A Methodological Assessment of Pharmacist Therapeutic Intervention Documentation (TID) in a Single Tertiary Care Hospital in Jeddah, Kingdom of Saudi Arabia

Abstract

Pharmacist intervention has valuable input to the healthcare system by reducing medication errors, costs of treatment and improving therapeutic outcomes. This study aimed to analyze pharmacists’ interventions during the verification of computerized physician order entry and to determine the association between prescribers’ level and type of prescribing errors. In this cross-sectional, observational study, data collection was carried out over three months starting from 1 January 2020 to 31 March 2020. Included were 2405 interventions documented by 52 different pharmacists. The prevalence of prescribing order entry errors was 9.1%. The most identifiable type of intervention was incorrect dilution (40.2%) followed by dose substitution (27.7%). The drug category associated with a high percentage of interventions was perfusion solutions (41%), followed by antibacterial (35%). The number of junior physician orders that required pharmacist intervention was higher than other prescribers (45.2%), followed by specialist and senior physicians, (31.4% and 15.5%, respectively). Prescriber ordering time and types of prescribing errors were shown to have a significant (p < 0.05) association. Internal medicine physicians entered the highest percentage of prescribing errors, representing 22.7%. The current study concluded that TID has significant potential to reduce drug-related problems; TID fatigue is a real problem that might be under-reported and addressing this point in future studies would be of great value.

Pharmacists’ Interventions on Electronic Prescriptions from Various Specialty Wards in a Malaysian Public Hospital: A Cross-Sectional Study

“…E-prescribing has been advocated as a potential medication error reduction mechanism by studies showing lower rates of interventions [4,17]: 2.3 and 0.68%, respectively, for discharged patients. However, other studies [8] recorded a higher rate of interventions: 9.1 and 10.1%, respectively, at an inpatient pharmacy and at an emergency department for discharge prescriptions with the implementation of computerised prescribing order entry. Up to 45.1% of pharmaceutical interventions were performed on e-prescriptions in Norwegian community and hospital pharmacies [18].…”

“…Studies in different health care settings have found that up to 10% of prescriptions reviewed had problems that needed pharmacists' intervention [3][4][5][6][7]. Prescription errors requiring pharmacists' interventions are usually minor errors, though a small number of prescription errors have been reported to cause major harm to patients [8,9]. A pharmacist intervention is defined as any appropriate action taken by a pharmacist to change patient management or therapy [10].…”

“…In certain Malaysian hospitals, the prescriptions are usually hand-written and then screened for completeness, prescribers' authenticity, suitability of drug and dosing regimen, drug interaction, polypharmacy, and the route of administration before dispensing [3,[9][10][11][12]. When issues arise, prescribers will be contacted by pharmacists for clarification or amendment of the prescriptions [8]. To smoothen and quicken the process of dispensary at inpatient services, a computerised system that is fool-proof and reliable could serve as an alternative to replace manual order entries made by physicians and to assist in prescription screening, especially when the use of medicines is promptly required for critically ill patients.…”

Documentation and classification of hospital pharmacist interventions: A scoping review

“…All studies were descriptive, with three prospective 21,22,27 and six retrospective, 6,17,18,28,34,39,45 while one also included a survey. 17 Most of the studies were from the Middle East (Saudi Arabia, 6,17,22 Iran, 21 Lebanon 28 and Oman 18 ), two were from the United States, 27,34 one from Germany 39 and the other one from Australia. 45 For their own use, the hospitals or private health systems developed the internal documentation and/or classification systems mentioned in these studies.…”

“…6,17,21,27,34,45 Others (40%) were a result of in-house modifications and adaptations of previous published studies. 18,22,28,39 The amount of information documented and the number of categories used for classifying PIs was highly variable and is detailed in Table 2.…”