서울아산병원 처방관리실 QI활동에 의한 처방오류 감소 및 업무개선 효과

Abstract

Since the separation of dispensary from medical practice has been affected from July 2000, AMC has operated the "Prescription Consulting Unit"(PCU), which acts as a mediator among internal clinics, outside pharmacies and patients. The main services of PCU are outpatient prescriptions relating affairs such as correction errors or change, substitution, inspection of each prescriptions, or consultation with outside pharmacy, etc. We conducted this study to enhance the customer's satisfaction and AMC credit by reducing errors through analyzing high frequency prescription error types, finding better solutions and building better operation systems of PCU. We have classified the prescription errors as following 5 major categories; (1) Prescription contents error, (2) Insufficient information for prescription medications or mistake in inputting the prescription, (3) Double prescription (4) Errors related to insurance (5) Miscellaneous. We could draw some solution to decrease errors by Quality Improvement(QI) program from these classifications. The QI program was composed of (1) Notice the procedure for correction, refunding and reissue outside prescription(at July. 2003), (2) Information e-mail according to attending physicians and prescribes(July.2003), (3) Rounding outpatient' department for reporting the errors to nurses(September. 2003), (4) Weekly error report system, (5) Computer program restriction for frequent error medications(From May.2003 to September. 2003). We compared the error rate before executing this program with it after executing this program. The mean error rate from the execution of QI program increased for a while(0.16% vs. 0.18~0.22%), but from December 2003 the error rate decreased steadily and the mean value went to 0.08% from January 2004 to September 2004 and after applying the computer programed restriction for medicines such as HRT, weekly dosing, contraindicated to be divided or powdered, these kind of errors have disappeared. The reason for temporary increase in error rate at early stage was presumed that it took some time for practitioners to be familiar with the new system. Additional roundings and reviews also led to improvements. PCU based QI program allowed prescription errors to be effectively monitored and managed. Ongoing QI programs, follow-up reminders, and feedback to physicians have solved significantly prescription related problems.