Shannon Zhang, MD, Justine Ring, Michelle Methot, PharmD, Boris Zevin, MD. Queen’s University
Introduction: Sleep deprivation in physicians has been linked to impaired decision making, poor psychomotor skills, increased medical errors and increased adverse events. General surgery residents are frequently exposed to sleep deprivation; however, a relationship between fatigue and prevalence of provigil medication prescription errors for general surgery residents is yet to be established. Our study objective was to determine the prevalence of medication prescription errors for general surgery residents at a Canadian academic hospital, without an electronic order entry system, during post-call (PC) and well-rested (WR) times. We hypothesized that sleep deprivation was associated with increased prevalence of medication prescription errors.
Methods: We conducted a prospective within-subject observational pilot study comparing the prevalence of medication prescription errors written by PC and WR general surgery residents during patient care rounds (0500-0800). PC residents were defined as having just completed a 24-plus-2 hours call shift, while WR residents did not have a preceding call shift. Pilot data was collected between July and August 2017. Medication errors were identified and classified using a previously defined taxonomy. Error rates were calculated as the total number of errors divided by the total number of medication orders, and stratified between WR and PC residents. Statistical significance was calculated using the chi-square test. Significance was set to p < 0.05.
Results: PC residents made significantly more errors as compared to WR residents (9.2% vs 3.2%; p=0.04). Errors in decision making comprised 33% of the total errors, while prescription writing errors comprised 67% (p=0.30). Among junior residents, 80% of the medication errors related to prescription writing and 20% related to decision making. Sixty-seven percent of errors were made by junior and 33% were made by senior residents (p=0.30). PC and WR error rates are 4.3% and 12.5% respectively in July (p=0.078), and 2.0 and 3.3% in August (p=0.684).
Conclusion: There is a significant difference in the rates of medication prescription errors between well-rested and post-call residents, with most errors occurring during prescription writing. Residents may be particularly vulnerable to the effects of sleep deprivation at the beginning of their residency and the start of the academic year. Our pilot data demonstrates a need for preventive strategies to address medication prescription errors and possible resultant patient adverse events. Such strategies may include a retraining curriculum on prescription writing, and an electronic order entry systems to minimize prescription writing errors.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86868
Program Number: S011
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium