ED overcrowding is associated with an increased frequency of medication errors

Erik B. Kulstad, Rishi Sikka, Rolla T. Sweis, Kenneth M Kelley, Kathleen H. Rzechula

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objectives: Despite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists. Methods: We performed a prospective, observational study in a large, community hospital ED of all patients whose medication orders were evaluated by our ED pharmacists for a 3-month period. Our ED pharmacists review the orders of all patients in the ED critical care section and the Chest Pain unit, and all admitted patients boarding in the ED. We measured the Spearman correlation between average daily EDWIN score and number of medication errors detected and determined the score's predictive performance with receiver operating characteristic (ROC) curves. Results: A total of 283 medication errors were identified by the ED pharmacists over the study period. Errors included giving medications at incorrect doses, frequencies, durations, or routes and giving contraindicated medications. Error frequency showed a positive correlation with daily average EDWIN score (Spearman's ρ = 0.33; P = .001). The area under the ROC curve was 0.67 (95% confidence interval, 0.56-0.78) with failure defined as greater than 1 medication error per day. Conclusions: We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score.

Original languageEnglish (US)
Pages (from-to)304-309
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume28
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

Fingerprint

Medication Errors
Hospital Emergency Service
Pharmacists
ROC Curve
Hospital Departments
Community Hospital
Critical Care
Chest Pain
Observational Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

ED overcrowding is associated with an increased frequency of medication errors. / Kulstad, Erik B.; Sikka, Rishi; Sweis, Rolla T.; Kelley, Kenneth M; Rzechula, Kathleen H.

In: American Journal of Emergency Medicine, Vol. 28, No. 3, 03.2010, p. 304-309.

Research output: Contribution to journalArticle

Kulstad, Erik B. ; Sikka, Rishi ; Sweis, Rolla T. ; Kelley, Kenneth M ; Rzechula, Kathleen H. / ED overcrowding is associated with an increased frequency of medication errors. In: American Journal of Emergency Medicine. 2010 ; Vol. 28, No. 3. pp. 304-309.
@article{fadae4c716594d1abc8065e826e0dc4d,
title = "ED overcrowding is associated with an increased frequency of medication errors",
abstract = "Objectives: Despite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists. Methods: We performed a prospective, observational study in a large, community hospital ED of all patients whose medication orders were evaluated by our ED pharmacists for a 3-month period. Our ED pharmacists review the orders of all patients in the ED critical care section and the Chest Pain unit, and all admitted patients boarding in the ED. We measured the Spearman correlation between average daily EDWIN score and number of medication errors detected and determined the score's predictive performance with receiver operating characteristic (ROC) curves. Results: A total of 283 medication errors were identified by the ED pharmacists over the study period. Errors included giving medications at incorrect doses, frequencies, durations, or routes and giving contraindicated medications. Error frequency showed a positive correlation with daily average EDWIN score (Spearman's ρ = 0.33; P = .001). The area under the ROC curve was 0.67 (95{\%} confidence interval, 0.56-0.78) with failure defined as greater than 1 medication error per day. Conclusions: We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score.",
author = "Kulstad, {Erik B.} and Rishi Sikka and Sweis, {Rolla T.} and Kelley, {Kenneth M} and Rzechula, {Kathleen H.}",
year = "2010",
month = "3",
doi = "10.1016/j.ajem.2008.12.014",
language = "English (US)",
volume = "28",
pages = "304--309",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - ED overcrowding is associated with an increased frequency of medication errors

AU - Kulstad, Erik B.

AU - Sikka, Rishi

AU - Sweis, Rolla T.

AU - Kelley, Kenneth M

AU - Rzechula, Kathleen H.

PY - 2010/3

Y1 - 2010/3

N2 - Objectives: Despite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists. Methods: We performed a prospective, observational study in a large, community hospital ED of all patients whose medication orders were evaluated by our ED pharmacists for a 3-month period. Our ED pharmacists review the orders of all patients in the ED critical care section and the Chest Pain unit, and all admitted patients boarding in the ED. We measured the Spearman correlation between average daily EDWIN score and number of medication errors detected and determined the score's predictive performance with receiver operating characteristic (ROC) curves. Results: A total of 283 medication errors were identified by the ED pharmacists over the study period. Errors included giving medications at incorrect doses, frequencies, durations, or routes and giving contraindicated medications. Error frequency showed a positive correlation with daily average EDWIN score (Spearman's ρ = 0.33; P = .001). The area under the ROC curve was 0.67 (95% confidence interval, 0.56-0.78) with failure defined as greater than 1 medication error per day. Conclusions: We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score.

AB - Objectives: Despite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists. Methods: We performed a prospective, observational study in a large, community hospital ED of all patients whose medication orders were evaluated by our ED pharmacists for a 3-month period. Our ED pharmacists review the orders of all patients in the ED critical care section and the Chest Pain unit, and all admitted patients boarding in the ED. We measured the Spearman correlation between average daily EDWIN score and number of medication errors detected and determined the score's predictive performance with receiver operating characteristic (ROC) curves. Results: A total of 283 medication errors were identified by the ED pharmacists over the study period. Errors included giving medications at incorrect doses, frequencies, durations, or routes and giving contraindicated medications. Error frequency showed a positive correlation with daily average EDWIN score (Spearman's ρ = 0.33; P = .001). The area under the ROC curve was 0.67 (95% confidence interval, 0.56-0.78) with failure defined as greater than 1 medication error per day. Conclusions: We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score.

UR - http://www.scopus.com/inward/record.url?scp=77649214032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77649214032&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2008.12.014

DO - 10.1016/j.ajem.2008.12.014

M3 - Article

C2 - 20223387

AN - SCOPUS:77649214032

VL - 28

SP - 304

EP - 309

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 3

ER -