Development of a Prescription Screening System for Inpatients by Pharmacists at Songklanagarind Hospital

Abstract

Objective: To develop the prescription screening system for in-patients by adding the process of evaluating and analyzing the prescriptions by pharmacists, and to assess the rate and severity of prescribing errors detected by pharmacists before and after implementation of the system. Methods: This action research was divided into 4 phases including 1. Analysis of problems analyzing and development of the prescription screening system. 2. System implementation and defining the performance indicators. 3. Training of staff and development of program for reviewing the in-patient prescriptions to be ready for the system expansions and 4. Revision of prescription screening process by setting it at the first step of work process. Results: The number of prescribing errors detected by pharmacists from 1.58 errors per 1000 patient-days at baseline to 4.32 errors per 1000 patient-days in the first phase of system development. The number of detected prescribing errors continuously increased to approximately 5 times as the prescription screening system was expanded to cover every in-patient prescription. Three most common errors identified by pharmacists were wrong dose, wrong/ unspecified/unclear/incomplete medication order and prescribing drugs to which the patients were allergic or at high risk of allergic reaction. At the end of the system implementation, the proportion of prescribing errors prevented from reaching patients (Level B) by pharmacists increased from 79.90% to approximately 87 - 95%.  Conclusion: Developing a prescription screening system in in-patients with the pharmacists responsible for reviewing and evaluating appropriateness of medication orders before proceeding to drug preparation and dispensing leads to more detection of prescribing errors and by pharmacists. It also increases the proportion of errors prevented from reaching patients.