[Erroneous and unsatisfactory filling in of drug charts--a potential source of medication error].

Tidsskr Nor Laegeforen

Medisinsk klinikk, Sykehuset Buskerud, 3004 Drammen.

Published: September 2004

Background: Medication errors may have serious consequences for patients and erroneous drug charts represent one of several causes of error. As part of a quality assurance survey, we studied whether user documentation on the charts was in accordance with the guidelines for chart keeping.

Material And Methods: On the same day, the drug charts of all hospitalized patients (n = 401) were copied and a representative sample of 207 charts was reviewed.

Results: 15 charts had no prescriptions; 14 of the remaining 192 charts (7 %) were correctly filled in. 152 charts (79 %) had deviations that we considered might pose only minor potential health risk; 26 (14 %) had deviations implying potential risk. No charts had deviations considered to pose major risk.

Interpretation: Several deviations from the guidelines were found and better training is needed; we recommend standardisation of drug charts and guidelines.

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