PRESCRIPTION ERRORS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

Abstract

The problem associated with medication arising from prescription error is widespread and has received public attention. Prescription error is a dimension of quality of care seldom used because of lack of data. There is a dearth of knowledge on prescription error in the Nigerian health care systems. This study examined the prevalence of prescription errors in the University College Hospital (UCH) lbadan. Prescription sheets from the different pharmacy points at the UCH were selected using a three stage sampling method. A pool of error descriptors was collected through literature review out of-which twelve with the highest face validity were selected. A total of 1866 prescription sheets from the four pharmacy points namely. Medical-Out-Patient (MOP), General Outpatient (GOP), Wards, and Accident and Emergency (A&E) were reviewed. The process of dispensing was also observed for thirty minutes for two days at the pharmacy points to see how prescriptions were handled to avoid prescription errors. In depth interviews were conducted with five pharmacists and five physicians from the departments of Pediatrics, Surgery, Medicine, Ear, Nose and Throat (ENT), and Accident and Emergency (A&E). Descriptive analysis was used to analyse the quantitative data while content analysis was performed for the in-depth interview data. A total of 1424 (76%) prescription errors were detected. The error types were: illegitimacy (no date, no age. ) 52%, omission (no dose, no dosage form, no dosage frequency, no duration, and no strength) 24%, style (illegal abbreviation and writing) (19%) wrong dose (5%) and irrational prescription (polypharmacy and PRN meaning when necessary) 0.8%. Prevalence of prescription errors by units were 33.6% in the wards, 24.6% in GOP, 23.4% in MOP, and 18.5% in A&E (p> 0.05). From the prescriptions observed, the age group affected most by prescription errors was between 35-49 years (58.1%). Drugs affected by prescription error were infusions (29.0%), analgesics and routine drugs (18.0%), anti-infectives (17.0%) antimalarials and those used in emergencies such as hydrocortisone (12.0%). Only 10% of the errors were detected and corrected during the process of dispensing. while 90% were not. Information given to patients at the pharmacy points were also not adequate to avert prescription errors. Of the 19 observation indicators set. only (36.8%) met the observation to practice criteria. The in-depth interviews revealed that workload and uncondusive work environment adversely affected activity of prescribers and dispensers. In-depth interviewees revealed that the institution does not have a written policy or format on reporting and handling prescription errors neither is a system put in place to monitor, evaluate and prevent medication errors arising from presciption errors. Prescription errors are common in the drug use system of the UCH. It is therefore recommended that regular in-service training for prescribers and dispensers, equitable distribution of workload and institution of a quality assurance mechanism for monitoring the drug use system be implemented in this institution.