G.L.J. WONG1, D. MANOHARAN2, S. Z. SIM2
MOH Holdings Pte Ltd (MOHH)1, NHG Polyclinics2
Prescription near-misses are important contributors to patient morbidity and mortality.
Prescription incidences refer to prescription near miss incidents which were highlighted and rectified before reaching the patient. We described prescription incidents and their associated factors in a primary care clinic to facilitate brainstorming of targeted interventions.
A retrospective cross-sectional study was conducted using audit database and patient medical records from Hougang polyclinic for March 2021. Data collected included details about prescription incidents, prescribing physicians, patient demographics and medical conditions.
There were 526 prescription incidents(incident rate=2.69%). The most common chronic conditions associated with prescription incidents were hyperlipidaemia(n=320,71.6%), hypertension(n=276,61.7%) and diabetes/pre-diabetes(n=245,54.8%). Anti-diabetic medications, including oral hypoglycemic agents(OHGA)(n=83,15.8%) and insulin and related consumables(n=30,5.7%), were most involved in the prescription incidents. For OHGA-related incidents, majority(n=52,62.6%) were related to Ramadan, of which 48 and 4 were due to missing instructions on medication adjustments and wrong dosages during the fasting period, respectively. Among insulin and consumables-related incidents, the most common causes included missing or incorrect instructions for Ramadan (n=6,20%), and wrong drug frequency for example OM instead of BD(n=6,20%). In keeping with our descriptive findings, our multi-linear regression model showed that diabetes was significantly associated with prescription incidents.
Overall prescription incident rate was low. However a fifth involved anti-diabetic medications, of which many were associated with Ramadan. This is important as Ramadan occurs annually and missing or incorrect prescription instructions put patients at risk of both hyperglycaemia and hypoglycaemia. There is a need for interventions targeting prescriptions of diabetic medications for these patients.