Effectiveness of a system development intervention to prevent medication prescribing errors in inpatients at Nakornping Hospital

Abstract

Background: Medication prescribing represents the initial step in the medication use process. If prescribing errors occur and remain undetected, they directly compromise patient safety.

Objectives: To compare the outcomes before and after implementing an enhanced inpatient medication prescribing error prevention system at Nakornping Hospital.

Methods: This retrospective study evaluated the incidence of inpatient medication prescribing errors using hospital medication error registry forms. Data were collected across two distinct periods: the pre-implementation period during October 2021, to September 2022, and the post-implementation period during October 2022, to September 2023. Prescribing errors were categorized into Clinical Decision-Making Errors and Writing Errors. Error severity was assessed using the NCC MERP index. Quantitative data were analyzed using descriptive statistics, and trend analysis was performed using ordinary least squares regression interrupted time-series analysis (ITSA).

Results: Following system implementation, the overall incidence of prescribing errors decreased significantly from 3.10 to 1.96 errors per 1,000 patient-days (p < 0.001). When classified by error type, writing errors decreased markedly from 2.18 to 0.87 errors per 1,000 patient-days (p < 0.001). For clinical decision making errors, the number of intercepted errors increased from 213 to 271 incidents, representing a rate change from 0.92 to 1.09 errors per 1,000 patient-days (p = 0.063). Regarding severity, no category D, E, or F errors were observed post-implementation, and no recurrent drug allergy incidents occurred. Most errors were classified as category B (99.59%). Trend analysis demonstrated that prescribing errors declined immediately in the first month of system implementation, with an average reduction of 0.29 errors per 1,000 patient-days (p = 0.001, 95% CI: -0.446, -0.147). Furthermore, a sustained downward trend was observed, with a continuous monthly decrease averaging 0.17 errors per 1,000 patient-days as system adherence persisted (p = 0.002, 95% CI: -0.287, -0.069).

Conclusion: The development of a prescribing error prevention system integrated with multidisciplinary collaboration demonstrates high efficacy in reducing both the incidence and severity of medication errors. The system successfully intercepts potential errors before they reach patients, thereby sustainably enhancing patient safety.