Transcript C-16_Watts - Advocate Health Care

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Further Characterization of the Influence of Crowding on Medication Errors
Hannah Watts, MD, Rishi Sikka, MD, Rolla Sweis, PharmD, Erik Kulstad, MD, MS
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois
Introduction
•Emergency department (ED) crowding
appears to contribute to ED medication errors
•Our prior analysis suggested that error
frequency increases disproportionately with
crowding
•To further clarify this relationship, we
measured the association between medication
errors and crowding in the ED over discrete
time intervals
•We controlled for:
•Number of charts reviewed
•Ambulance diversion status
•We hypothesized that errors would occur
significantly more frequently as crowding
increased, even after controlling for higher
patient volumes
Methods
•We performed a prospective, observational
study in our large community hospital ED from
May to October of 2009
•Our ED has full-time pharmacists who review
orders to help identify errors prior to their causing
harm
•Research volunteers shadowed our ED
pharmacists over discrete 4-hour time periods
•The total numbers of charts reviewed and errors
identified were documented along with details for
each error type, severity, and category
• We measured the correlation between error rate
(number of errors divided by total number of
charts reviewed) and ED occupancy rate while
controlling for diversion status during the
observational period.
•We estimated a sample size requirement of at
least 45 errors to allow detection of an effect size
of 0.6 based on our historical data
Results
•1171 charts were reviewed during 324 hours of
error surveillance
•87 errors were identified
•Errors included:
•Incorrect doses
•Incorrect routes
•Incorrect medications
•Medication duplications
•Delays in therapy
•Median error rate per 4-hour block was 5.8% of
charts reviewed (IQR 0-13)
•No significant change was seen with ED
occupancy rate (Spearman's rho = -.08, p=.49)
•Median error rate during times on ambulance
diversion was 11% (IQR 0-17)
Limitations
•Study data are from a single ED
•Pharmacy and volunteer coverage were not
available 24 hours a day
•ED Occupancy is a surrogate measure of
overcrowding
Conclusions
•Error frequency appears to remain relatively
constant across the range of crowding in our
ED when controlling for patient volume via
the quantity of orders reviewed
•Error quantity therefore increases with
crowding, but not at a rate greater than the
expected baseline error rate that occurs in
uncrowded conditions
•These findings suggest that crowding will
increase error quantity in a linear fashion
References
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Acknowledgements
We would like to thank Jim Jensen, PharmD,
Kathy Hesse, RN, and our research
volunteers for their help with data collection.