Effects of the Development of a Prescription Screening System for Inpatients on Medication Errors at Krathumbaen Hospital, Samut Sakhon Province

Abstract

Objective: To develop a prescription screening system for inpatient pharmacy services and to compare the rate of prescribing errors (PEs) before and after the development of the system. Method: This study was an action research with 4 phases. Phase 1 or planning consisted of a) data collection of work processes, criteria for screening prescription and PEs data in 3 periods, i.e., the period without screening of drug orders (January to September 2022), the period with prescription screening (October 2022 to June 2023), and the period with criteria for prescription screening (October 2023 to March 2024), b) analysis of PEs data in the 3 periods, and c) determination of the process for system development. Phase 2 was the implementation of the system or the developed prescription screening program (April to June 2024). Phase 3 or observation involved data collection of the effects of the implementation of the planned system, including the system development process and PEs data. Phase 4 involved reflection of system implementation and the improvement of the system. This phase consisted of a) evaluation of the outcomes of system implementation b) improvement of system by having pharmacists on duty at prescription screening point (July to September. 2024) and c) outcome evaluation by comparing PEs before and after system implementation at different time periods and those when pharmacists available at prescription screening points. Results: The developed processes in the system included development of a prescription screening program, determination of appropriate criteria for prescription screening, support in policies, technology, and personnel, development of pharmacists' knowledge and skills in prescription screening, participation of practitioners and multidisciplinary professionals in system development, and improvement of the completeness of prescription screening according to the criteria. After the implementation of the prescription screening system, more PEs were identified and resolved than those before system development. Identified PEs increased from 2.41 per 1,000 hospital days to 4.61 per 1,000 hospital days (P=0.001). After the implementation of the prescription screening program, more PEs could be discovered and resolved than those before implementing the program, with identified PEs increasing from 5.02 per 1,000 hospital days to 8.74 per 1,000 hospital days (P=0.009). Conclusion: The development and implementation of the prescription screening system and having a prescription screening program enable pharmacists to identify and resolve more PEs than before the system development, resulting in more appropriate drug use and drug safety in patients.