Effect of number of open charts on intercepted wrong-patient medication orders in an emergency department

Abstract

To reduce the risk of wrong-patient errors, safety experts recommend allowing only one patient chart to be open at a time. Due to the lack of empirical evidence, the number of allowable open charts is often based on anecdotal evidence or institutional preference, and hence varies across institutions. Using an interrupted time series analysis of intercepted wrong-patient medication orders in an emergency department during 2010-2016 (83.6 intercepted wrong-patient events per 100 000 orders), we found no significant decrease in the number of intercepted wrong-patient medication orders during the transition from a maximum of 4 open charts to a maximum of 2 (b = -0.19, P = .33) and no significant increase during the transition from a maximum of 2 open charts to a maximum of 4 (b = 0.08, P = .67). These results have implications regarding decisions about allowable open charts in the emergency department in relation to the impact on workflow and efficiency.

Figure 1.

The changes in number of RAR events over time. The dots represent the number of RAR events (per 100 000 orders); the dotted line shows the fitted line. The estimates of the change in intercept were: from 4 charts to 2 charts: b₁ = −0.19, P = .33; from 2 charts to 4 charts: b₂ = 0.08, P = .67 (marked in the figure). The changes in trend (slope) were as follows: after 4 charts to 2 charts: b₃ = −0.01, P = .49; after 2 charts to 4 charts: b₄ = −0.01, P = .46. The regression estimates are also provided.