其中615例（59%）为PW错误，435例（41%）为DM错误。实施前期每月用药处方错误总数平均为87.5（标准差=14.6）例，其中PW错误51.3（11.9）例，DM错误36.3（6.0）例。实施后期共发生472例用药处方错误，其中260例（55%）为PW错误，212例（45%）为DM错误。实施后期每月用药处方错误总数平均为78.7（10.3）例，其中PW错误43.3（9.5）例，DM错误35.3（4.2）例。在学年第一季度，实施后每月平均总错误数显著少于实施前（77.7（12.7）对107.3（8.1）；P=0.035），每月PW错误显著减少（40.7（13.2）对68.7（9.3）；P=0.046），每月DM错误无差异（37.0（2.0）对38.7（5.7）；P=0.671）。学年第二季度未发现差异。
用药处方错误源于PW和DM。用药处方课程减少了PW错误；然而，由于效果随时间减弱，有必要开展继续教育项目。
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