The Medication Prescribing Curriculum was delivered to 13 out of possible 16 (81%) general surgery trainees in post-graduate year (PGY) one to four (Table 1). The breakdown of general surgery and off-service post-graduate trainees on a general surgery service per month in shown in Table 2. There were no significant differences in the number of general surgery and off-service trainees on a general surgery service each month pre and post-curriculum implementation (Table 2).
Pre-Curriculum Implementation (Baseline) Data:
There were a total 1050 medication prescribing errors made over 12 months between July 1, 2018 to June 31, 2019 with 615 (59%) prescription-writing errors and 435 (41%) decision-making errors (Table 3). The mean number of errors per month was 87.5 (14.6), with significantly more PW compared to errors as DM errors per month (51.3 (11.9) vs 36.3 (6.0); p=0.001).
The most common PW errors were ‘Omission of frequency/not specifying PRN orders’ with 12.7 (5.5) errors per month, followed by ‘Prescribing one tab/ 1 puff of a drug that is available in more than one strength’ with 11.6 (4.4) errors per month (Table 4). The most common DM errors were ‘Prescribing a dose not recommended for the formulation prescribed’ with 7.5 (2.3) errors per month followed by ‘pharmaceutical issues’ with 7.0 (2.8) errors per month, such as prescribing medication only available in intravenous (IV) formulation to be given orally. The highest number of medication errors per month was recorded in July (n = 116) and August (n = 106), while the lowest was recorded November (n = 66).
The mean number of errors per month for each quarter of the academic year were 107.3 (8.08) for Q1 (July to September), 83.3 (15.0) for Q2 (October to December), 77.7 (4.7) for Q3 (January to March), and 81.7 (7.1) for Q4 (April to June) (Figure 1). The mean number of errors per month was significantly higher in Q1 versus Q3 (p=0.02) and Q4 (p=0.04). The most common classes of medications involved in medication prescribing errors were “other”, “gastrointestinal”, “respiratory” and “narcotic” medications (Table 5).
Post-curriculum Implementation Data:
There were a total 472 medication prescribing errors made over 6 months between July 1, 2019 and December 31, 2019 with 212 (45%) DM and 260 (55%) PW errors (Table 3). The mean number of total errors per month was 78.7 (10.3), with no significant difference between PW and DM errors per month (43.3 (9.8) vs 35.3 (4.2); p=0.13).
The most common PW errors were ‘Omission of frequency/not specifying PRN orders (i.e. morphine 2 mg PRN instead of q4h prn)’, with 10.8 (6.2) errors per month, followed by ‘Prescribing one tab/ 1 puff of a drug that is available in more than one strength’ with 10.3 (5.1) errors per month. The most common DM errors were ‘Pharmaceutical issues’ with 10 (2.7) errors per month, and ‘Prescribing two drugs for the same indication when only one is necessary’ with 7.5 (4.1) errors per month. The highest number of medication errors per month was recorded in August (n = 92) and October (n = 87), while the lowest was recorded in July (n=68) and December (n = 68) (Table 3).
The mean number of errors per month for each Q1 and Q2 of the academic year were 77.7 (12.7) for Q1 and 79.7 (10.2) for Q2 with no significant difference between Q1 and Q2 (p=0.84) (Figure 1). The most common classes of medications involved in medication prescribing errors post-curriculum implementation were “gastrointestinal”, “respiratory” and “other (Table 5)”.
Effectiveness of the Medication Prescribing Curriculum:
There were significantly fewer medication prescribing errors committed per month in Q1 post-curriculum implementation versus pre-curriculum implementation (77.7(12.7) vs. 107.3(8.1); p=0.04). There were also significantly fewer PW errors committed per month in Q1 post-curriculum implementation as compared to pre-curriculum implementation (40.7(13.2) vs. 68.7(9.3); p<0.05); however, there was no significant difference in DM errors committed per month in Q1 pre- and post-curriculum implementation (37.0(2.0) vs. 38.7(5.7); p=0.67).
There were no significant differences between medication prescribing errors committed per month in Q2 post-curriculum implementation versus pre-curriculum implementation (79.7(10.2) vs. 83.3(15.0); p=0.75). There were no significant differences in PW errors per month (46.0(6.6) vs. 49.3(5.0); p=0.53) and DM errors per month (33.7(5.7) vs. 34.0(10.4); p=0.96) in Q2 pre- and post-curriculum implementation.
There were significantly fewer errors per month related to antibiotic prescribing post-curriculum implementation versus pre-curriculum implementation (3.8 (1.7) vs 8.0 (3.1), p<0.01).