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APHA Scientific Session and Event Listing

Amanda Kennedy, PharmD, Benjamin Littenberg, MD, and Jan Carney, MD, MPH. Division of General Internal Medicine, University of Vermont, 371 Pearl Street, Burlington, VT 05401, 802-847-8268, amanda.kennedy@vtmednet.org

Medication errors are a public health problem. Approximately 0.5% of all new prescriptions written, or 9.8 million annually in the US, contain errors with the potential to harm patients. Traditional paper prescription forms are inadequate for promoting high quality care for patients. However, many rural prescribers do not currently have the means to adopt electronic prescribing technology.

We developed a novel paper prescription form using ergonomic design principles. The modified form contains prompts for medication name, form, strength, dose, route, frequency, refills, quantity, indication, and additional directions. We sought to determine if the modified form reduces two types of error compared to standard forms. “Clinically important errors” are those that prevent the pharmacist from dispensing. “Omission errors” include any exclusions from the legally mandated content of a prescription.

A pilot study included 443 prescriptions from 11 prescribers in an adult Internal Medicine clinic who participated in a before-after trial of the modified paper prescription form. Modified prescription forms significantly reduced clinically important prescribing problems compared to standard forms (1/150 vs. 9/293; P = .007). Modified forms also decreased omission errors compared to standard forms (13% vs. 18% P = .01).

To expand the evaluation of the modified forms, 100 rural primary care prescribers are being recruited from the most rural state in each US Census region. 64 enrollees to date include 34 from Vermont (Northeast), 6 from West Virginia (South), 12 from South Dakota (Midwest), and 12 from Montana (West). 47 are physicians; 17 are nurses or physician assistants. Prescribers serve as their own controls, completing 100 standard and modified forms each. Duplicates (containing no prescriber or patient identification) of the 20,000 prescriptions serve as the study data. They are being analyzed independently by two community pharmacists to determine the rates of both clinically important errors and omission errors.

The error rates with each form will be compared using the Mantel-Haenszel test to account for clustering within prescriber. Logistic regression models will be performed for subset analyses. The quantitative results of the study will be presented, along with qualitative examples of frequent, interesting, or particularly dangerous errors. Additional data presented will include comparisons of standard and modified forms for legibility and use of prohibited or inappropriate prescription abbreviations. Analysis will determine if this low-cost, low-technology solution to prescription errors is viable in community practice.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe frequent or dangerous prescribing errors found in outpatient rural primary care practices
• Discuss the implications of various types of prescribing errors
• Recognize a modified prescribing form as an alternative to a standard paper form for promoting safer prescribing in outpatient rural primary care practices

Keywords: Quality Improvement, Rural Health Service Providers

Presenting author's disclosure statement:

Not Answered