|Title:||Ambiguous prescribing practices in a large public hospital in Hong Kong|
|Subject:||Hospitals -- Drug distribution systems -- China -- Hong Kong -- Case studies|
Medication errors -- China -- Hong Kong -- Case studies
Hong Kong Polytechnic University -- Dissertations
Department of Nursing and Health Sciences
|Abstract:||Medication administration (MA) is one of the highest risk areas of nursing practice. When medication errors occur, the patients' health may be jeopardized and the nurses may face disciplinary or even legal actions. In order to ensure that MA is carried out safely, nurses can assume an active role to review and improve the process. As prescription errors represent a leading category of medication errors, which in turn represents a leading category of medical errors, it is an important issue for deliberation. Prescription errors can be classified into two categories: 'inappropriate prescribing decisions' and 'ambiguous prescribing practices'. This study was conducted to elicit the factual occurrence of 'ambiguous prescribing practices' in a large public hospital in Hong Kong. A total of 1,883 prescriptions documented in 413 medication administration records (MARs) in 235 medical records that were selected by systemic sampling were reviewed. The study found that patient's name, diagnosis and allergy history were not documented in 0.24%, 51.47% and 56.13% of MARs respectively. In addition, 0.21% of prescriptions were written in wrong MARs and 14.6% of prescriptions were either illegible or misspelled. Relevant information was not written in significant proportion of prescriptions, such as the absences of: dosage when indicated (0.57%), starting date of administration (3.45%), doctor's signature (4.89%), frequency of administration (5.15%), maximum dose or minimum interval for 'whenever necessary' medication (8.33%), doctor's name or other identifier (55.76%), route of administration (70.84%) and dosage form for non-parenteral medication (86.95%). Among the error-prompt abbreviations, 'c.c.', 'u' and 'ug' were used in 2.82%, 49.94% and 62.5% of relevant prescriptions respectively. There were other ambiguous prescribing practices such as used expressions other than SI units (22.28%), improper alteration of prescriptions (52.17%) and improper cancellation of prescriptions (65.48%). It is envisaged that the study will alert local healthcare professionals and the corresponding authority to the extent of this problem. The ultimate aim is to advocate safety of patient and health care professionals by catalysing the implementation of system improvement measures such as automation and computerization.|
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