Detection and Management of Medication Errors in Internal Wards of A Teaching Hospital by Clinical Pharmacists
,
Abstract
Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.
Statement by the Academy of Managed Care Pharmacy To the Institute of Medicine Committee on Identifying andPreventing Medication Errors, 2005.
Academy of Managed Care Pharmacy, Concepts in Managed Care Pharmacy Series: Pharmaceutical Care2003.
Zed PJ. Drug-related visits to the emergency department. J Pharm Pract 2005;18(5):329-35.
Grasso BC , Rothschild JM, Genest R, Bates DW. What do we know about medication errors in inpatient psychiatry? Jt Comm J Qual Saf 2003;29(8):391-400.
Pote S,Tiwari P, D'Cruz S. Medication prescribing errors in a public teaching hospital in India: A prospective study.Pharm Pract 2007;5(1):17-20.
Van den Bemt PM , Fijn R, Van der Voort PH, Gossen AA, Egberts TC, Brouwers JR.Frequency and determinants of drug administration errors in the intensive care unit. Crit Care Med 2002;30(4):846-50.
Tully M, Buchan I. Prescribing errors during hospital inpatient care: factors influencing identification bypharmacists. Pharm World Sci 2009;31(6):682–8.
Bond CA, Raehl CL, Pitterle ME, Franke T .Health care professional staffing, hospital characteristics, and hospital mortality rates. Pharmacotherapy 1999;19(2):130–8.
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL .Clinicalpharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166(9):955-64.
Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, Bates DW. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA1999;282(3):267–70.
Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med 2003;163(17):2014–8.
Haffner SM. The Metabolic Syndrome: Inflammation, Diabetes Mellitus, and Cardiovascular Disease. Am J Cardiol 2006;97(2 A):3A–11A.
Arauz-Pacheco C,Parrott MA, Raskin P; American Diabetes Association. Hypertension management in adultswith diabetes. Diabetes Care 2004; 27( Suppl 1):S65-7.
Khalili H, Dashti-Khavidaki S, Hossein Talasaz A, Tabeefar H,Hendoiee N. Descriptive Analysis of a Clinical Pharmacy Intervention to Improve the Appropriate Use of Stress Ulcer Prophylaxis in a Hospital Infectious Disease Ward. J Manag Care Pharm 2010;16(2):114-21.
Quon BS, Gan WJ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest 2008;133(3):756-66.
Abbasinazari M, Salamzadeh J, Hajebi G and Gilbert B .The Role of Clinical Pharmacists in Educating Nurses to Reduce Drug-Food Interactions (Absorption Phase) in Hospitalized Patients. Iran J Pharm Res 2011;10:173-8.
Lomaestro BM, Bailie GR. Effect of staggered dose of calcium on the bioavailability of ciprofloxacin. Antimicrob agent Chemother 1991;35(5):1004-7.
Gilard M ,Arnaud B, Cornily JC, Le Gal G, Lacut K, Le Calvez G, Mansourati J, Mottier D, Abgrall JF, Boschat J. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study. J Am Coll Cardiol 2008;51(3):256-60.
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993;329(20):1456-62.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2Suppl 1):S1-266.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16(1):31-41.
Sambol NC, Chiang J, O'Conner M, Liu CY, Lin ET, Goodman AM, Benet LZ, Karam JH. Kidney function and age are both predictors of pharmacokinetics of metformin. J Clin Pharmacol 1995;35(11):1094-102.
Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human. Washington, DC: National Academy Press; 2000.
Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci 2010;32(1):59-65.
Bohombol E ,Ramos LH, D'Innocenzo M. Medication errors in an intensive care unit. J Adv Nurs 2009;65(6):1259-67.
Fraser GL,Stogsdill P, Dickens JD Jr, Wennberg DE, Smith RP Jr, Prato BS .Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157(15):1689-94.
Gentry CA, Greenfield RA, Slater LN. Outcomes of an antimicrobial control program in a teaching hospital. Am J Health Syst Pharm 2000;57(3):268-274.
Bailey TC, Ritchie DJ, McMullin ST, Kahn M, Reichley RM, Casabar E, Shannon W, Dunagan WC. A randomized, prospective evaluation of an interventional program to discontinue intravenous antibiotics at two tertiary care teaching institutions. Pharmacotherapy 1997;17(2):277-81.
Gums JG, Yancey RW Jr, Hamilton CA. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 1999;19(12):1369-77.
| Files | ||
| Issue | Vol 51, No 7 (2013) | |
| Section | Original Article(s) | |
| Keywords | ||
| Clinical pharmacist Intervention Medication error | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
