Incidence of anticoagulation medication prescribing errors in patients discharged from the emergency department

IntroductionIt is well-known that the Emergency Department (ED) is an area at high risk for medication errors due to several factors including providing care to unfamiliar patients in a high-stress environment and relying heavily on verbal orders. ObjectivesThis primary objective of this study was to characterize the incidence and describe the impact of medication errors that occur within anticoagulation prescriptions written for patients who are discharged from the ED. MethodsAnticoagulation prescriptions written to patients discharged from the adult ED at a large academic medical center between January 1, 2015 and August 1, 2018 were retrospectively evaluated to identify and characterize errors. Errors identified included dosing errors for the indication, dosing adjustment errors, incorrect quantity, refills given inappropriately, and readmission rate due to errors. ResultsA total of 797 prescriptions for anticoagulation medications were reviewed and a total of 392 errors were identified within 321 (40.3%) prescriptions. Of the errors identified, 88 (22.4%) were an error in dose for the indication, 83 (21.2%) were errors in dose adjustments based on patient-specific factors, 81 (20.7%) were errors in quantity prescribed, and 140 (35.7%) were prescriptions written with refills. Prescriptions written by non-emergency medicine residents had significantly more errors compared with attending physicians, emergency medicine residents, and advanced practice providers (P < .001 for all comparisons). Of the errors identified, 2 (0.6%) led to patient readmission. ConclusionAn error rate of 40.3% was identified among prescriptions for anticoagulation written for patients discharged from the ED. Limited literature exists evaluating anticoagulation errors for patients discharged from the ED, however these findings are consistent with available data. The findings of this study will aid in the development of targeted mitigation strategies in reducing anticoagulation prescribing errors for patients discharged from the ED.