Medication safety in a psychiatric hospital

• Published in: General hospital psychiatry Vol. 29; no. 2; pp. 156 - 162
• Main Authors: Rothschild, Jeffrey M., M.D., M.P.H, Mann, Klaus, M.D, Keohane, Carol A., B.S.N., R.N, Williams, Deborah H., M.H.A, Foskett, Cathy, R.N, Rosen, Stanley L., R.P.H., M.H.A, Flaherty, Linda, A.P.R.N., B.C, Chu, James A., M.D, Bates, David W., M.D., M.Sc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Drug toxicity and drugs side effects treatment; Drug-Related Side Effects and Adverse Reactions; Female; Hospitals, Psychiatric; Humans; Institution therapy. Inpatient treatment; Length of Stay; Male; Medical sciences; Medication Errors; Miscellaneous (drug allergy, mutagens, teratogens...); Patients safety; Pharmacology. Drug treatments; Prospective Studies; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Treatments; United States; North America; America; Patients safety; Medication errors; Psychiatry; Psychopharmacology; Social environment; Human; Psychiatric hospital; Prevalence; Psychotropic; Toxicity; Medical error; Mental health; Pharmacotherapy; Epidemiology; Treatment; Follow up study; Mental disorder; Patient safety; Public health
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2006.12.002

Abstract Objective We sought to assess the epidemiology of medication errors (MEs) and adverse drug events (ADEs) in a psychiatric hospital. Methods We conducted a 6-month prospective observational study in a 172-bed academic psychiatric hospital. Errors and ADEs were found by way of chart review, staff reports and pharmacy intervention reports. Physicians rated incidents as to the presence of injury, preventability and severity of an injury. Serious MEs were nonintercepted MEs with potential for harm (near misses) and preventable ADEs. Results We studied 1871 admissions with 19,180 patient-days. The rate of ADEs and serious MEs were 10 and 6.3 per 1000 patient-days, respectively. Preventable ADEs accounted for 13% of all ADEs (25/191). The most common classes of drugs associated with ADEs were atypical antipsychotics (37%). Nonpsychiatric drugs accounted for only 4% of nonpreventable ADEs but were associated with nearly one third of all preventable ADEs and near misses. MEs were most frequently associated with physician orders (68%), but there was also a high rate of nursing transcription errors (20%). Conclusions ADEs and serious MEs were common among psychiatric inpatients and similar to rates in studies of general hospital inpatients. Medication safety interventions targeting psychiatric care need further study.