Reducing Medication Errors in a Surgical Residency Training Program

Abstract

Medication errors contribute to in-hospital morbidity and mortality. Teaching hospitals and the surgical residency training programs they support should take proactive steps to reduce error frequency. In order to accomplish meaningful error reduction, we must first define the scope and nature of the problem. Pharmacists at the Monmouth Medical Center prospectively recorded medication prescribing errors made by surgical residents during 2 years. These data were reviewed to determine the types of medication errors made most frequently by surgical house officers. Seventy-five medication-prescribing errors were made by surgical house staff in the years 2001 and 2002. Thirty-three of these errors involved orders for antibiotic therapy. Errors that could not be directly attributed to knowledge deficits were responsible for 36 of the 75 errors (48%), whereas specific knowledge deficits were responsible for 39 of the 75 errors (52%). Twenty-eight of the 36 errors not directly attributable to knowledge deficits (78%) were made at the postgraduate year one level, whereas only 15 of the 39 knowledge deficit errors (38%) were made at the postgraduate year one level. Though targeted education to address specific knowledge deficits may substantially reduce the occurrence of “knowledge deficit” medication errors within surgical residency training programs, more costly measures such as the implementation of physician computerized order entry will likely be needed to reduce maximally the frequency of medication ordering errors. Many prescribing errors cannot be attributed to specific knowledge deficits.

Medication Prescribing Errors on a Surgery Service – Addressing the Gap with a Curriculum for Surgery Residents: A Prospective Observational Study

“…Medication prescribing errors in a non-electronic order entry (EOE) (paper-based) system have been shown to be associated with ‘knowledge deficits’ and ‘other’ factors, such as mistakes made during the process of order writing. 10 In a pilot study of medication prescribing errors in a Canadian academic hospital, without an EOE system, we demonstrated that surgery trainees made errors in 3% to 9% of medication prescription orders with 1/3 of errors related to DM and 2/3 to PW. 9 EOE systems can decrease adverse events related to medication prescription errors by 48–50% 11 , 12 ; however, EOE systems do not appear to address all types of medication prescribing errors as medication prescribing errors can occur during both DM and PW phases.…”