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American Journal of Hospice and Palliative Medicine®
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Improving Medication Error Reporting in Hospice Care

Rachel Boyer, PharmD

School of Pharmacy University of Maryland, Baltimore, Maryland, rboyer{at}rx.umaryland.edu

Mary Lynn McPherson, PharmD, BCPS

Department of Pharmacy Practice and Science, University of Maryland, Baltimore, Maryland

Guarav Deshpande, MS

School of Pharmacy, University of Maryland, Baltimore, Maryland

Sheila Weiss Smith, PhD

Department of Pharmacy Practice and Science, University of Maryland, Baltimore, Maryland

The aims of this study are to determine the incidence of medication errors, characterize the type/severity of errors, and estimate the impact of an educational intervention on medication error processes in a hospice population. Medication errors from 2 hospice organizations were collected and coded for type of error/ outcome severity. The educational intervention included a 2-hour in-service and twice weekly reminders. A survey to assess participants’ change in knowledge and attitudes regarding medication error reporting through the study period and was administered at 3 different time points. Data analysis revealed that medication error reporting increased in one hospice program, that participants’ ability to correctly identify medication errors increased (P < .001), and awareness of medication errors in hospice care increased (P < .01) after the intervention.

Key Words: medication error reporting • hospice • quality assurance • education

This version was published on October 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 5, 361-367 (2009)
DOI: 10.1177/1049909109335145
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