Outpatient prescriptions practice and writing quality in a paediatric  university hospital

Ermindo R Di Paolo; Mario Gehri; Lauriane Ouedraogo-Ruchet; Guibet Sibailly; Nicolas Lutz; André Pannatier

doi:10.4414/smw.2012.13564

Original article

Vol. 142 No. 1516 (2012)

Outpatient prescriptions practice and writing quality in a paediatric university hospital

Ermindo R Di Paolo
Mario Gehri
Lauriane Ouedraogo-Ruchet
Guibet Sibailly
Nicolas Lutz
André Pannatier

DOI: https://doi.org/10.4414/smw.2012.13564
Cite this as:: Swiss Med Wkly. 2012;142:w13564
Published: 08.04.2012

Summary

BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital.

METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects.

RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010.

CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.

References

WHO patient safety [homepage on the Internet]. Geneva: World Health Organization; 2011. [cited 2011 oct 10]. Available from: http://www.who.int/patientsafety/en/
Taxonomy of Medication errors [homepage on the Internet]. National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP); 1998–2011 [cited 2011 oct 10]. Available from: http://www.nccmerp.org.
Levine S, Cohen MR. Preventing medication errors in pediatric and neonatal patients. In: Cohen MR, editor. Medication errors. 2nd ed. Washington: American Pharmacists Association. 2007; p. 469–92.
Ghaleb MA, Barber N, Dean Franklin B, Wong ICK. What constitutes a prescribing error in paediatrics? Qual Saf Health Care. 2005;14(5):352–7.
Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285(16):2114–20.
Chan CY, Maxwell PR, Koger CA, Gamboa CD, Brewer JG. Screening discharge prescriptions on a pediatric ward. Am J Hosp Pharm. 1990;47(9):2060–1.
McPhillips HA, Stille CJ, Smith D, Hecht J, Pearson J, Stull J, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr. 2005;147(6):761–7.
Christiansen SR, Morgan JA, Hilmas E, Shepardson E. Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting. J Pediatr Pharmacol Ther. 2008;13(4):226–32.
Jani YH, Barber N, Wong ICK. Paediatric dosing errors before and after electronic prescribing. Qual Saf Health Care 2010;19(4):337–40.
Kaushal R, Goldmann DA, Keohane CA, Abramson EL, Woolf S, Yoon C, et al. Medication errors in paediatric outpatients. Qual Saf Health Care. 2010;19(6):e30.
Livio F, Buclin T, Pannatier A, Biollaz J. Generic drugs and legal incentives: which impact? Rev Med Suisse. 2006;2(61):966–9.
Wasserfallen JB, Bütschi AJ, Muff P, Biollaz J, Schaller MD, Pannatier A, et al. Format of medical order sheet improves security of antibiotics prescription: the experience of an intensive care unit. Crit Care Med. 2004;32(3):655–9.
Compendium Suisse des Médicaments [homepage on the Internet]. Basel: Documed; 2010. Available from: http://www.compendium.ch.
Pharmavista [homepage on the Internet]. Bern: e-Mediat AG; 2010. Available from: http://www.pharmavista.ch.
List of pharmaceutical specialties [homepage on the Internet]. Bern: Federal Office of Public Health. 2010. Available from: http://www.bag.admin.ch.
UpToDate [homepage on the Internet]. Waltham: UpToDate Inc; 2010. Available from: http://www.uptodate.com.
Shann F. Drug doses. 13th ed. Parkville: Royal Children’s Hospital. 2008.
GraphPad Software [homepage on the Internet]. La Jolla: GraphPad Software Inc. [cited 2011 oct 10]. Available from: http://www.graphpad.com.
Di Paolo ER, Stoetter H, Cotting J, et al. Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly. 2006;136(13-14):218–22.
Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44(3):489–506.
Pappas DE, Hendley JO. The common cold and decongestant therapy. Pediatr Rev. 2011;32(2):47–54.
Kwo EC, Kamat P, Steinman MA. Physician use of brand versus generic drug names in 1993–1994 and 2003–2004. Ann Pharmacother. 2009;43(3):459–68.
Kennedy AG, Littenberg B. A modified outpatient prescription form to reduce prescription errors. Jt Comm J Qual Saf. 2004;30:480–7.
Paul M, Brossier PL, Broissand I, Cordonnier C, Astier A, Roudot-Thoraval F. Evaluation of the quality drug prescription for patients to be discharged from a university teaching hospital: statutory aspects. Ann Pharm Fr. 2001;59(2):130–8.
Moniz TT, Seger AC, Keohane CA, Seger DL, Bates DW, Rothschild JM. Addition of electronic prescription transmission to computerized prescriber order entry: Effect on dispensing errors in community pharmacies. Am J Health Syst Pharm. 2011;68(2):158–63.

How to Cite

1.

Di Paolo ER, Gehri M, Ouedraogo-Ruchet L, Sibailly G, Lutz N, Pannatier A. Outpatient prescriptions practice and writing quality in a paediatric university hospital. Swiss Med Wkly [Internet]. 2012 Apr. 8 [cited 2024 Apr. 23];142(1516):w13564. Available from: https://smw.ch/index.php/smw/article/view/1465

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] WHO patient safety [homepage on the Internet]. Geneva: World Health Organization; 2011. [cited 2011 oct 10]. Available from: http://www.who.int/patientsafety/en/

[2] Taxonomy of Medication errors [homepage on the Internet]. National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP); 1998–2011 [cited 2011 oct 10]. Available from: http://www.nccmerp.org.

[3] Levine S, Cohen MR. Preventing medication errors in pediatric and neonatal patients. In: Cohen MR, editor. Medication errors. 2nd ed. Washington: American Pharmacists Association. 2007; p. 469–92.

[4] Ghaleb MA, Barber N, Dean Franklin B, Wong ICK. What constitutes a prescribing error in paediatrics? Qual Saf Health Care. 2005;14(5):352–7.

[5] Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285(16):2114–20.

[6] Chan CY, Maxwell PR, Koger CA, Gamboa CD, Brewer JG. Screening discharge prescriptions on a pediatric ward. Am J Hosp Pharm. 1990;47(9):2060–1.

[7] McPhillips HA, Stille CJ, Smith D, Hecht J, Pearson J, Stull J, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr. 2005;147(6):761–7.

[8] Christiansen SR, Morgan JA, Hilmas E, Shepardson E. Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting. J Pediatr Pharmacol Ther. 2008;13(4):226–32.

[9] Jani YH, Barber N, Wong ICK. Paediatric dosing errors before and after electronic prescribing. Qual Saf Health Care 2010;19(4):337–40.

[10] Kaushal R, Goldmann DA, Keohane CA, Abramson EL, Woolf S, Yoon C, et al. Medication errors in paediatric outpatients. Qual Saf Health Care. 2010;19(6):e30.

[11] Livio F, Buclin T, Pannatier A, Biollaz J. Generic drugs and legal incentives: which impact? Rev Med Suisse. 2006;2(61):966–9.

[12] Wasserfallen JB, Bütschi AJ, Muff P, Biollaz J, Schaller MD, Pannatier A, et al. Format of medical order sheet improves security of antibiotics prescription: the experience of an intensive care unit. Crit Care Med. 2004;32(3):655–9.

[13] Compendium Suisse des Médicaments [homepage on the Internet]. Basel: Documed; 2010. Available from: http://www.compendium.ch.

[14] Pharmavista [homepage on the Internet]. Bern: e-Mediat AG; 2010. Available from: http://www.pharmavista.ch.

[15] List of pharmaceutical specialties [homepage on the Internet]. Bern: Federal Office of Public Health. 2010. Available from: http://www.bag.admin.ch.

[16] UpToDate [homepage on the Internet]. Waltham: UpToDate Inc; 2010. Available from: http://www.uptodate.com.

[17] Shann F. Drug doses. 13th ed. Parkville: Royal Children’s Hospital. 2008.

[18] GraphPad Software [homepage on the Internet]. La Jolla: GraphPad Software Inc. [cited 2011 oct 10]. Available from: http://www.graphpad.com.

[19] Di Paolo ER, Stoetter H, Cotting J, et al. Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly. 2006;136(13-14):218–22.

[20] Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44(3):489–506.

[21] Pappas DE, Hendley JO. The common cold and decongestant therapy. Pediatr Rev. 2011;32(2):47–54.

[22] Kwo EC, Kamat P, Steinman MA. Physician use of brand versus generic drug names in 1993–1994 and 2003–2004. Ann Pharmacother. 2009;43(3):459–68.

[23] Kennedy AG, Littenberg B. A modified outpatient prescription form to reduce prescription errors. Jt Comm J Qual Saf. 2004;30:480–7.

[24] Paul M, Brossier PL, Broissand I, Cordonnier C, Astier A, Roudot-Thoraval F. Evaluation of the quality drug prescription for patients to be discharged from a university teaching hospital: statutory aspects. Ann Pharm Fr. 2001;59(2):130–8.

[25] Moniz TT, Seger AC, Keohane CA, Seger DL, Bates DW, Rothschild JM. Addition of electronic prescription transmission to computerized prescriber order entry: Effect on dispensing errors in community pharmacies. Am J Health Syst Pharm. 2011;68(2):158–63.