ERRORS IN PRESCRIPTION OF REGULAR MEDICATION IN EMERGENCY SURGICAL ADMISSIONS – CLINICAL AUDIT

Abstract

Aim: To identify the incidence of regular medication not being prescribed on initial admission of emergency surgical cases

Material and Method: The data for this audit was taken from all surgical admissions over an approximately one month period between December 2004 and January 2005. Prescribed drugs for each patient were checked the morning after admission. If the patient was unable to provide this information, we obtained their regular medication list from the GP.

A total of 71 admissions were studied, 58% were referred from A& E, whereas 34% from the GP or primary care and a small percentage came from referrals from other wards within the hospital.

Results: Out of the 71 admissions, 46 patients were receiving at least one regular medication. Obviously, some patients were on medications for more than one disease and these were looked at individually.

From all 71 admissions, 21% of them had at least one error, i.e. at least one regular medication was not prescribed on admission.

If there was a documented reason for the omission of a particular drug then this was not counted as an error.

Analysing each co morbidity individually, 42% of IHD medication were not prescribed despite being taken on a regular basis by the patient, 33% for hypertensive and diabetic medication, 50% for asthmatic and psychiatric medication and 29% for medication for other less serious conditions.

81% of the errors made were on patients referred from A& E, while 15% where from patients received from the GP/primary care. Only 4% of the errors was made on patients referred from other wards. However, A& E referrals were almost double those of GPs. Hence, in a total of 41 A& E referrals 21 errors were made, while in a total of 24 GP referrals only 4 errors were made. Only 1 error was made in the total of 6 ward referrals.

Conclusion and Discussion: The results of this audit are surprising and alarming. 21% of admissions had at least one regular medication not prescribed by the admitting doctors.

Missing out on regular medication can have potentially life-threatening effects on patients as well as severe medico-legal implications.

Most of the mistakes were being made with patients that are referred from the accident and emergency department. These patients are generally more unwell than the ones referred from the GP or primary care, and quite often are elderly patients on a multitude of drugs that are unable to remember some or all of their tablets. Patients admitted out of hours present an added difficulty in that GPs are not available for confirmation of the patient’s regular medication.

So, more care and emphasis need to be given on drug history when admitting a patient.