Outpatient anti-epileptic drug prescribing errors in a Children's Hospital: An audit and literature review

PURPOSE Prescription errors are a common and potentially hazardous problem and may cause patient harm. This review evaluates all new anti-epileptic drug (AED) outpatient prescriptions over one year and reviews the subject literature. METHODS A 12-month retrospective review of all outpatient prescriptions of AEDs within a large Children's Hospital. Copies of all prescriptions were obtained from the Trust's Pharmacy. The evaluation included the completeness of the required information, prescribing errors and the need for pharmacist intervention before the drug could be dispensed. It did not address the severity of prescribing errors or the potential harm to the patient. RESULTS Two hundred and sixty two new prescriptions were evaluated. Incomplete prescriptions (that omitted at least one piece of required information) were found in 72.1%. The most common omission was the dose strength (mg/ml) or actual dose (mg) of the AED. No clinical diagnosis was documented in 62.6% and in 22%, only the word 'epilepsy', was stated with no reference to the epilepsy syndrome or seizure type. Pharmacist intervention was required in approximately 17% (approximately 1 in 6) of all prescriptions before the AED could be dispensed. CONCLUSION This review highlights the importance of clinical information on prescriptions and that incomplete or poor documentation may contribute to prescribing errors. It also emphasises the importance of pharmacists in the identification and correction or resolution of potential prescribing errors. There is a need to develop a well-validated measure to assess the severity of prescribing errors that will better address their clinical significance and risk.