Incidence of anticoagulation medication prescribing errors in patients discharged from the emergency department

Abstract

Introduction: It is well-known that the Emergency Department (ED) is an area at high risk for medication errors due to several factors including providing care to unfamiliar patients in a high-stress environment and relying heavily on verbal orders. Objectives: This primary objective of this study was to characterize the incidence and describe the impact of medication errors that occur within anticoagulation prescriptions written for patients who are discharged from the ED. Methods: Anticoagulation prescriptions written to patients discharged from the adult ED at a large academic medical center between January 1, 2015 and August 1, 2018 were retrospectively evaluated to identify and characterize errors. Errors identified included dosing errors for the indication, dosing adjustment errors, incorrect quantity, refills given inappropriately, and readmission rate due to errors. Results: A total of 797 prescriptions for anticoagulation medications were reviewed and a total of 392 errors were identified within 321 (40.3%) prescriptions. Of the errors identified, 88 (22.4%) were an error in dose for the indication, 83 (21.2%) were errors in dose adjustments based on patient-specific factors, 81 (20.7%) were errors in quantity prescribed, and 140 (35.7%) were prescriptions written with refills. Prescriptions written by non-emergency medicine residents had significantly more errors compared with attending physicians, emergency medicine residents, and advanced practice providers (P