Stimulant Prescribing Error Assessment Rubric Development

Objective: Stimulant medications are used to treat attention-deficit/hyperactivity disorder (ADHD) in adults. However, stimulants are among the most frequently prescribed medications that have a potential to be used nonmedically. We sought to define types of errors associated with treatment of ADHD in adults and to describe a classification rubric for stimulant-related prescribing faults.

Methods: An expert panel conducted a scoping review of the literature and rubric development. The literature search including relevant English language publications indexed in Medline (1990-present, human) and Embase (1990-present, human). In addition, we reviewed relevant documentation such as medication labels and guides containing information related to medications used for the treatment of adult ADHD. The initial version draft rubric was developed by adapting an existing framework for prescribing errors. The expert panel further defined a classification rubric and developed error subcategories, classifications, and descriptions.

Results: Two error categories were identified. Category 1 errors are errors resulting from prescribing faults, which further included errors in decision making/judgment; errors related to monitoring for potential harm of stimulants; possible errors: events that should generally be avoided or be used with caution; and suboptimal prescribing. Category 2 errors result from prescription writing, further defined as failure to communicate essential information and transcription errors.

Conclusions: This study provides a comprehensive description of medication errors associated with stimulant and related medications. Our findings have the potential to assist decision making and to tailor delivery programs, recommendations, guidelines, and clinical decision support health information technology on stimulant prescribing and monitoring.