An analysis of errors, discrepancies, and variation in opioid prescriptions for adult outpatients at a teaching hospital

Bicket, Mark C.; Kattail, Deepa; Yaster, Myron; Wu, Christopher L.; Pronovost, Peter J.

doi:10.5055/jom.2017.0367

Cited by 15 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…name, dose, frequency). 23 Unrelieved pain is a major issue in health settings, with opioid incidents, particularly omission of dose, contributing to the burden of patient pain. 18 In this and other studies, 12,18 the most common types of opioid incidents reported related to 'incorrect dose' or 'omission of dose'.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid related medication incidents in Western Australia public hospitals: types, causes and level of harm

Fitzsimons

Ferguson

Jovanovska

et al. 2020

Pharmacy Practice and Res

View full text Add to dashboard Cite

Background: Medication incidents in hospitals are common and occur at all phases of the medication management cycle. Clinical incidents for high-risk medications such as opioids have the potential to cause significant harm, yet opioid incidents are an under researched area of health service safety and quality. Aim: The aim of this study was to identify opioid medication safety incident types, occurrence in the medication management cycle, causative factors and level of patient harm to inform clinical care. Method: A multi-methods analysis of all reported opioid-related medication incidents, in all 93 Western Australian (WA) public hospitals, between 1 July 2017 and 30 June 2018 was conducted. Results: Opioid medications as a class were implicated in 11.0% (857) of all medication-related clinical incidents reported in 2017-18, with tapentadol, a relatively new opioid, the most reported (131; 15.3%). No reported incidents resulted in death, however, 0.5% (4) caused severe harm and 3.5% (30) caused moderate harm. The majority of incidents occurred during the administration phase of the medication management cycle (630; 73.5%). 'Incorrect dose' (146; 17%) followed by 'omission of dose' (116; 13.5%) were the most frequent incident types reported. 'Not checking properly' (554; 64.6%) followed by 'not following procedures' (167; 19.5%) were the most frequent causative factors. Conclusion: Vigilance in identifying, reporting and reviewing opioid medication safety incidents and causative factors are imperative to mitigating errors and preventing patient harm. Study findings should be used to develop targeted strategies to reduce opioid incidents in public hospitals.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Compared to hand written opioid prescriptions, eMMS are less likely to contain deviations from best‐practice such as missing patient identifiers, error‐prone abbreviations, illegible or incomplete text and medication errors (e.g. name, dose, frequency) 23 …”

Section: Discussionmentioning

confidence: 99%

Opioid related medication incidents in Western Australia public hospitals: types, causes and level of harm

Fitzsimons

Ferguson

Jovanovska

et al. 2020

Pharmacy Practice and Res

View full text Add to dashboard Cite

show abstract

“…In a study by Bricket et al, handwritten opioid prescriptions were associated with a significantly higher rate of errors, discrepancies and variation from ideal practice and government regulations as compared with electronic, health-record, computer-generated prescriptions. 30 The authors concluded that electronic prescriptions should be used to improve the safety and relevance of opioid prescriptions. On the other hand, the difficulty or inability of community pharmacists to speak with the prescriber within an acceptable time frame to provide effective patient care is a direct communication problem.…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing and dispensing: Experiences and perspectives from a survey of community pharmacists practising in the province of Quebec

et al. 2018

View full text Add to dashboard Cite

Background: canada leads in opioid prescription and consumption rates, and this has resulted in high levels of opioid-related morbidity and mortality. Pharmacists' input could contribute significantly to understanding the disadvantages of opioid prescribing and dispensing and improving the service. this study aimed to examine the experiences of community pharmacists in relation to opioid prescribing and dispensing, with a focus on optimizing collaboration and communication. Methods: An online survey was performed among pharmacists from the province of Quebec, canada, in 2016. Pharmacists were eligible if registered and working in community pharmacies. Results: In all, 542 questionnaires were analyzed (participation rate of 8.1%). Pharmacotherapyrelated problems were reported in at least 50% of opioid prescriptions: additional drug(s) required (reported by 30% of pharmacists), interaction(s) between opioid(s) and other drug(s) (16%), physician did not meet the general issuing standards for opioid prescriptions (26%) and patient had mild to moderate pain that was easily managed by a nonopioid analgesic (20%). Half of the patients were reported as requesting anticipated refills, possibly indicating abuse or poor pain control. Most pharmacists (89.6%) reported needing to contact physicians in 1 to 3 out of 10 opioid prescriptions, but many pharmacists (71.8%, often or very often) reported difficulties communicating with physicians. Conclusions: Pharmacists' observations of pharmacotherapy-related problems and patients' unusual behaviours reveal a significant number of issues related to opioid prescribing and dispensing in an outpatient setting. Improved collaboration between physicians and pharmacists appears mandatory to address the issues reported in this study.

show abstract

“…There was a 12% error rate in the non-EHR computer-generated prescriptions. 15 Of the handwritten prescriptions, 87% of these prescriptions were noncompliant with DEA rules, and 46% lacked two patient identifiers, whereas 0% of EHR computer-generated prescriptions were noncompliant with DEA rules; they all included two patient identifiers. 15 electronic application (Figure 3).…”

Section: Software Accessmentioning

confidence: 99%

The Adoption and Increased Use of Electronic Prescribing of Controlled Substances

Achar¹,

Sinha²,

Norcross³

2021

Journal of Medical Regulation

View full text Add to dashboard Cite

The electronic prescribing of controlled substances (EPCS) is now becoming implemented in most health care practices and pharmacies in the United States. This review aims to detail the steps needed for EPCS adoption and synthesize the most current literature on the benefits and challenges associated with its adoption. Our systematic review of seven published studies from 1990 to 2020 notes the benefits of EPCS in the reduction of errors, fraud, overprescribing, cost and efficiency improvements. There is limited published evidence of challenges, such as the cost of implementation and prescriber burden. With EPCS becoming a nationwide process, further research needs to be conducted to maximize the effectiveness of EPCS and explore additional benefits and challenges. We used a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system for systematic reviews highlighted in the “Cochrane Handbook for Systematic Reviews of Interventions” to assess the quality of the primary studies reviewed.1 Each author was tasked with determining the quality of each primary study reviewed and assigning a quality score of either high, moderate or low quality. Evidence stemming from randomized controlled trials starts as high quality while evidence from observational studies starts as low quality. Quality can be lowered by five factors: risk of bias, imprecision, inconsistency, indirectness, and publication bias and can be raised by a large magnitude of effect and a clear dose-response gradient. We extracted data from the text, tables and graphs of the original publications. Appendix A illustrates the quality of the studies. Databases reviewed included PubMed, Google Scholar, Cochrane and SCOPUS. The search was started in 1990, with the first wave of the opioid epidemic and the first published studies of e-prescribing, and continued to the year of 2020. The key phrases “electronic prescribing of controlled substances,” “e-prescribing of controlled substances,” “fraudulent prescribing of controlled substances,” “EPCS with PDMP,” and “drug interactions with e-prescribing of controlled drugs” were used as an inclusion criterion to search online scholarly databases for articles. Only primary and secondary data from reports, reviews and research studies written in English were included. The Centers for Disease Control (CDC), National Institute on Drug Abuse (NIDA), Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Academy of Family Medicine (AAFP), and nationally represented health information networks were used to obtain updated statistics regarding EPCS.

show abstract

An analysis of errors, discrepancies, and variation in opioid prescriptions for adult outpatients at a teaching hospital

Cited by 15 publications

References 13 publications

Opioid related medication incidents in Western Australia public hospitals: types, causes and level of harm

Opioid related medication incidents in Western Australia public hospitals: types, causes and level of harm

Opioid prescribing and dispensing: Experiences and perspectives from a survey of community pharmacists practising in the province of Quebec

The Adoption and Increased Use of Electronic Prescribing of Controlled Substances

Contact Info

Product

Resources

About