ED overcrowding is associated with an increased frequency of medication errors

Kulstad, Erik; Sikka, Rishi; Sweis, Rolla T.; Kelley, Kenneth M; Rzechula, Kathleen H.

doi:10.1016/j.ajem.2008.12.014

Cited by 223 publications

(144 citation statements)

References 49 publications

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“…Patients who are seen and discharged from the ED during periods of overcrowding have higher risk of mortality and hospitalization within 7 days as compared to patients who are discharged during non-overcrowded times [36]. Overcrowding is associated with increased number of medication errors [37]. Finally, and not unexpectedly, overcrowding leads to increased length of stay and delay to treatment, even in patients with ESI 2 triage scores [38].…”

Section: The Impact Of Overcrowding On Patient Carementioning

confidence: 99%

Overcrowding in the Emergency Department and Patient Safety

Jeanmonod¹,

Jeanmonod²

2018

Vignettes in Patient Safety - Volume 2

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Emergency department (ED) overcrowding is a recognized problem worldwide. This chapter reviews the scope of the problem, manifestations, repercussions, and potential solutions to this problem.Keywords: emergency department overcrowding, emergency department safety, emergency department systems, emergency department patient care, emergency department throughput, emergency department output A 68-year-old Case vignete

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Section: The Impact Of Overcrowding On Patient Carementioning

confidence: 99%

Overcrowding in the Emergency Department and Patient Safety

Jeanmonod¹,

Jeanmonod²

2018

Vignettes in Patient Safety - Volume 2

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“…1 Emergency physicians provide episodic care to patients they typically do not have a previous relationship with in urgent and emergent situations and in a suboptimal environment. Factors such as overcrowding, 2 staffing shortages, 3,4 frequent interruptions, and handovers in care 4 contribute to making the ED a high-risk setting.…”

Section: Ré Sumémentioning

confidence: 99%

Detection and correction of prescription errors by an emergency department pharmacy service

Stasiak¹,

Afilalo

Castelino

et al. 2014

CJEM

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Objectives: Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors. Methods: This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists' recommendations. Results: A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5-3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32-4.13), prescriptions with more than one medication (OR 5.03;, and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18-4.14). Conclusions: Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents. RÉ SUMÉObjectifs: C'est connu, les services d'urgence (SU) sont un lieu où le risque d'erreurs de prescription est é levé . Alors, les pharmaciens peuvent jouer un rô le important dans la ré vision des prescriptions dans le but de repé rer et de corriger les erreurs. L'é tude avait pour objectifs de dé crire la fré quence des erreurs de prescription dé celé es par les pharmaciens au SU et leur type, de dé terminer la proportion des erreurs susceptibles de correction et de cerner les facteurs associé s aux erreurs de prescription. Medication errors are one of the most common types of ED errors. 3,5,6 Most medication errors are related to one or more of ''five wrongs'' involved in the act of prescribing: wrong drug, wrong dose, wrong route, wrong time, and wrong patient. 7,8 Certain types of drugs, such as analgesics, antibiotics, sedatives, and cardiovascular drugs, have been associated with more frequent prescription errors compared to other drug classes. 3,7,9 In addition, prescribing to more complex and acutely ill patients at nighttime, on weekends, or by trainees has been associated with more frequent errors. 7,9 Previous studies have estimated the proportion of ...

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“…[4][5][6] In fact, clinical data indicate that the rate of medication errors or adverse events is approximately 4%. 2,[7][8][9] Many errors were considered preventable, but the cost of managing them exceeded $10 billion. 1,4 At a time when institutions are operating with stringent resources, it is imperative to avoid financial burdens induced by medication errors or adverse reactions.…”

Section: -Hour Pharmacy Service In the Edmentioning

confidence: 99%

Implementation of a 24-Hour Pharmacy Service with Prospective Medication Review in the Emergency Department

et al. 2015

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Background:It is reported that more than 128 million patients are seen in emergency departments (EDs) annually. Patient overcrowding had been associated with an increased occurrence of medication errors. Purpose: Due to increased patient volume and the need for improved patient safety, a 24-hour pharmacy service was established for our institution's ED. The purpose of the study is to quantify and demonstrate the impact of a 24-hour pharmacy service in an urban ED. Methods: This was a retrospective descriptive study conducted at a regional level 1 trauma center. The study period occurred between December 2012 and July 2013. The following variables were quantified and analyzed: number of medication orders reviewed, number of intravenous medications compounded, and number of clinical interventions that were recommended by the ED pharmacy team (EDPT) and accepted by ED clinicians. Results: A total of 3,779 medication orders were reviewed by the EDPT. Of these orders, 3,482 (92%) were prospectively reviewed. A total of 3,068 (81.2%) and 711 (18.8%) orders were reviewed for the adult and pediatric ED, respectively. During the study period, the EDPT procured 549 intravenous admixtures and conducted 642 clinical interventions. Most of the interventions involved providing drug information for physicians and nurses (45.9%), adjusting drug dosages (21.1%), and recommending antimicrobial therapy (15.1%). Conclusion:The implementation of a 24-hour pharmacy service at our institution was an innovative practice that increased the role of pharmacists in the ED. The EDPT conducted prospective medication review, procured intravenous admixtures from a sterile environment, and provided therapeutic recommendations for the ED interdisciplinary team.

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ED overcrowding is associated with an increased frequency of medication errors

Cited by 223 publications

References 49 publications

Overcrowding in the Emergency Department and Patient Safety

Overcrowding in the Emergency Department and Patient Safety

Detection and correction of prescription errors by an emergency department pharmacy service

Implementation of a 24-Hour Pharmacy Service with Prospective Medication Review in the Emergency Department

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