Prescribing errors on medical wards and the impact of clinical pharmacists

Abstract

Objectives To assess the incidence of prescribing errors, predict patient outcome from clinical pharmacists' recommendations made in response to identified prescribing errors, and evaluate the influence of clinical pharmacists on recommendation implementation. Method Clinical pharmacy activities were conducted on two wards, one of which had an existing clinical pharmacy service (intervention ward) while the other did not (control ward). For the control ward, prescribing errors were documented but not followed up unless a potentially life‐threatening problem was identified. Prescribing errors were identified and recommendations made by pharmacists. A consultant physician and pharmacist conducted an independent, blinded assessment of these recommendations to predict the impact on patient outcome if implemented. Recommendations were communicated to medical staff or implemented by the pharmacist on the intervention ward only. The proportion of recommendations implemented for intervention and control group patients were recorded. Setting Two medical wards in a UK district general hospital. The study was carried out over 12 weeks. Key findings There were 740 errors recorded for 235 patients. Fourteen recommendations could not be assessed. For all recommendations, the consultant and pharmacist predicted patient outcomes with life‐saving (one consultant vs three pharmacist), major (186 vs 318), minor (328 vs 324), neutral (211 vs 85) or harmful (five vs five) impact respectively. For the intervention group, 79% of recommendations were implemented, including 81 of 92 (88%) predicted by the consultant to have major impact on patient outcomes. In the control group, only 18% of recommendations were spontaneously implemented, including only 10 of 94 (11%) recommendations predicted by the consultant to have major impact. Conclusion Ward‐based clinical pharmacists identified large numbers of prescribing errors and made clinically significant recommendations. Implementation of recommendations was predicted to improve the outcome of patient care. Further research, specifically assessing the outcome of pharmacists' recommendations on patient care, is warranted.

Clinical pharmacy services in an Iranian teaching hospital: a descriptive study

“…The acceptance rate of pharmacist's recommendations differs from 36 to 38% in Australian reports [10] to 73-89% in European [14,17,18] and 85-99% in American reports [15,19]. This finding shows the appreciation of Iranian physicians of clinical pharmacy services.…”

“…In the present study clinical pharmacists provided 1.2 accepted services per patient which is less than that what reported by English pharmacists; about three interventions per patient [17]. We evaluated the clinical significance of clinical pharmacy services according to Australian standards [13] which differ from those used in European studies.…”

“…Based on both consultant and clinical pharmacist opinions respectively, about half of the Iranian clinical pharmacy services were of moderate to life-saving clinical significance. In the English study 26.6 or 44.2% of the clinical pharmacists' interventions had significant impact according to consultant or pharmacist opinion respectively [17]. In the first study in the Netherlands, 52 and 83 of 173 clinical pharmacists' interventions (30 and 48% respectively) were evaluated as having an extremely significant to significant impact by physicians and pharmacists respectively [18].…”

Evaluation of pharmacist clinical interventions in a Dutch hospital setting

“…A comparable English study showed that clinical pharmacists identified large numbers of prescribing errors (346 errors/113 patients on the intervention ward) [21]. In this study a ward with an already existing clinical pharmacy service was compared to a ward with no clinical pharmacy involvement.…”

Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

“…Although several studies have investigated pharmacist interventions in prescribing errors around the world [6,8,[19][20][21][22][23][24][25], almost all of these studies were limited to evaluations of the incidence rate, causes, clinical significance and types of prescribing errors. However, a little is known about physician acceptance rate of pharmacist recommendations and only a couple of studies have focused on implementation of recommendations [26,27]. None of the previous prescribing error studies in hospitals (to our knowledge) investigated factors influencing physician agreement with pharmacist recommendations.…”