Reducing Prescribing Errors through Iterations of the PDSA Cycle
Medication errors are a constant threat to patients in the hospital. Without properly and consciously utilizing the technology available to practitioners, this threat becomes more dangerous. Tools such as Cerner’s power plans enable caregivers to reduce this threat significantly.
Hamad Medical Corporation’s (HMC) Women Wellness and Research Center (WWRC) decided it was time to take a deep dive into what was causing medication errors in their hospital. What they found was startling: 23% of their medication errors were occurring to NICU patients. Of those, 53% of the errors were directly related to antibiotic and total parental nutrition (TPN) prescribing errors.
Dr. Mohammed Rijimms of WWRC made the decision to form an interdisciplinary team and leverage Cerner tools and pharmacy expertise to address this multipronged safety risk using a PDSA model of improvement. Marked improvements soon followed.
Prior to building a Cerner Power plan, several problems were highlighted:
- Difficulties reported optimizing the total fluid intake required for the nutritional support for the preterm infants as the physician has to manually calculate the volume of ingredients.
- Trouble identifying total calorie intake while prescribing.
- Hardships calculating osmolarity for peripheral infusion which may lead to extravasation.
- Patients at risk of medication errors due to lack of available tools within the electronic medical record.
At a glance
- HMC serves as the leading government sponsored healthcare organization
- 13 Hospitals
- 27 Primary Health Care Centers
- Specialist Hospitals include Heart Hospital and Cancer Hospital
- Provides care for over 2 million residents
- Recently ranked top 5 Healthcare organizations by leading U.K. Think tank Legatum
- Patient Safety increased
- Leveraged expertise of Cerner Consultants
- Created antibiotic power plan in Cerner
- Creation of quick reference guides
- All antibiotics added to powerplan
- Average of 11% prescribing error reduced to less than 1%
- Development of electronic TPN form in Cerner
When compared to the beginning of the project, there was a drop in prescribing medication errors from an average of 9% to 2% of the total number of prescriptions. This was accomplished by developing antibiotic powerplans using Cerner functionality. This surpassed the targets set by the HMC and Cerner team. Further, there was sustained improvement which demonstrated a sustained reduction of errors at less than 1% per month or a total of 6 out of 930 prescription orders from July to December 2018.
There were two PDSA projects used for this great achievement. The first focused on Decreasing Medication Errors from Antimicrobial Prescribing. The second focused on reducing errors associated with TPN prescribing. Both cycles produced measurable and sustained results which translated into the sharp decrease in prescribing errors.
HMC WWRC will continue monitoring this wonderful new process as needed. It is truly a remarkable sustained improvement and the team deserves recognition for their contributions to patient care. Congrats to both WWRC and Cerner staff.