Development of the System for Screening and Analysis of Prescriptions of Inpatients, Maharat Nakhon Ratchasima Hospital

Abstract

Limitation of the patient information accessed by the pharmacist through only a copy of a doctor’s order sheet, checking the laboratory value through the computer and using the individual experience of pharmacist may result in incomplete or inappropriate analysis of prescriptions or problems undetected. The aims of this study were to develop a system for screening and analying prescriptions of inpatients in order to detect prescription errors; and to assess the effectiveness of the system by comparing the rate, types and severity of the errors both before and after the development of the system. It was an action research with 3 phases: (1) problem analysis and system development using information from the visiting report of the hospital pharmacy associations; the outcomes of discussions among multidisciplinary team regarding the reports on prescription errors for inpatients; and the cooperation with the computer centre. The developed system includes a capability to show the essential laboratory results, the trigger tool that relates to the medicines which might be a cause of adverse events in the medication profile for individual patient; and development of a preliminary practicing standard, (2) 2-month implementation of the system based on the proposed standard, and (3) evaluation phase. It was found that under the constant environmental factors, the system was able to detect more prescription errors as the detection rate was increased from 0.7 incidents to 1.4 incidents per 1,000 patient days, with an incident rate ratio of 1.85 (95%CI=1.84-1.86). The most common error was the prescriptions of too low or too high dose of drugs (the detection rate increased from 0.44 incidents to 0.90 incidents per 1,000 patient days). Other 2 leading errors were repeated prescriptions and no prescripton of drugs that the patients needed. The severity of B level (the correction of errors before affecting the patients) increased from 97.1% to 97.9%. In conclusion, the development of the system for screening and analysis of the prescriptions of inpatients could assist pharmacists to be able to access the necessary information for all patients and able to work competently to surpass the minimum professional standard.