Impact of a standard medication chart on prescribing errors: a before-and-after audit

Coombes, I., Stowasser, D., Reid, C. and Mitchell, C. A. (2009) Impact of a standard medication chart on prescribing errors: a before-and-after audit. Quality & Safety In Health Care, 18 6: 478-485. doi:10.1136/qshc.2007.025296

Author Coombes, I.
Stowasser, D.
Reid, C.
Mitchell, C. A.
Title Impact of a standard medication chart on prescribing errors: a before-and-after audit
Journal name Quality & Safety In Health Care   Check publisher's open access policy
ISSN 1475-3898
Publication date 2009-12-01
Sub-type Article (original research)
DOI 10.1136/qshc.2007.025296
Volume 18
Issue 6
Start page 478
End page 485
Total pages 8
Editor Stevens, P. D.
Place of publication United Kingdom
Publisher BMJ Group
Language eng
Subject C1
111502 Clinical Pharmacology and Therapeutics
111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified
920299 Health and Support Services not elsewhere classified
920204 Evaluation of Health Outcomes
Abstract Objectives: (1) To develop and implement a standard medication chart, for recording prescribing (medication orders) and administration of medication in public hospitals in Queensland. (2) To assess the chart’s impact on the frequency and type of prescribing errors, adverse drug reaction (ADR) documentation and safety of warfarin prescribing. (3) To use the chart to facilitate safe medication management training. Design, setting and participants: The medication chart was developed through a process of incident analysis and work practice mapping by a multidisciplinary collaborative. Observational audits by nurse and pharmacist pairs, of all available prescriptions before and after introduction of the standard medication chart, were undertaken in five sites. Results: Similar numbers of both patients (730 pre-implementation and 751 post-implementation; orders, 9772 before and 10 352 after) were observed. The prescribing error rate decreased from 20.0% of orders per patient before to 15.8% after (Mann–Whitney U test, p = 0.03). Previous ADRs were not documented for 19.5% of 185 patients before and 11.2% of 197 patients after (χ2, p = 0.032). Prescribing errors involving selection of a drug to which a patient had had a previous ADR decreased from 11.3% of patients before to 4.6% after (χ2, p = 0.021). International normalised ratios (INRs) >5 decreased from 1.9% of 14 405 INRs in the 12 months before to 1.45% of 15 090 INRs after (χ2, p = 0.004). After minor modifications, the chart was introduced into all hospitals statewide, which enabled standardised medication training and safer rotation of staff. The chart also formed the basis for the National Inpatient Medication Chart. Conclusion: Introduction of a standard revised medication chart significantly reduced the frequency of prescribing errors, improved ADR documentation and decreased the potential risks associated with warfarin management. The standard chart has enabled uniform training in medicine management.
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Pharmacy Publications
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Citation counts: TR Web of Science Citation Count  Cited 26 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 13 Dec 2009, 10:01:15 EST