Effects of the Development of the Medication Management System in Inpatient Departments on Medication Errors at Krathumbaen Hospital, Samut Sakhon Province

Abstract

Objectives: 1) To develop a medication management system for inpatient pharmacy services at Krathumbaen Hospital, Samut Sakhon Province, and 2) To compare the rate of prescribing errors (PE) and pre-dispensing errors (PDE) before and after the development of the medication management system. Methods: This study was action research comparing medication errors between the pre-development period (January 2022 to September 2022, a total of 9 months) and the period after system development (October 2022 to June 2023, a total of 9 months). The research process consisted of four phases. Phase 1 or planning consisted of: a) Collection of general information for inpatient pharmacy services, including PE and PDE data before system development, b) Analyzing PE and PDE data before system development, and c) Determining the process for developing medication management system. Phase 2 or action involved the implementation of the system development process in cycle 1 from October 2022 to December 2022. Phase 3 or observation consisted of the collection of outcomes after system development in cycle 1 including the various processes used to develop the system, PE and PDE data. Phase 4 or reflection and improvement involved a) Evaluating the outcomes of system development in cycle 1, b) Improving plans for the effort in cycle 2 from January to March 2023 and cycle 3 from April to June 2023, and c) Evaluating outcomes by comparing PE and PDE before and after system development. Results: The process of developing a medication management system to reduce medication errors included: 1) Holding meetings and encouraging participation in various levels of meetings, namely IPD meetings, discussions by all inpatient pharmacy, meetings of the Medication Error Working Group by representatives of all patient wards, and the Pharmacy and Therapeutics Committee meetings to create awareness and understanding in resolving medication errors, 2) Developing a system for collecting and reporting medication errors, 3) Revising pharmacists' daily work schedules, pharmacy technicians, and other pharmacy staff, 4) Developing a prescription screening system, 5) Medication reconciliation, 6) Establishing guidelines for preventing drug errors, and 7) Determining measures to prevent medication errors. After developing the system, more PEs (4.61 times per 1,000 patient-days) were detected and resolved compared to those before system implementation (2.41 times per 1,000 patient days) (P<0.001). Additionally, PDE decreased from 13.95 times per 1,000 patient days to 9.97 times per 1,000 patient days (P=0.022). Conclusion: After developing the medication management system, pharmacists can identify and resolve more PE than before the system development, and PDE rates are lower.