Evaluation of stat orders in a teaching hospital: a chart review.

backgroundPhysicians frequently prescribe 'stat' orders that need to be actioned immediately or within a limited time frame. This process can be time consuming and expensive. Stat medications are reserved for the highest priority orders and life-threatening situations that need to be dealt with immediately or within a limited time frame.

objectivesThe goals of this study were to evaluate whether stat medications in a teaching hospital were ordered appropriately and to assess the rationale for the stat order.

methodsThe study was carried out between July and August 2009 in Masih Daneshvari Hospital. All newly admitted patients' charts were reviewed and the records of all inpatients who received at least one stat order were included in the study. Detailed analyses were undertaken to examine the stat use of agents and the rationale for their prescription. Several different guidelines were used to evaluate the rationale for the prescriptions.

resultsCharts for 175 patients were reviewed. Of these, 109 (62.3%) patients received a total of 220 stat orders. The mean number of stat orders on each chart of patients who received stat orders was 2.0. Stat orders were divided into two categories: 146 (66.4%) that were administered only once and 74 (33.6%) that were reordered. The internal medicine ward accounted for the most stat medications (35%). The major reasons for stat medication orders were: prophylaxis or management of emesis (22.3%), control of dyspnoea (15.9%), preoperative medications (8.2%) and treatment of exacerbations of chronic obstructive pulmonary disease (7.2%). Hydrocortisone (14.1%), dexamethasone (11.3%), granisetron (9.5%), ceftriaxone (8.6%) and morphine (6.8%) accounted for the most common stat orders. Analysis showed that 133 of the total 220 stat orders (60.5%) were prescribed appropriately; the rationale for 19 orders (8.6%) could not be evaluated.

conclusionThis study showed that most stat orders at Masih Daneshvari Hospital during the study period were prescribed appropriately. Further investigations are recommended to evaluate the outcomes of unnecessary stat orders with respect to adverse drug events.