Medication Prescribing Errors on a Surgery Service - Addressing the Gap with a Curriculum for Surgery Residents: A Prospective Observational Study

Justine Ring; Jesse Maracle; Shannon Zhang; Michelle Methot; Boris Zevin

doi:10.1177/23821205241226819

Medication Prescribing Errors on a Surgery Service - Addressing the Gap with a Curriculum for Surgery Residents: A Prospective Observational Study

J Med Educ Curric Dev. 2024 Jan 22:11:23821205241226819. doi: 10.1177/23821205241226819. eCollection 2024 Jan-Dec.

Authors

Justine Ring¹, Jesse Maracle², Shannon Zhang³, Michelle Methot⁴, Boris Zevin⁵

Affiliations

¹ Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
² School of Medicine, Queen's University, Kingston, Ontario, Canada.
³ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Kingston Health Sciences Center, Kingston, Ontario, Canada.
⁵ Department of Surgery, Queen's University, Kingston, Ontario, Canada.

Abstract

Objectives: Educational interventions with proven effectiveness to reduce medication prescribing errors are currently lacking. Our objective was to implement and assess the effectiveness of a curriculum to reduce medication prescribing errors on a surgery service.

Methods: This was a prospective observational cohort study at a Canadian academic hospital without an electronic order entry system. A pharmacist-led medication prescribing curriculum for surgery residents was developed and implemented over 2 days (2 h/day) in July 2019. Thirteen (76%) out of 17 surgery residents contributed pre-implementation data, while 13 (81%) out of 16 surgery residents contributed post-implementation data. Medication prescribing errors were tracked for 12 months pre-implementation and 6 months post-implementation. Errors were classified as prescription writing (PW) or decision making (DM).

Results: There were a total of 1050 medication prescribing errors made in the pre-implementation period with 615 (59%) PW errors and 435 (41%) DM. There were a mean of 87.5 (SD = 14.6) total medication prescribing errors per month in the pre-implementation period with 51.3 (11.9) PW and 36.3 (6.0) DM errors. There were a total of 472 medication prescribing errors made in the post-implementation period with 260 (55%) PW and 212 (45%) DM errors. There were a mean of 78.7 (10.3) total medication prescribing errors per month in the post-implementation period with 43.3 (9.5) PW and 35.3 (4.2) DM errors. In the first quarter of the academic year, there were significantly fewer mean total errors per month post-implementation versus pre-implementation (77.7(12.7) versus 107.3(8.1); P = .035), with significantly fewer PW errors per month (40.7(13.2) versus 68.7(9.3); P = .046) and no difference in DM errors per month (37.0(2.0) versus 38.7(5.7);P = .671). There were no differences noted in the second quarter of the academic year.

Conclusion: Medication prescribing errors occurred from PW and DM. Medication prescribing curriculum decreased PW errors; however, a continued education program is warranted as the effect diminished over time.

Keywords: Education; general surgery; inappropriate prescribing; medication errors; residency.