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Keywords
Quality assurance, Health care, Hospitals, Pharmaceuticals
Abstract
This paper aims to evaluate the effectiveness of a program designed to improve the quality of drug prescription-writing at a university hospital in France. Improvement actions included feed-back from yearly audits and the dissemination of recommendations on how best to write the prescriptions. A random sample of 30 stays was selected from among the hospitalizations for the year 1996. From each patient, medical records were searched for the first prescription order of the stay and its quality was assessed according to standards. A total of 872 records were relevant and included 3,289 medications. The results were compared to those obtained for the two previous years. Actions to sensitize prescribers resulted in an insufficient improvement of most indicators of prescription-writing quality with results remaining well below ideal standards. The hospital staff concerned had a positive opinion of the program which led to an awareness of prescription problems. This assessment showed that the program had a moderate impact on prescribers' practice and efforts must be continued.
Introduction
The most frequent undesirable iatrogenic events are linked to medical drug therapies (Fleming, 1996). Mistakes and malpractice may occur at every step of the therapeutic process: prescription, transcription,
distribution, and administration of medications. Studies have shown that most preventable adverse drug events occur at the prescription stage, resulting in the most serious consequences (Leape et al., 1995).
An accurate drug prescription may be defined as one which tries to achieve four aims, sometimes contradictory: maximizing effectiveness, minimizing risks, minimizing costs and respecting the patient's choices (Barber, 1995). However, this definition does not take into account the quality of prescription-writing, which must be legible, clear, complete and unambiguous. Indeed the prescription order is a major physician act which situates itself between different health care professionals: the physician who writes the prescription order, the pharmacist who verifies and validates it, and the nurse who administers the drugs (Saanum and Mellbye, 1996). Many studies have shown that the lack of information on a prescription order could give rise to therapeutic mistakes (Leape et al., 1995; Saanum and Mellbye, 1996; Winslow
et al., 1997). With regard to medication distribution, the present hospital, as with most French hospitals, dispenses drugs using a decentralized...