Testing of Defects per Million Medication Orders as a SMART Indicator for Monitoring Medication Safety in Admission and Discharge Orders

Abstract

Introduction: The study investigated the use of defects per million medication orders (DPMMO) as a SMART (specific, measurable, achievable, realistic, and timely) indicator for monitoring medication safety in admission and discharge orders. The study aimed to develop and test a new indicator as an investigator of medication safety.

Methods: The study was conducted in 2018 at King Saud Medical City in Riyadh City in Saudi Arabia. A retrospective cross-sectional design was used. The research sample had 292 patients. The selected medication orders included two types of medication orders (admission and discharge order). After sufficient data had been gathered from the hospitals, a statistical analysis was carried out.

Results: Analysis of admission and discharge orders indicated that defects per million opportunities (DPMO) and DPMMO count were slightly low, while the sigma level for admission orders was slightly high. Thus, the admission order process was slightly better than the discharge order process.

Conclusion: The DPMMO indicator could serve as a SMART indicator of medical safety. It can be used as a standardized indicator in any healthcare facility, which serves as a recommendation guide in monitoring and evaluating healthcare processes or systems that affect the safety and outcomes of patients.

Keywords: SMART indicator; admission order; defects per million opportunities; discharge order; medication safety.

Figure 1

Flow chart for sampling patient file. GH: general hospital; PedH: pediatric hospital; MatH: maternity hospital; DAMA: discharge against medical advice.

Figure 2

Normality test for admission and discharge order defects. AD: Anderson-Darling statistic.

Figure 3

Pareto chart of defects in admission orders.

Figure 4

Pareto chart of defects in overall discharge orders.