Takeaways include ensuring additional supervision, consultation, and continued pharmacy support.
In academic teaching hospitals, medical residents typically enter most of their medication orders for patients by using electronic prescribing systems. However, little is known about the association between the residents’ level of training and the frequency of medication prescribing errors or when they occur. A recent study helps shed light on these errors.
The results of a retrospective cohort study on medication e-prescribing errors made by 335 internal medicine residents in an academic medical center were published in the January 2019 issue of Southern Medical Journal.1 The study looked at more than 1.7 million inpatient electronic medication orders placed from 2011 to 2015. The objectives of the study were to analyze the frequency and types of resident medication e-prescribing errors, their association with the postgraduate year (PGY) of residency training, and the time of day and month that the errors occurred.
Here are highlights of the study1:
Frequency and Harm
Pharmacists identified an error in about 4% of the residents’ medication orders. None of the errors resulted in patient harm, because the pharmacists identified and corrected them before the medications reached the patients.
Medication classes associated with the highest rates of pharmacy-detected errors were antimicrobials (14%), anticoagulants (9%), colony-stimulating factor agents (8%), biologicals (8%), and antidotes (6%). Among these medications:
Add resident supervision. Although autonomy fosters resident learning, do not withdraw resident supervision after the first month of training. The timing of errors suggests the need for increased supervision in August and September, not just in July.
Continue pharmacy support. The frequency of resident e-prescribing errors underscores the need and value of ongoing pharmacy review of all residents’ medication orders, particularly given the widespread fatigue that contributes to bypassing EHR error detection functionality.
Educate residents. Inform them about common errors when ordering certain types of medications, particularly anticoagulants, antidotes, antimicrobials, biologicals, and colony-stimulating factor agents, as well as the different types of errors seen with com- monly versus less commonly prescribed medications.
Encourage consultation. Urge PGY-3 residents to consult with other health care professionals when caring for complex patients or ordering medications prescribed infrequently.
Strengthen renal dosing/monitoring capabilities. Establish a reliable plan to ensure medication dose adjustment and monitoring for patients with renal impairment, particularly when certain anti-coagulants and antimicrobials are prescribed. One way to accomplish this is with a pharmacy renal dosing protocol that targets at-risk patients and medications.
Garber A, Nowacki AS, Chaitoff A, et al. Frequency, timing, and types of medication ordering errors made by residents in the electronic medical records era. South Med J. 2019;112(1):25-31. doi: 10.14423/SMJ.0000000000000923.
Michael J. Gaunt, PharmD, is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/ Ambulatory Care Edition.