Prescribing errors in the emergency department



J Pharm Pharmacogn Res 10(1): 104-112, 2022.

Original Article

Antibiotic prescribing errors generated by the use of an electronic prescribing system in the emergency department: A mixed-method study

[Errores de prescripción de antibióticos generados por el uso de un sistema de prescripción electrónica en el servicio de urgencias: un estudio de método mixto]

Ahmad Z. Al Meslamani1, Derar H. Abdel-Qader2, Noura Ziad3, Nadia Al Mazrouei4, Asma A. El-Shara5, Husam El Sharu6, Eman Merghani Ali7 , Rand Haider Al Zahawi8, Samah Bahy Mohammed Ebaed9, Osama Mohamed Ibrahim4,10

1College of Pharmacy, Al Ain University of Science and Technology, Abu Dhabi, United Arab Emirates.

2Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan.

3Allied Medical Sciences, Zarqa University, Zarqa, Jordan.

4Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates.

5Faculty of Pharmacy, Philadelphia University, Amman, Jordan.

6Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA.

7College of Pharmacy, Jazan University, Jazan, Saudi Arabia.

8Dubai Pharmacy College for Girls, Dubai, United Arab Emirates.

9Clinical Pharmacology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt.

10Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Egypt.

*E-mail: amaslamanie1095@gmail.com, ahmad.almeslamani@aau.ac.ae

Abstract

Context: Inappropriate prescribing of antibiotics can result in serious patient harm.

Aims: To investigate the incidence, nature, clinical severity, and causes of antibiotic prescribing errors (APEs) in the emergency department (ED) of a large hospital in Jordan.

Methods: A mixed-method approach was used to explore the incidence and types of APEs by direct observation of electronic prescriptions (EPS) of antibiotics over four weeks, and to identify causes of errors by semi-structured interviews with ED physicians. The clinical severity of APEs was rated by a committee of experts. SPSS V26 and NVivo 10 were used for the analysis of quantitative and qualitative data, respectively.

Results: The incidence of APEs caused by the use of EPS was 4.3%. Wrong quantity (32.62%), wrong dose (15.25%), and duplicate drugs (13.55%) were identified as the most common types of APEs. More than one-third of APEs identified were deemed clinically significant, seven were serious, and one was lethal. Minor and significant antibiotic APEs across physicians who attended workshops on EPS and those who did not were 75.00% versus 46.77% (p = 0.001) and 18.75% versus 52.41% (p = 0.013), respectively. Three major causes of errors were identified: 1) System-related (system crash, drop-down menu), 2) user-related (lack of computer skills), and 3) workplace-related (overcrowding, inadequate staffing).

Conclusions: APEs generated by the use of EPS were common in EDs in Jordan, clinically significant, and multifactorial. Further research is required to cover pharmacists’ perspectives of this kind of errors.

Keywords: antibiotics; emergency departments; prescribing errors.

This image has an empty alt attribute; its file name is jppres_pdf_free.png
Resumen

Contexto: La prescripción inadecuada de antibióticos puede provocar daños graves al paciente.

Objetivos: Investigar la incidencia, naturaleza, gravedad clínica y causas de los errores en la prescripción de antibióticos (APE) en el departamento de emergencias (DE) de un gran hospital en Jordania.

Métodos: Se utilizó un enfoque de método mixto para explorar la incidencia y los tipos de APE mediante la observación directa de prescripciones electrónicas de antibióticos (EPS) durante cuatro semanas, y para identificar las causas de los errores mediante entrevistas semiestructuradas con los médicos del servicio de urgencias. Un comité de expertos calificó la gravedad clínica de los APE.

Resultados: La incidencia de APE causada por el uso de EPS fue del 4,3%. La cantidad incorrecta (32,62%), la dosis incorrecta (15,25%) y los fármacos duplicados (13,55%) se identificaron como los tipos más comunes de APE. Más de un tercio de los APE identificados se consideraron clínicamente significativos, siete fueron graves y uno fue letal. Los APE antibióticos menores y significativos entre los médicos que asistieron a talleres sobre EPS y los que no asistieron fueron 75,00% versus 46,77% (p = 0,001) y 18,75% versus 52,41% (p = 0,013), respectivamente. Se identificaron tres causas principales de errores: 1) relacionadas con el sistema (caída del sistema, menú desplegable), 2) relacionadas con el usuario (falta de conocimientos informáticos) y 3) relacionadas con el lugar de trabajo (hacinamiento, personal inadecuado).

Conclusiones: Los APE generados por el uso de EPS fueron comunes en los DE en Jordania, clínicamente significativos y multifactoriales. Se requiere más investigación para cubrir las perspectivas de los farmacéuticos sobre este tipo de errores.

Palabras Clave: antibióticos; departamentos de emergencia; prescribir errores.

This image has an empty alt attribute; its file name is jppres_pdf_free.png
Citation Format: Al Meslamani AZ, Abdel-Qader DH, Ziad N, Al Mazrouei N, El-Shara AA, El Sharu H, Merghani Ali EM, Al Zahawi RH, Ebaed SBM, Ibrahim OM (2022) Antibiotic prescribing errors generated by the use of an electronic prescribing system in the emergency department: A mixed-method study. J Pharm Pharmacogn Res 10(1): 104–112.

© 2022 Journal of Pharmacy & Pharmacognosy Research (JPPRes)