International Journal of Risk & Safety in Medicine 26 (2014) 191–198 DOI 10.3233/JRS-140634 IOS Press
191
Medication errors in psychiatric patients boarded in the emergency department Hussain T. Bakhsha,b , Stephen J. Peronac , Whitney A. Shieldsc , Sara Salekd , Arthur B. Sanderse and Asad E. Patanwalaa,∗ a
Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA b Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia c Department of Pharmacy, Northwest Medical Center, Tucson, AZ, USA d Department of Psychiatry, Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA e Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA Received 21 April 2014 Accepted 16 September 2014 Abstract. BACKGROUND: Patients boarded in the emergency department (ED) with psychiatric complaints may be at risk for medication errors. However, no studies exist to characterize the types of errors and risk factors for errors in these patients. OBJECTIVE: To characterize medication errors in psychiatric patients boarded in ED, and to identify risk factors associated with these errors. METHODS: A prospective observational study conducted in a community ED included all patients seen in the ED for primary psychiatric complaints and remained in the ED pending transfer to a psychiatric facility. An investigator recorded all medication errors requiring an intervention by an emergency pharmacist. RESULTS: A total of 288 medication errors in 100 patients were observed. Overall, 65 patients had one or more medication errors. The majority of errors (n = 256, 89%) were due to errors of omission. The final severity classification of the medication errors was: Insignificant (n = 77), significant (n = 152), and serious (n = 3). In the multivariate analysis (R-squared 19.6%), increasing number of home medications (OR 1.17, 95% CI 1.01 to 1.36; p = 0.035), and increasing number of comorbidities (OR 1.89, 95% CI 1.10 to 3.27; p = 0.022) were associated with the occurrence of medication errors. CONCLUSION: Psychiatric patients boarded in the ED commonly have medication errors that require intervention. Keywords: Medication errors, safety, emergency department, boarding
1. Introduction Boarding patients in the emergency department (ED) has been associated with adverse clinical outcomes and increased cost [1, 2]. Boarding is defined as the time spent in an ED awaiting a hospital bed or transfer to another inpatient facility [1]. Patients with a primary psychiatric diagnosis are particularly susceptible to ∗ Address for correspondence: Asad E. Patanwala, PharmD, 1295 N. Martin, PO Box 210202, Tucson, AZ 85721, USA. Tel.: +1 520 626 5404; Fax: +1 520 626 7355; E-mail: [email protected].
0924-6479/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
192
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
boarding and may have an ED length of stay that is more than three times longer than patients who present with other complaints [2]. A report from the American Medical Association cited an average boarding time of 34 hours and noted many patients waited several days for placement [3]. In addition, up to 40% of boarded patients may experience a missed or incorrectly timed medication [4]. In addition, it is difficult to obtain accurate medication histories of psychiatric patients because of the nature of their condition (e.g. agitation), poor recollection, or lack of desire to interact with providers. This combination of factors may place boarded psychiatric patients at increased risk for medication errors and poor outcomes. In our review of the literature, we did not find any studies characterizing the types of medication errors and risk factors for errors in boarded ED psychiatric patients. Approximately 25% of the prescription drugs patients are taking at home may not be recorded during the initial assessment at the time of hospitalization [5]. Incomplete medication histories at the time of admission lead to medication errors including potentially important errors of omission for medications used for chronic disease [5]. Patients presenting with primary psychiatric chief complaints often have concurrent medical issues. It has been estimated that medical issues may be present in up to 63% of these patients [6]. These chronic medical conditions may not be addressed while the patient is waiting for their psychiatric admission. The primary objective of this study was to characterize medication errors in psychiatric patients boarded in ED. The secondary objective was to identify factors associated with errors. We hypothesized that errors are common in this patient population. 2. Methods 2.1. Study design This was a prospective observational study conducted between December 2012 and May 2013. Institutional review board approval was obtained prior to conducting the study. 2.2. Setting The study was conducted in a 50-bed community medical center ED with an estimated annual census of 76,000 patients. A six-bed behavioral unit within the ED is reserved for patients with psychiatric complaints. These patients receive a risk assessment evaluation by an independent licensed practitioner to determine if they can be discharged or require transfer to a psychiatric facility. The medical center does not have its own psychiatric ward, and patients who require hospital admission are transferred to another facility. The ED has a dedicated emergency pharmacist available from 1400 to 2230 daily. The emergency pharmacist evaluates patients in the ED to optimize their drug therapy. The pharmacist was a fixture in the ED prior to the study being conducted. At the time of data collection the ED did not use computerized physician order entry. The usual process of care includes an initial medication history obtained by the patients’ nurse, which is then verified by the physician during the full medical history, which includes medication use. During the ED stay, the physician decided on all medications that needed to be prescribed. 2.3. Selection of participants All patients were included if they were located in the ED behavioral unit and required transfer to an inpatient psychiatric care facility. If a patient was to be transferred within 4 hours, they were not included
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
193
because it is unlikely that their home medications would be initiated in this time period. Also, patients who were primarily seen for medical issues, but were in the behavioral unit for concurrent psychiatric complaints were excluded. The intent was to select patients who were primarily in the ED for psychiatric reasons and were expected to be there for an extended duration while they awaited transfer to another facility. A target sample of 100 patients was considered to be adequate for descriptive analyses. No formal power analysis was conducted. 2.4. Data collection and processing Medication errors were identified using a direct observational approach, similar to previous investigations conducted in the ED [7, 8]. As part of routine care, an ED pharmacist evaluated all psychiatric patients boarded in the ED for drug therapy optimization and potential errors. The investigator observed the ED pharmacist and recorded all medication errors that required intervention. It was decided a priori that medication errors that do not require intervention would not be considered to be clinically meaningful. The pharmacist tried to obtain medication lists via physicians’ office, pharmacy, or hospital records. When objective information was unavailable, home medication lists were based on patient interview alone. In this setting, we considered that observation of the pharmacist would best position the investigator to identify errors that are most likely to occur during the reconciliation process [8]. The observation periods were based on the convenience of the observer and ED pharmacist. To minimize selection bias, the observer recorded data on all consecutive patients during the observation days. The observer did not have any discussions with the ED pharmacist that could influence drug therapy changes or interventions. There is the possibility of the Hawthorne effect with this methodology. However, previous studies have shown that this method is valid and reliable [9]. The observer documented data using a standardized data collection tool. Data collected included patient demographics, reason for visit, medications, and interventions made by the ED pharmacist for potential medication errors. After data collection was complete, an ED physician and a psychiatrist independently evaluated each medication error intervention for severity. The severity categorization was as follows: 1) Insignificant - highly unlikely to cause symptoms such as a duplicate order for a single dose of a drug with minimal side-effects; 2) Significant - potential to cause harmful symptoms but little or no threat to life functions; 3) Serious - potential to cause temporary or permanent alteration of life function or organ injury but not life threatening; 4) life-threatening; or 5) unable to determine [8]. If there was a discrepancy in categorization between raters, the lower severity was considered to be the final rating. This was done to maintain a conservative bias similar to previous studies [7, 10, 11]. If either of the two raters classified an intervention as ‘unable to determine’ then it was excluded from the final severity classification. 2.5. Outcomes The primary outcome was to evaluate and characterize medication errors in terms of rate, type and severity. The secondary outcome was to identify risk factors associated with medication errors in these patients. 2.6. Data analysis Demographic information and primary outcomes were summarized descriptively. Inter-rater reliability of severity classification was assessed using a weighted kappa statistic. Univariate logistic regression
194
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
was conducted to assess the relationship between predictor variables and the occurrence of a medication error intervention. Variables of interest included age, sex, number of home medications, and number of comorbidities. A stepwise multivariate logistic regression analysis was performed to identify factors associated with the need for intervention. A backward elimination technique was used with variables retained in the model if p < 0.2. Number of home medications and number of comorbidities were entered into the model as ordinal variables. Variables retained in the final model were checked for interactions. Goodness-of-fit was assessed using the Hosmer-Lemeshow test. The receiver-operator-characteristics (ROC) curve was generated to determine predictive ability of the final model. The a priori level of significance for all analyses was p < 0.05. All analyses were performed using Stata 13 (StataCorp, College Station, TX). 3. Results 3.1. Characteristics of study subjects A total of 288 medication error interventions were conducted in the 100 patients observed in the study. Mean patient age was 43 ± 20 years, 56% were female and all patients were of white race. White race included Hispanic ethnicity. However, this is not coded in the medical record and the ED pharmacist could not specifically ask about ethnicity as part of their daily activities per the Institutional Review Board guidelines. The median number of home medications patients were taking was 5 (IQR 3 to 8) and the median number of comorbidities was 1 (IQR 0 to 2). A total of 28%, 35% and 37% of patients had 0, 1, or 2 or more comorbidities. The median length of stay from triage to ED pharmacist evaluation was 9 hours (IQR 6 to 21 hours). The primary reason for ED visit was suicidal ideation (55%), followed by medical detoxification (10%), drug overdose (9%), hallucinations (8%), agitation (7%), and other (11%). 3.2. Main results In the overall cohort, 65 patients required one or more medication errors that required intervention; 15 required 1 drug therapy intervention, 10 required 2 drug therapy interventions, and 40 required 3 or more drug therapy interventions. The majority of interventions (n = 256, 89%) were due to errors of omission, which primarily included home medications that were not restarted (Table 1). Most of the errors occurred at the prescribing stage (95%). The interventions were initially verbally approved by the ED physician and then ordered in a written format. The overall physician acceptance rate by the ED physicians was high (n = 266, 92%). The most common medication classes associated with the interventions are in Table 2. The final severity classification of the medication errors was as follows: insignificant (n = 77), significant (n = 152), and serious (n = 3). There were no interventions that were considered to be life threatening. The raters were unable to determine error severity in the remaining interventions (n = 56). There was fair agreement between the ED physician and psychiatrist raters (agreement 84%, expected agreement 78%, kappa 0.26). On univariate analysis, age, number of home medications, and number of comorbidities was significantly associated with the occurrence of a medication error intervention (Table 3). In the multivariate analysis (R-squared 19.6%), increasing number of home medications (OR 1.17, 95% CI 1.01 to 1.36; p = 0.035), and increasing number of comorbidities (OR 1.89, 95% CI 1.10 to 3.27; p = 0.022) were associated with the occurrence of a medication error requiring intervention (Table 3). The model fit the data well (Hosmer-
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
195
Table 1 Type of Error Intervention Type Omission Wrong frequency Drug or class duplication Wrong strength/concentration Inadequate monitoring or lab Contraindication Extra dose Wrong dosage Wrong time Other (e.g. consultation)
N (%) 256 (89) 13 (4.5) 4 (1.3) 3 (1) 3 (1) 2 (0.7) 2 (0.7) 1 (0.3) 1 (0.3) 3 (1)
Table 2 Drug classes involved in the errors Drug Class
N (%)
Antidepressants Analgesics Cardiovascular Anxiolytics Gastrointestinal Endocrine Neuroleptics Other CNS drugs Mood stabilizer Respiratory Electrolytes/Vitamins/supplements Anti-platelets Anti-infective Antiepileptic Ophthalmic/Otic Anti-coagulants/Thrombolytic
42 (14) 37 (13) 37 (13) 31 (10) 26 (9) 24 (8.3) 21 (7.2) 20 (7) 13 (4.5) 12 (4.1) 11 (3.8) 5 (1.7) 4 (1.4) 2 (0.6) 2 (0.6) 1 (0.3)
Lemeshow goodness-of-fit, p = 0.296). The area under the ROC curve showed excellent discrimination (0.80). 4. Discussion The key finding in this study is that 65% of the patients with a primary psychiatric diagnosis boarded in the ED had one or more medication errors that required intervention. In the multivariate analysis, increasing number of home medications and patient comorbidities was associated with greater risk for error. Interestingly a majority of the errors (89%) were related to the re-initiation of home medications.
196
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department Table 3 Predictors of medication errors Variable Univariate analysis Age Sex Number of home medications Number of comorbidities Multivariate analysis (R2 = 19.6%) Number of home medications Number of comorbidities
Odds Ratio
95% CI
P value
1.03 0.63 1.28 2.53
1.01 to 1.06 0.28 to 1.44 1.12 to 1.47 1.54 to 4.14
0.005 0.273
191
Medication errors in psychiatric patients boarded in the emergency department Hussain T. Bakhsha,b , Stephen J. Peronac , Whitney A. Shieldsc , Sara Salekd , Arthur B. Sanderse and Asad E. Patanwalaa,∗ a
Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA b Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia c Department of Pharmacy, Northwest Medical Center, Tucson, AZ, USA d Department of Psychiatry, Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA e Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA Received 21 April 2014 Accepted 16 September 2014 Abstract. BACKGROUND: Patients boarded in the emergency department (ED) with psychiatric complaints may be at risk for medication errors. However, no studies exist to characterize the types of errors and risk factors for errors in these patients. OBJECTIVE: To characterize medication errors in psychiatric patients boarded in ED, and to identify risk factors associated with these errors. METHODS: A prospective observational study conducted in a community ED included all patients seen in the ED for primary psychiatric complaints and remained in the ED pending transfer to a psychiatric facility. An investigator recorded all medication errors requiring an intervention by an emergency pharmacist. RESULTS: A total of 288 medication errors in 100 patients were observed. Overall, 65 patients had one or more medication errors. The majority of errors (n = 256, 89%) were due to errors of omission. The final severity classification of the medication errors was: Insignificant (n = 77), significant (n = 152), and serious (n = 3). In the multivariate analysis (R-squared 19.6%), increasing number of home medications (OR 1.17, 95% CI 1.01 to 1.36; p = 0.035), and increasing number of comorbidities (OR 1.89, 95% CI 1.10 to 3.27; p = 0.022) were associated with the occurrence of medication errors. CONCLUSION: Psychiatric patients boarded in the ED commonly have medication errors that require intervention. Keywords: Medication errors, safety, emergency department, boarding
1. Introduction Boarding patients in the emergency department (ED) has been associated with adverse clinical outcomes and increased cost [1, 2]. Boarding is defined as the time spent in an ED awaiting a hospital bed or transfer to another inpatient facility [1]. Patients with a primary psychiatric diagnosis are particularly susceptible to ∗ Address for correspondence: Asad E. Patanwala, PharmD, 1295 N. Martin, PO Box 210202, Tucson, AZ 85721, USA. Tel.: +1 520 626 5404; Fax: +1 520 626 7355; E-mail: [email protected].
0924-6479/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
192
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
boarding and may have an ED length of stay that is more than three times longer than patients who present with other complaints [2]. A report from the American Medical Association cited an average boarding time of 34 hours and noted many patients waited several days for placement [3]. In addition, up to 40% of boarded patients may experience a missed or incorrectly timed medication [4]. In addition, it is difficult to obtain accurate medication histories of psychiatric patients because of the nature of their condition (e.g. agitation), poor recollection, or lack of desire to interact with providers. This combination of factors may place boarded psychiatric patients at increased risk for medication errors and poor outcomes. In our review of the literature, we did not find any studies characterizing the types of medication errors and risk factors for errors in boarded ED psychiatric patients. Approximately 25% of the prescription drugs patients are taking at home may not be recorded during the initial assessment at the time of hospitalization [5]. Incomplete medication histories at the time of admission lead to medication errors including potentially important errors of omission for medications used for chronic disease [5]. Patients presenting with primary psychiatric chief complaints often have concurrent medical issues. It has been estimated that medical issues may be present in up to 63% of these patients [6]. These chronic medical conditions may not be addressed while the patient is waiting for their psychiatric admission. The primary objective of this study was to characterize medication errors in psychiatric patients boarded in ED. The secondary objective was to identify factors associated with errors. We hypothesized that errors are common in this patient population. 2. Methods 2.1. Study design This was a prospective observational study conducted between December 2012 and May 2013. Institutional review board approval was obtained prior to conducting the study. 2.2. Setting The study was conducted in a 50-bed community medical center ED with an estimated annual census of 76,000 patients. A six-bed behavioral unit within the ED is reserved for patients with psychiatric complaints. These patients receive a risk assessment evaluation by an independent licensed practitioner to determine if they can be discharged or require transfer to a psychiatric facility. The medical center does not have its own psychiatric ward, and patients who require hospital admission are transferred to another facility. The ED has a dedicated emergency pharmacist available from 1400 to 2230 daily. The emergency pharmacist evaluates patients in the ED to optimize their drug therapy. The pharmacist was a fixture in the ED prior to the study being conducted. At the time of data collection the ED did not use computerized physician order entry. The usual process of care includes an initial medication history obtained by the patients’ nurse, which is then verified by the physician during the full medical history, which includes medication use. During the ED stay, the physician decided on all medications that needed to be prescribed. 2.3. Selection of participants All patients were included if they were located in the ED behavioral unit and required transfer to an inpatient psychiatric care facility. If a patient was to be transferred within 4 hours, they were not included
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
193
because it is unlikely that their home medications would be initiated in this time period. Also, patients who were primarily seen for medical issues, but were in the behavioral unit for concurrent psychiatric complaints were excluded. The intent was to select patients who were primarily in the ED for psychiatric reasons and were expected to be there for an extended duration while they awaited transfer to another facility. A target sample of 100 patients was considered to be adequate for descriptive analyses. No formal power analysis was conducted. 2.4. Data collection and processing Medication errors were identified using a direct observational approach, similar to previous investigations conducted in the ED [7, 8]. As part of routine care, an ED pharmacist evaluated all psychiatric patients boarded in the ED for drug therapy optimization and potential errors. The investigator observed the ED pharmacist and recorded all medication errors that required intervention. It was decided a priori that medication errors that do not require intervention would not be considered to be clinically meaningful. The pharmacist tried to obtain medication lists via physicians’ office, pharmacy, or hospital records. When objective information was unavailable, home medication lists were based on patient interview alone. In this setting, we considered that observation of the pharmacist would best position the investigator to identify errors that are most likely to occur during the reconciliation process [8]. The observation periods were based on the convenience of the observer and ED pharmacist. To minimize selection bias, the observer recorded data on all consecutive patients during the observation days. The observer did not have any discussions with the ED pharmacist that could influence drug therapy changes or interventions. There is the possibility of the Hawthorne effect with this methodology. However, previous studies have shown that this method is valid and reliable [9]. The observer documented data using a standardized data collection tool. Data collected included patient demographics, reason for visit, medications, and interventions made by the ED pharmacist for potential medication errors. After data collection was complete, an ED physician and a psychiatrist independently evaluated each medication error intervention for severity. The severity categorization was as follows: 1) Insignificant - highly unlikely to cause symptoms such as a duplicate order for a single dose of a drug with minimal side-effects; 2) Significant - potential to cause harmful symptoms but little or no threat to life functions; 3) Serious - potential to cause temporary or permanent alteration of life function or organ injury but not life threatening; 4) life-threatening; or 5) unable to determine [8]. If there was a discrepancy in categorization between raters, the lower severity was considered to be the final rating. This was done to maintain a conservative bias similar to previous studies [7, 10, 11]. If either of the two raters classified an intervention as ‘unable to determine’ then it was excluded from the final severity classification. 2.5. Outcomes The primary outcome was to evaluate and characterize medication errors in terms of rate, type and severity. The secondary outcome was to identify risk factors associated with medication errors in these patients. 2.6. Data analysis Demographic information and primary outcomes were summarized descriptively. Inter-rater reliability of severity classification was assessed using a weighted kappa statistic. Univariate logistic regression
194
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department
was conducted to assess the relationship between predictor variables and the occurrence of a medication error intervention. Variables of interest included age, sex, number of home medications, and number of comorbidities. A stepwise multivariate logistic regression analysis was performed to identify factors associated with the need for intervention. A backward elimination technique was used with variables retained in the model if p < 0.2. Number of home medications and number of comorbidities were entered into the model as ordinal variables. Variables retained in the final model were checked for interactions. Goodness-of-fit was assessed using the Hosmer-Lemeshow test. The receiver-operator-characteristics (ROC) curve was generated to determine predictive ability of the final model. The a priori level of significance for all analyses was p < 0.05. All analyses were performed using Stata 13 (StataCorp, College Station, TX). 3. Results 3.1. Characteristics of study subjects A total of 288 medication error interventions were conducted in the 100 patients observed in the study. Mean patient age was 43 ± 20 years, 56% were female and all patients were of white race. White race included Hispanic ethnicity. However, this is not coded in the medical record and the ED pharmacist could not specifically ask about ethnicity as part of their daily activities per the Institutional Review Board guidelines. The median number of home medications patients were taking was 5 (IQR 3 to 8) and the median number of comorbidities was 1 (IQR 0 to 2). A total of 28%, 35% and 37% of patients had 0, 1, or 2 or more comorbidities. The median length of stay from triage to ED pharmacist evaluation was 9 hours (IQR 6 to 21 hours). The primary reason for ED visit was suicidal ideation (55%), followed by medical detoxification (10%), drug overdose (9%), hallucinations (8%), agitation (7%), and other (11%). 3.2. Main results In the overall cohort, 65 patients required one or more medication errors that required intervention; 15 required 1 drug therapy intervention, 10 required 2 drug therapy interventions, and 40 required 3 or more drug therapy interventions. The majority of interventions (n = 256, 89%) were due to errors of omission, which primarily included home medications that were not restarted (Table 1). Most of the errors occurred at the prescribing stage (95%). The interventions were initially verbally approved by the ED physician and then ordered in a written format. The overall physician acceptance rate by the ED physicians was high (n = 266, 92%). The most common medication classes associated with the interventions are in Table 2. The final severity classification of the medication errors was as follows: insignificant (n = 77), significant (n = 152), and serious (n = 3). There were no interventions that were considered to be life threatening. The raters were unable to determine error severity in the remaining interventions (n = 56). There was fair agreement between the ED physician and psychiatrist raters (agreement 84%, expected agreement 78%, kappa 0.26). On univariate analysis, age, number of home medications, and number of comorbidities was significantly associated with the occurrence of a medication error intervention (Table 3). In the multivariate analysis (R-squared 19.6%), increasing number of home medications (OR 1.17, 95% CI 1.01 to 1.36; p = 0.035), and increasing number of comorbidities (OR 1.89, 95% CI 1.10 to 3.27; p = 0.022) were associated with the occurrence of a medication error requiring intervention (Table 3). The model fit the data well (Hosmer-
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195
Table 1 Type of Error Intervention Type Omission Wrong frequency Drug or class duplication Wrong strength/concentration Inadequate monitoring or lab Contraindication Extra dose Wrong dosage Wrong time Other (e.g. consultation)
N (%) 256 (89) 13 (4.5) 4 (1.3) 3 (1) 3 (1) 2 (0.7) 2 (0.7) 1 (0.3) 1 (0.3) 3 (1)
Table 2 Drug classes involved in the errors Drug Class
N (%)
Antidepressants Analgesics Cardiovascular Anxiolytics Gastrointestinal Endocrine Neuroleptics Other CNS drugs Mood stabilizer Respiratory Electrolytes/Vitamins/supplements Anti-platelets Anti-infective Antiepileptic Ophthalmic/Otic Anti-coagulants/Thrombolytic
42 (14) 37 (13) 37 (13) 31 (10) 26 (9) 24 (8.3) 21 (7.2) 20 (7) 13 (4.5) 12 (4.1) 11 (3.8) 5 (1.7) 4 (1.4) 2 (0.6) 2 (0.6) 1 (0.3)
Lemeshow goodness-of-fit, p = 0.296). The area under the ROC curve showed excellent discrimination (0.80). 4. Discussion The key finding in this study is that 65% of the patients with a primary psychiatric diagnosis boarded in the ED had one or more medication errors that required intervention. In the multivariate analysis, increasing number of home medications and patient comorbidities was associated with greater risk for error. Interestingly a majority of the errors (89%) were related to the re-initiation of home medications.
196
H.T. Bakhsh et al. / Medication errors in psychiatric patients boarded in the emergency department Table 3 Predictors of medication errors Variable Univariate analysis Age Sex Number of home medications Number of comorbidities Multivariate analysis (R2 = 19.6%) Number of home medications Number of comorbidities
Odds Ratio
95% CI
P value
1.03 0.63 1.28 2.53
1.01 to 1.06 0.28 to 1.44 1.12 to 1.47 1.54 to 4.14
0.005 0.273
