Study of the results of developing a reporting system for prescription errors and procedures in the outpatient pharmacy, Khon Kaen Hospital

Abstract

This research is an action research with the purpose to study the results of developing a prescription errors reporting system and adjusting the process in the pharmacy, and to study the comparison of prescription errors when physicians order medication by the CPOE system compared to the original system after adjusting the reporting system and processes in the outpatient pharmacy room, Khon Kaen Hospital, conducted between October 1, 2023 - October 1, 2024. The results showed that the development of a reporting system and process adjustments in the pharmacy room increased the incidence of prescription errors from 0.92 to 4.50 per 1,000 prescriptions, The number of reported medication errors increased from 378 reports to 2,412 reports. It was found that there were 1,214 reports of the CPOE system and 1,198 reports of the traditional system, and both the CPOE system and the traditional system were all at level B severity. The results of comparing medication order errors when doctors ordered by the CPOE system compared to the traditional system found statistically significant differences in medication order errors, the total of 4 items are including ordering in the wrong way, ordering the wrong amount, failure to order drugs that need to be continuously prescribed, unclear orders, and errors from drug orders that are not significantly different, the total of 13 items are including ordering the wrong dose, ordering when the patient has a history of drug allergies, ordering the wrong type, ordering duplicate, ordering drugs against PTC regulations, ordering the wrong time, prescribing unnecessary drugs, prescribing the wrong dosage forms, prescribing drugs that are not on the hospital drug list, prescribing drugs with interactions, prescribing the wrong person, prescribing the wrong documents, and prescribing drugs with contraindications.