Evaluation of duplicate medication orders at a tertiary care hospital

Introduction: Evaluation of duplicate medication orders at an institution is important for minimizing patient risk, improving patient outcomes, and complying with regulatory standards, such as Joint Commission standards.

Objectives: The objective of this evaluation is to determine the extent to which duplicate medication orders exist and to identify key characteristics of duplicate medication orders at a tertiary care hospital.

Study Design: Duplicate medication orders were identified using the electronic medical record. Data collection occurred on four consecutive Fridays at a pre-specified time to obtain a snapshot of duplicate medication order incidence. Duplicate medications were defined as active (i.e. verified) PRN medications without clear administration instructions, exact medication orders, and therapeutic duplications as clinically determined by the evaluator.

Methods: A total of 18,544 orders were reviewed during the data collection period, averaging 4,366 orders per day. The total number of duplicate medication orders was collected for each hospital unit; duplicate orders as a percentage of all orders was calculated.

Results: There were a total of 262 duplicate medication orders with a duplication rate of 1.4%. Analgesic medications and PRN medications without clear administration instructions consisted of the highest percentage of duplicate medication orders. Duplicate medication orders were similar for ICUs and non-ICUs, with an average of 14.8 and 15.7 duplicate medication orders per unit, respectively. Further analysis will be performed to determine the percentage of duplicate medication orders originating from an order set by February 2016.

Conclusions: This evaluation confirmed a low incidence of duplicate medication orders, relative to incidence rates found in published articles, within the hospital. PRN medication orders and analgesic agents composed the majority of the institution’s duplicate medication orders. By understanding the extent and characteristics of duplicate medication orders within the institution, future educational initiatives can be implemented in targeted areas.