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May 2, 1990, Vol 263, No. 17 >
ARTICLE | May 2, 1990

Medication Prescribing Errors in a Teaching Hospital FREE

Timothy S. Lesar, PharmD; Laurie L. Briceland, PharmD; Karen Delcoure, RPh; Janet Crilly Parmalee, MBA, RRA; Vickey Masta-Gornic; Henry Pohl, MD
[+] Author Affiliations

Reprint requests to Department of Pharmacy, Albany Medical Center Hospital, 47 New Scotland Ave, Albany, NY 12208 (Dr Lesar).


JAMA. 1990;263(17):2329-2334. doi:10.1001/jama.1990.03440170051035
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References

A study of prescribing errors committed by physicians that occurred in a tertiarycare teaching hospital is reported. From a total of 289 411 medication orders written during the 1-year study period, 905 prescribing errors were detected and averted, of which 522 (57.7%) were rated as having potential for adverse consequences. The overall detected error rate was 3.13 errors for each 1000 orders written and a rate of 1.81 significant errors per 1000 orders. The error rate (4.01 per 1000 orders) was greatest between 12 PM and 3:59 PM. First-year postgraduate residents were found to have a higher error rate (4.25 per 1000 orders) than other prescriber classes, and obstetrics/gynecology services (3.54 per 1000 orders) and surgery/anesthesia services (3.42 per 1000 orders) had greater error rates than other services. The study results demonstrate the significant risk to patients from medication prescribing errors. Educational, operational, and risk-management activities should include efforts directed at reducing the risk to patients from prescribing errors.

(JAMA. 1990;263:2329-2334)

REFERENCES

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Barr DP.  Hazards of modern diagnosis and therapy—the price we pay . JAMA. 1956;;159:1452-1456.
2 +
Moser RH.  Diseases of medical progress . N Engl J Med. 1956;;255:606-614.
3 +
Schimmel EM.  Hazards of hospitalization . Ann Intern Med. 1964;;60:100-110.
4 +
Steel K, Gertman P, Crescenzi C, Anderson J.  Iatrogenic illness on a general medical service at a university hospital . N Engl J Med. 1981;;304:638-642.
5 +
Dubois RW, Brook RH.  Preventable deaths: who, how often, why? Ann Intern Med. 1988;; 109:582-589.
6 +
Fink JL.  Liability claims based on drug use . Drug Intell Clin Pharm. 1983;;17:667-670.
7 +
Perlstein P, Callison C, White M, Barnes B, Edwards NK.  Errors in drug computations during newborn intensive care . AJDC. 1979;;133:376-379.
8 +
Davis NM, Cohen MR. Medication Errors: Causes and Prevention . Philadelphia, Pa: George F Stickley; 1981;
9 +
Folli H, Poole RL, Benitz WE, Russo JC.  Medication error prevention by clinical pharmacists in two children's hospitals . Pediatrics. 1987;;79:718-722.
10 +
Blum KV, Abel SR, Urbanski CJ, Pierce JM.  Medication error prevention by pharmacists . Am J Hosp Pharm. 1988;;45:1902-1903.
11 +
Hawkey CJ, Hodgson SE, Garner ST, Norman AJ.  Reactive pharmacy intervention: potential medical impact of prescribing errors . Br J Clin Pharmacol. 1988;;27:118-119P.
12 +
Rupp MT, Schondelmeyer SW, Wilson GT, Krause JE.  Documenting prescribing errors and pharmacist interventions in community pharmacy practice . Am Pharm. 1988;;NS28:574-580.
13 +
Wingert WA, Chan LS, Stewart K, Lawrence L, Portnoy B.  A study of the quality of prescriptions issued in a busy pediatric emergency room . Public Health Rep. 1975;;90:402-408.
14 +
Walson PD, Hammel M, Martin R.  Prescription writing by pediatric house officers . J Med Educ. 1981;;56:423-428.
15 +
Christensen DB, Campbell WH, Madsen S, Hartzema AG, Nudelman PM.  Documenting outpatient problem intervention activities of pharmacists in an HMO . Med Care. 1981;;19:104-117.
16 +
Betz RP, Levy HB.  An interdisciplinary method of classifying and monitoring medication errors . Am J Hosp Pharm. 1985;;42:1724-1732.
17 +
Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA.  Drug errors and incidents in a neonatal care unit: a quality assurance activity . AJDC. 1989;;143:737-740.
18 +
Barker KN.  The effect of an experimental medication system on medication errors and cost, part I: introduction and errors study . Am J Hosp Pharm. 1969;;26:324-333.
19 +
Hynniman CE, Conrad WF, Urch WA, Ridnick BR, Parker PF.  A comparison of medication errors under the University of Kentucky unit dose system and traditional drug distribution system in four hospitals . Am J Hosp Pharm. 1970;;27:803-804.
20 +
Barker KN, Mikeal RL, Pearson RE, Illig NA, Morse ML.  Medication errors in nursing homes and small hospitals . Am J Hosp Pharm. 1982;;39: 387-391.
21 +
Raju TN, Thornton JP, Kecskes S, Perry M, Feldman S.  Medication errors in neonatal and pediatric intensive care units . Lancet. 1989;;2:374-376.
22 +
Kirchbaum DW, Malone PM.  Subcutaneous administration of nifedipine . Drug Intell Clin Pharm. 1988;;22;891-892.
23 +
Hoffman RS, Smilkstein MJ, Rubenstein F.  An 'amp' by any other name: the hazards of intravenous magnesium dosing . JAMA. 1989;;261:557.
24 +
Bakris G.  It may seem obvious to you...: giving medication instructions to patients . JAMA. 1988;;260:1243.
25 +
 Patient dies from 10-fold digoxin overdose . Pharm J. 1989;;242:250.
26 +
Deaconson TF, O'Hair DP, Levy MF, Lee MB-F, Schueneman AL, Condon RE.  Sleep deprivation and resident performance . JAMA. 1988;;260:1721-1727.
27 +
Health and Public Policy Committee,  American College of Physicians. Improving medical education in therapeutics . Ann Intern Med. 1988;; 108:145-147.
28 +
Errors were assigned to a specific error class if the error detected met any of the listed criteria for each class.
29 +
Adapted from Folli et al.9

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Barr DP.  Hazards of modern diagnosis and therapy—the price we pay . JAMA. 1956;;159:1452-1456.
2 +
Moser RH.  Diseases of medical progress . N Engl J Med. 1956;;255:606-614.
3 +
Schimmel EM.  Hazards of hospitalization . Ann Intern Med. 1964;;60:100-110.
4 +
Steel K, Gertman P, Crescenzi C, Anderson J.  Iatrogenic illness on a general medical service at a university hospital . N Engl J Med. 1981;;304:638-642.
5 +
Dubois RW, Brook RH.  Preventable deaths: who, how often, why? Ann Intern Med. 1988;; 109:582-589.
6 +
Fink JL.  Liability claims based on drug use . Drug Intell Clin Pharm. 1983;;17:667-670.
7 +
Perlstein P, Callison C, White M, Barnes B, Edwards NK.  Errors in drug computations during newborn intensive care . AJDC. 1979;;133:376-379.
8 +
Davis NM, Cohen MR. Medication Errors: Causes and Prevention . Philadelphia, Pa: George F Stickley; 1981;
9 +
Folli H, Poole RL, Benitz WE, Russo JC.  Medication error prevention by clinical pharmacists in two children's hospitals . Pediatrics. 1987;;79:718-722.
10 +
Blum KV, Abel SR, Urbanski CJ, Pierce JM.  Medication error prevention by pharmacists . Am J Hosp Pharm. 1988;;45:1902-1903.
11 +
Hawkey CJ, Hodgson SE, Garner ST, Norman AJ.  Reactive pharmacy intervention: potential medical impact of prescribing errors . Br J Clin Pharmacol. 1988;;27:118-119P.
12 +
Rupp MT, Schondelmeyer SW, Wilson GT, Krause JE.  Documenting prescribing errors and pharmacist interventions in community pharmacy practice . Am Pharm. 1988;;NS28:574-580.
13 +
Wingert WA, Chan LS, Stewart K, Lawrence L, Portnoy B.  A study of the quality of prescriptions issued in a busy pediatric emergency room . Public Health Rep. 1975;;90:402-408.
14 +
Walson PD, Hammel M, Martin R.  Prescription writing by pediatric house officers . J Med Educ. 1981;;56:423-428.
15 +
Christensen DB, Campbell WH, Madsen S, Hartzema AG, Nudelman PM.  Documenting outpatient problem intervention activities of pharmacists in an HMO . Med Care. 1981;;19:104-117.
16 +
Betz RP, Levy HB.  An interdisciplinary method of classifying and monitoring medication errors . Am J Hosp Pharm. 1985;;42:1724-1732.
17 +
Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA.  Drug errors and incidents in a neonatal care unit: a quality assurance activity . AJDC. 1989;;143:737-740.
18 +
Barker KN.  The effect of an experimental medication system on medication errors and cost, part I: introduction and errors study . Am J Hosp Pharm. 1969;;26:324-333.
19 +
Hynniman CE, Conrad WF, Urch WA, Ridnick BR, Parker PF.  A comparison of medication errors under the University of Kentucky unit dose system and traditional drug distribution system in four hospitals . Am J Hosp Pharm. 1970;;27:803-804.
20 +
Barker KN, Mikeal RL, Pearson RE, Illig NA, Morse ML.  Medication errors in nursing homes and small hospitals . Am J Hosp Pharm. 1982;;39: 387-391.
21 +
Raju TN, Thornton JP, Kecskes S, Perry M, Feldman S.  Medication errors in neonatal and pediatric intensive care units . Lancet. 1989;;2:374-376.
22 +
Kirchbaum DW, Malone PM.  Subcutaneous administration of nifedipine . Drug Intell Clin Pharm. 1988;;22;891-892.
23 +
Hoffman RS, Smilkstein MJ, Rubenstein F.  An 'amp' by any other name: the hazards of intravenous magnesium dosing . JAMA. 1989;;261:557.
24 +
Bakris G.  It may seem obvious to you...: giving medication instructions to patients . JAMA. 1988;;260:1243.
25 +
 Patient dies from 10-fold digoxin overdose . Pharm J. 1989;;242:250.
26 +
Deaconson TF, O'Hair DP, Levy MF, Lee MB-F, Schueneman AL, Condon RE.  Sleep deprivation and resident performance . JAMA. 1988;;260:1721-1727.
27 +
Health and Public Policy Committee,  American College of Physicians. Improving medical education in therapeutics . Ann Intern Med. 1988;; 108:145-147.
28 +
Errors were assigned to a specific error class if the error detected met any of the listed criteria for each class.
29 +
Adapted from Folli et al.9

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