Identifying medication documentation errors using handwritten versus pre‑printed ICU flowcharts

Abstract

Objective: To compare and review medication documentation errors using handwritten versus pre‑printed ICU flowcharts. Design: Randomised retrospective audit comparing handwritten ICU flowcharts from 2004 and pre‑printed ICU flowcharts from 2009. Setting: Ten bedded, Level 2 Intensive Care Unit in Australia. Subjects: Total of 60 ICU flowcharts: 30 handwritten flowcharts from 2004 and 30 pre‑printed flowcharts from 2009. Main outcome measures: To determine whether using pre‑printed ICU flowcharts eliminated or significantly reduced the number of medication documentation errors compared to handwritten medication orders using ICU flowcharts. Results: Although the sample size of this audit was small, this audit showed that there was no overall difference when using handwritten and pre‑printed ICU medication flowcharts. Four error categories were initially measured against, but a fifth category was identified during the audit. The third category ‘prescribing documentation errors’ was identified as the largest category for errors, with a 44% error rate using handwritten ICU flowcharts and a 78% error rate using pre‑printed ICU flowcharts. Conclusion: This audit demonstrated although there was no overall difference using handwritten or pre‑printed ICU medication flowcharts, using pre‑printed ICU medication flowcharts reduces the risk of an adverse drug event that may result in patient harm by classifying error categories. This audit has also highlighted the need for further research into medication documentation errors using paper‑based or electronic medication charting in the ICU, the role of pharmaceutical review during the prescribing process and to explore the role of nurse practitioners in the ICU.