Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals

Introduction: It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.

Obkective: This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.

Methods: Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.

Results: Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.

Conclusions: The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.

Semantics for possibilistic answer set programs: uncertain rules versus rules with uncertain conclusions

Although Answer Set Programming (ASP) is a powerful framework for declarative problem solving, it cannot in an intuitive way handle situations in which some rules are uncertain, or in which it is more important to satisfy some constraints than others. Possibilistic ASP (PASP) is a natural extension of ASP in which certainty weights are associated with each rule. In this paper we contrast two different views on interpreting the weights attached to rules. Under the first view, weights reflect the certainty with which we can conclude the head of a rule when its body is satisfied. Under the second view, weights reflect the certainty that a given rule restricts the considered epistemic states of an agent in a valid way, i.e. it is the certainty that the rule itself is correct. The first view gives rise to a set of weighted answer sets, whereas the second view gives rise to a weighted set of classical answer sets.

Characterizing and Extending Answer Set Semantics using Possibility Theory

Answer Set Programming (ASP) is a popular framework for modelling combinatorial problems. However, ASP cannot be used easily for reasoning about uncertain information. Possibilistic ASP (PASP) is an extension of ASP that combines possibilistic logic and ASP. In PASP a weight is associated with each rule, whereas this weight is interpreted as the certainty with which the conclusion can be established when the body is known to hold. As such, it allows us to model and reason about uncertain information in an intuitive way. In this paper we present new semantics for PASP in which rules are interpreted as constraints on possibility distributions. Special models of these constraints are then identified as possibilistic answer sets. In addition, since ASP is a special case of PASP in which all the rules are entirely certain, we obtain a new characterization of ASP in terms of constraints on possibility distributions. This allows us to uncover a new form of disjunction, called weak disjunction, that has not been previously considered in the literature. In addition to introducing and motivating the semantics of weak disjunction, we also pinpoint its computational complexity. In particular, while the complexity of most reasoning tasks coincides with standard disjunctive ASP, we find that brave reasoning for programs with weak disjunctions is easier.

Using Answer Set Programming for Solving Boolean Games

Boolean games are a framework for reasoning about the rational behaviour of agents, whose goals are formalized using propositional formulas. They offer an attractive alternative to normal-form games, because they allow for a more intuitive and more compact encoding. Unfortunately, however, there is currently no general, tailor-made method available to compute the equilibria of Boolean games. In this paper, we introduce a method for finding the pure Nash equilibria based on disjunctive answer set programming. Our method is furthermore capable of finding the core elements and the Pareto optimal equilibria, and can easily be modified to support other forms of optimality, thanks to the declarative nature of disjunctive answer set programming. Experimental results clearly demonstrate the effectiveness of the proposed method.