Factors Associated with Prescribing Errors at the Premium Outpatient Pharmacy in Somdech Phra Debaratana Medical Center

Abstract

Objective: To investigate the factors associated with prescription errors (PEs) in the outpatient pharmacy at Somdech Phra Debaratana Medical Center. Methods: This retrospective analytical research collected the data from 82,137 prescriptions during January 1, 2024 to March 1, 2024. Seven predictive factors in the study were prescribing system, estimated glomerular filtration rate (eGFR), prescription with warfarin, hospital unit providing care to patients, number of drug items in prescription, patients receiving more than one prescription in one day, and medications with quantity restrictions based on hospital policy. The association between PEs and these factors was analyzed using logistic regression. Results: Factors significantly influencing PEs included patients with eGFR ≥ 30 and < 60 mL/min/1.73m² (OR_adjust =1.31, 95% CI=1.20-1.44, P<0.001), eGFR < 30 mL/min/1.73m² (OR_adjust =1.99, 95% CI=1.75-2.27, P<0.001), absence of eGFR (OR_adjust =0.87, 95% CI=0.79-0.97, P=0.011), prescription of medicine department (OR_adjust =1.95, 95% CI=1.72-2.22, P<0.001), prescription of surgery and orthopedic department (OR_adjust =2.95, 95% CI=2.58-3.39, P<0.001), prescription with 3-4 drug items (adjusted OR_adjust =1.53, 95% CI=1.39-1.67, P<0.001), prescription with 5-6 drug items (OR_adjust =2.18, 95% CI=1.97-2.42, P<0.001), prescription with more than 7 drug items. (OR_adjust =4.13, 95% CI=3.76-4.53, P<0.001), patients receiving more than one prescription per day (OR_adjust =1.37, 95% CI=1.27-1.48, P<0.001), and prescriptions with medications restricted by hospital policy (OR_adjust =4.21, 95% CI=3.88-4.58, P<0.001). Factors with no association with PEs included prescribing system and prescriptions with warfarin. Three most commonly found PEs were incorrect dosage/frequency/duration, prescribing in CPOE system with medication units not consistent to drugs and prescriptions not complying with hospital policies. Top three drugs involving in PEs were denosumab, icosapent ethyl and erythropoietin alfa Conclusion: Top three factors with the highest association with PEs included prescriptions with medications restricted by hospital policy, having at least 7 drug items in prescriptions, and prescription of surgery and orthopedic department.  The Hospital should consider identified significant factors in the effort to improve the prescribing system and presented them to the Pharmacy and Therapeutics Committee for establishing safer prescribing practices, and reducing PEs in order to maximize patients’ drug safety.