We read the article by Parihar and Passi(1) with interest. It was a
very good attempt to study an important aspect of clinical practice.
However, there are some problems with the article. First, the
authors report a medical error rate of 35.5%, which is very high. The
authors have this figure by dividing the number of medical errors by
total number of patients under evaluation. However, it would have been
better, if authors used total number of prescriptions as the
denominator to report the rate of medical errors. Further, it is
possible that in many cases multiple errors would have occurred in a
single patient. Hence, the figure of 35.5% appears to be an erroneous
conclusion. Second, on the same issue, if we take to understand
that total numbers of prescriptions in the intensive care units are
more compared to other service areas, the figure of number of errors
would come down significantly. The authors also report the percentage
of errors between 8 am to 8 pm and from 8 pm to 8 am. Again these
figures can also be significantly be affected by total number of
prescription under evaluation, rather than the time frame alone. We
know that in our practice, in most cases the clinical rounds are
mostly held during the day time and possibly more number of
prescriptions are written during the day time. Third, the
authors have not mentioned anything about the blinding of clinicians
and other staff who were under scanner. Because it is quite possible
that if the clinicians and staff were aware about the study, then the
reported rates would be less than the actual rates in clinical
practice, because of being conscious about avoiding mistakes.
Fourth, the alarming aspect of the study was the fact that more
number of errors were committed by Senior residents than Junior
Residents. If this fact is true (after taking total number of
prescriptions as denominator for the each group), than it is very
important to look at the training aspect. Fifth, the authors
have not mentioned about the time of assessment, because it would give
us important lead as to whether the erroneous prescriptions were
intercepted or not. Sixth, it has been frequently shown in
Western studies(2) that the numbers of errors correlate with level of
stress and psychiatric morbidity in the residents. The study could
have been strengthened by including such measures.
Archana Malik,
Sandeep Grover,
From the Department of Ophthalmology
Government Medical College and Hospital,
Chandigarh; and
* Department of Psychiatry, PGIMER,
Chandigarh, India.
E-mail:
[email protected]
1. Parihar M, Passi GR. Medical errors in
paediatric practice. Indian Paediatr, 2008; 45: 586-589.
2. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D,
Chiang VW, et al. Rates of medication errors among depressed
and burnt out residents: prospective cohort study. BMJ 2008; 336:
488-491.
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