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Medication errors are a leading cause of iatrogenic morbidity and mortality in acute care.1 Medication error events affect 19%–58% of inpatients and are likely underreported in the literature.1,2 A major contributor to errors is distractions during transcription,3 and issues with communication are widespread.4 The Institute for Safe Medication Practices (US) recently re-emphasized its read-back recommendation,5 originally dating back to 2003. Within separate 12and 10-bed Surgical and Medical Intensive Care Units (ICUs) in the Regina General Hospital, orders from intensivist-led patient care rounds are transcribed into the paper chart by a critical care associate physician not leading the discussion, on behalf of the multidisciplinary team in attendance, which includes a respiratory therapist, clinical pharmacist, dietitian, nurse, and learners. After medication orders are written, they are sent to the dispensary pharmacist for review and are processed in the pharmacy, following which an interim dose of each medication is sent to the appropriate ICU. Simultaneously, the orders are transcribed into patients’ medication administration records by the unit clerk in each ICU and double-checked by nursing staff. Any need for order clarification at any of these steps may translate into a delay in care. Members of the intensivist group started having all transcribed orders “read back at rounds” (termed “RAR”) for the team to ensure accuracy and appropriateness. We investigated the effect of confirming, as a formal process, all orders written during patient care rounds, the goal being to decrease the number of prescribing errors and workload. A nonrandomized, observational trial was conducted over 11 nonconsecutive weeks between January and July 2016 while the observing pharmacist (J.F.M.) was on clinical service. After orders were transcribed by the physician, the bedside or charge nurse read back the written orders to the team (through RAR) to clarify accuracy of information and clarity of handwriting. The outcomes measured were number of orders requiring clarification and the time required for the clinical pharmacist to correct such orders in collaboration with the prescribers, as well as data collected by the clinical pharmacist. Any medication order identified by the dispensary pharmacist, nursing staff, or clinical pharmacist as requiring clarification after rounds was included. RAR was performed at the discretion of the intensivist, and members of the multidisciplinary rounding team were blinded to observations.

Ensuring Accurate, Timely Medication Orders and Reducing Errors: Assessment of a Read-Back Tactic