Prevalence and sources of errors in positive airway pressure therapy provisioning

Study Objectives: The prevalence and mechanism of medication errors have been well characterized in the literature. However, no prior studies have investigated the frequency and characteristics of errors in the positive airway pressure (PAP) therapy provisioning process when treating patients with sleep-disordered breathing. Just as medication errors may result in unwanted outcomes, it might be anticipated that errors in providing PAP to patients might lead to suboptimal outcomes. Our study seeks to examine the characteristics and frequency of PAP provisioning errors. Methods: This was a retrospective analysis of a cohort of patients in whom sleep-disordered breathing had been diagnosed and subsequently PAP therapy was prescribed. At a 90-day return visit, the PAP therapy the patient was receiving was compared with the intended therapy. Discrepancies were categorized as either prescribing errors (the prescription did not match the intended modality or settings), or setup errors (the modality or settings did not match the prescription). Results: The overall PAP provisioning error rate was 8%, with errors most commonly occurring during the set-up process. In univariate analysis, insurance type (P = .003), treatment modality (P = .002), and device brand (P = .05) were associated with error and remained significant in multivariate analysis (model fit P = .002). Compliance, residual AHI, and difference in Epworth Sleepiness Scale were not affected by the presence of error. Conclusions: PAP provisioning errors are common and might contribute to poor treatment outcomes. Errors might be reduced by standardizing terminology across devices, standardizing prescription forms to improve clarity, and by enhanced quality assurance at durable medical equipment suppliers.