The Outcomes of the Improved Prescription Screening Process for Outpatient Medication Errors at Surin Hospital

Abstract

Background: In the fiscal year 2023, Surin Hospital identified 8.6 medication errors per 1,000 prescriptions in outpatients, with 2.2 errors per 1,000 prescriptions due to prescribing mistakes. This resulted in three serious adverse patient outcomes. In December 2023 - February 2024 , prescribing errors were found at a rate of 4.2 per 1,000 prescriptions. These errors included prescribing medications that did not match the patient's history and prescribing drugs to patients with contraindications. Consequently, a screening improvement for medication prescribing was implemented.
Objective: To study the effects of improving prescription screening in outpatients, on medication errors at Surin Hospital.
Methods: This action research, conducted over six months (December 2023 – May 2024), was divided into four phases: 1) Situation analysis, 2) Multidisciplinary team meetings to improve the prescription screening process by setting screening criteria, redesign prescription forms , and consulting physicians when issues arise, 3) Implementing the established guidelines, 4) Evaluating the outcomes. The population studied was outpatient prescriptions, with the sample group consisting of internal medicine outpatient prescriptions. Data were analyzed using descriptive statistics , Chi-Squared and the Independent t-test.
Results: A comparison of outcomes before and after the screening improvement showed an increase in the number of prescriptions from 26,705 to 27,000. Prescribing errors rose from 4.2 to 6.6 per 1,000 prescriptions. Errors due to discrepancies with patients' medical history increased from 0.2 to 1.1 per 1,000 prescriptions. Incorrect dosage errors increased from 0.9 to 2.0 per 1,000 prescriptions, with significant statistical differences (p<0.001). Prescribing contraindicated medications, such as metformin in patients with eGFR < 30 ml/min/1.73 m², rose from one to three cases. However, the impact on patients at severity level C (affecting the patient but without harm) decreased from two cases to zero.
Conclusion: The improved prescription screening process led to a higher detection of prescribing errors without causing harm to patients, achieving 100% error interception, reduce medication errors and improve patient safety.