Medication errors in psychiatric practice — A Cross-sectional Study.

ABSTRACT

Objectives: To analyse current prescription writing practices among psychiatrists and to identify and quantify various types of medication errors in psychiatric prescriptions in general and specifically in the prescriptions of antipsychotics. Method: A cross-sectional study of medication errors was carried out in the extra-mural psychiatry prescriptions brought by the patients attending the psychiatry outpatient department of a tertiary care hospital in Delhi. The study period ranged from 1st March, 2009 to 1st November, 2011. Microsoft Excel was used for data analysis. The WHO guidelines for prescription writing were used as a standard while making an assessment of the results. Results: Most of the prescriptions analysed exhibited polypharmacy, illegible handwriting, lack of necessary details pertaining to the patients (address, weight) as well as those pertaining to the prescriber (signature, contact details, registration number) and necessary instructions for the patient regarding taking drugs and advice for follow up.In the 648 extramural prescriptions analysed, the most common error was prescription of drug without dose (30 %). The least common error was the prescription of a wrong drug (2 %). In comparison to the rates found in all the 648 prescriptions, the error of prescribing drugs with same indication was identified at a relatively higher frequency (15%) among antipsychotics (only) prescriptions. Among the various antipsychotic drugs, the errors related to wrong frequency and wrong route of administration were observed at relatively higher frequencies in the prescriptions of the newly introduced drug asenapine while the first generation antipsychotic drugs like haloperidol and trifluoperazine exhibited comparatively higher rates of wrong dose errors. Conclusions: Routine psychiatric prescriptions exhibit large number of easily identifiable errors which are preventable. The need of the hour is to promote rational drug prescribing practices among psychiatrists, encouraging them to detect and report medication errors encountered by them. This approach will enrich our existing research base about this hitherto neglected domain of psychiatric practice thereby helping us in developing and implementing effective strategies to combat this menace of medication errors.