Dataset Information

Pharmacist intervention on prescribing errors: Use of a standardized approach in the inpatient setting.

ABSTRACT:

Purpose

The objective of this study was to implement a standardized process across health systems to determine the prevalence and clinical relevance of prescribing errors intercepted by pharmacists.

Methods

This prospective, multicenter, observational study was conducted across 11 hospitals. Pharmacist-intercepted prescribing errors were collected during inpatient order verification over 6 consecutive weeks utilizing a standardized documentation process. The potential harm of each error was evaluated using a modified National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) index with physician validation, and errors were stratified into those with potentially low, serious, or life-threatening harm. Endpoints included the median error rate per 1,000 patient days, error type, and potential harm with correlating cost avoidance.

Results

Pharmacists intervened on 7,187 errors, resulting in a mean error rate of 39 errors per 1,000 patient days. Among the errors, 46.6% (n = 3,349) were determined to have potentially serious consequences and 2.4% (n = 175) could have been life-threatening if not intercepted. This equates to $874,000 in avoided cost. The top 3 error types occurring with the highest frequency were "wrong dose/rate/frequency" (n = 2,298, 32.0%), "duplicate therapy" (n = 1,431, 19.9%), and "wrong timing" (n = 960, 13.4%). "Wrong dose/rate/frequency" (n = 49, 28%), "duplicate therapy" (n = 26, 14.9%), and "drug-disease interaction" (n = 24, 13.7%) errors occurred with the highest frequency among errors with potential for life-threatening harm. "Wrong dose/rate/frequency" (n = 1,028, 30.7%), "wrong timing" (n = 573, 17.1%), and "duplicate therapy" (n = 482, 14.4%) errors occurred with the highest frequency among errors with potentially serious harm.

Conclusion

Documentation of pharmacist intervention on prescribing errors via a standardized process creates a platform for multicenter analysis of prescribing error trends and an opportunity for development of system-wide solutions to reduce potential harm from prescribing errors.

SUBMITTER: Cabri A

PROVIDER: S-EPMC8406888 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Publications

Pharmacist intervention on prescribing errors: Use of a standardized approach in the inpatient setting.

Cabri Ann A Barsegyan Naira N Postelnick Michael M Schulz Lucas L Nguyen Victoria V Szwak Jennifer J Shane Rita R

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 20211101 23

<h4>Purpose</h4>The objective of this study was to implement a standardized process across health systems to determine the prevalence and clinical relevance of prescribing errors intercepted by pharmacists.<h4>Methods</h4>This prospective, multicenter, observational study was conducted across 11 hospitals. Pharmacist-intercepted prescribing errors were collected during inpatient order verification over 6 consecutive weeks utilizing a standardized documentation process. The potential harm of each ...[more]

PMID: 34283219

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Project description:BackgroundPharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no literature exists about pharmacist prescribing for inpatients at the time of discharge.ObjectivesThe primary objective was to report the proportion of patients for whom inpatient pharmacists with APA prescribed at discharge across Alberta, Canada. Secondary objectives were to describe discharge interventions other than prescribing that were provided, enablers of and barriers to discharge prescribing, and differences in discharge prescribing by facility or population type, clinical area, and health care charting system.MethodsA descriptive, cross-sectional web-based survey of inpatient pharmacists with APA across Alberta was conducted over a 6-week period in early 2022.ResultsA total of 104 respondents met the inclusion criteria. Under half (45/102, 44.1%) of the participants reported prescribing at discharge. Those that reported prescribing at discharge did so for only a median 14.5% of their patients. The most common enabler of discharge prescribing was a supportive care team, and the most common barrier was the presence of other prescribers. Pharmacists who did not report prescribing at discharge selected "discomfort with being responsible for the prescription" and "fear of professional liability" as barriers more often than those who did report discharge prescribing (51.0% [26/51] vs 33.3% [13/39] and 43.1% [22/51] vs 25.6% [10/39], respectively). The proportion of pharmacists who reported prescribing at discharge was greater with increasing population/facility size (30% [6/20] of pharmacists in settings that served small populations vs 50% [29/58] of those in settings that served large populations).ConclusionsInpatient pharmacists who use APA at discharge reported prescribing for only a minority of patients, and discharge prescribing practices varied widely across the province. Future areas of research include how pharmacists can overcome barriers to prescribing at discharge.

Project description:Background: While clinical pharmacists are expected to have a potential role in minimizing prescribing errors (PEs) in patients with diabetes, the effectiveness of their interventions on the incidence and clinical significance of PEs remains unclear. Objectives: To investigate the effectiveness of clinical pharmacist interventions in correcting PEs in diabetic patients with major polypharmacy. Methods: This was a prospective pre-post study conducted in a secondary care hospital in Jordan over 4 months. There were 2 phases: Control, in which PEs were identified and categorized and active, in which clinical pharmacists intercepted and corrected PEs. Clinical severity of prescribing incidents was evaluated by an expert panel, comprising a senior clinical pharmacist, an internist, and cardiologist. SPSS V26 was used for data analysis. Results: Of 928 patients, 432 were followed and reviewed during the control phase and 496 during the active phase. Clinical pharmacist interventions reduced PEs by 89.5%; from 27.6% (control) to 2.9% (active). PEs per patient and PEs per medication orders were reduced from 2.1 to 0.2 and from 0.3 to 0.03, respectively. Electronic selection errors, wrong dose frequency, duplicate drugs, and allergy errors disappeared in the active phase. Significant, serious, and lethal errors were significantly reduced from 35.4%, 11.6%, and 0.2% (control) to 13.5%, 3.1%, and 0.0% (active), respectively. drugs related to CVS (OR = 5.2; 95% CI, 3.1-8.6; P < .05) versus drugs related to endocrine system was more likely to be associated with the occurrence of PEs versus no PEs. However, drug belonging to infectious (OR = 0.6; 95% CI, 0.1-0.9; P < .05) versus drugs related to endocrine system was less likely to be associated with the occurrence PEs versus no PEs. Conclusion: Clinical pharmacist interventions significantly reduced PEs in patients with diabetes by 89.5% and most of these interventions were clinically significant.

Project description:ImportanceUse of secure messaging for clinician-to-clinician communication has increased exponentially over the past decade, but its association with clinician work is poorly understood.ObjectiveTo investigate the association between secure messaging use and wrong-patient ordering errors.Design, setting, and participantsThis cohort study included inpatient attending physicians, trainee physicians, and advanced practice practitioners (APPs) from 14 academic and community hospitals. Secure messaging volume was assessed over a 3-month period (February 1 to April 30, 2023).ExposureSecure messaging volume per clinician-day, measured as the count of secure messages sent and received by a clinician on a given clinician-day.Main outcomes and measuresRetract-and-reorder events were used to identify wrong-patient ordering errors, and the presence of any retract-and-reorder event on a clinician-day was the primary outcome. Multilevel logistic regression was used to examine the association between secure messaging volume and wrong-patient ordering errors after adjusting for clinician age, sex, patient load, order volume, and clinical service.ResultsA total of 3239 clinicians (median [IQR] age, 37 [32-46] years; 1791 female [55.3%]; 1680 attending physicians [51.2%], 560 trainee physicians [17.3%], and 999 APPs [30.8%]) with 75 546 clinician-days were included. Median secure messaging volume was 16 (IQR, 0-61) messages per day. Retract-and-reorder events were identified on 295 clinician-days (0.4%). Clinicians with secure messaging volume at the 75th percentile had a 10% higher odds of wrong-patient ordering errors compared with those at the 25th percentile (odds ratio [OR], 1.10; 95% CI, 1.01-1.20). After stratifying by clinician role, the association between secure messaging and wrong-patient ordering errors was observed only for attending physicians (OR, 1.20; 95% CI, 1.02-1.42) and APPs (OR, 1.18; 95% CI, 1.00-1.40).Conclusions and relevanceIn this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.

Project description:Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs).To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge.Randomized, controlled trial with concealed allocation and blinded outcome assessors. (ClinicalTrials.gov registration number: NCT00632021)Two tertiary care academic hospitals.Adults hospitalized with acute coronary syndromes or acute decompensated heart failure.Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge.The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable ADEs, as well as potential ADEs.Among 851 participants, 432 (50.8%) had 1 or more clinically important medication errors; 22.9% of such errors were judged to be serious and 1.8% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential ADEs in 253 patients (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (unadjusted incidence rate ratio, 0.92 [95% CI, 0.77 to 1.10]) or ADEs (unadjusted incidence rate ratio, 1.09 [CI, 0.86 to 1.39]). Patients in the intervention group tended to have fewer potential ADEs (unadjusted incidence rate ratio, 0.80 [CI, 0.61 to 1.04]).The characteristics of the study hospitals and participants may limit generalizability.Clinically important medication errors were present among one half of patients after hospital discharge and were not significantly reduced by a health-literacy-sensitive, pharmacist-delivered intervention.National Heart, Lung, and Blood Institute.

Project description:BackgroundAnticoagulants including direct oral anticoagulants (DOACs) are among the highest-risk medications in the United States. We postulated that routine consultation and follow-up from a clinical pharmacist would reduce clinically important medication errors (CIMEs) among patients beginning or resuming a DOAC in the ambulatory care setting.ObjectiveTo evaluate the effectiveness of a multicomponent intervention for reducing CIMEs.DesignRandomized controlled trial.ParticipantsAmbulatory patients initiating a DOAC or resuming one after a complication.InterventionPharmacist evaluation and monitoring based on the implementation of a recently published checklist. Key elements included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests.ControlCoupons and assistance to increase the affordability of DOACs.Main measureAnticoagulant-related CIMEs (Anticoagulant-CIMEs) and non-anticoagulant-related CIMEs over 90 days from DOAC initiation; CIMEs identified through masked assessment process including two physician adjudication of events presented by a pharmacist distinct from intervention pharmacist who reviewed participant electronic medical records and interview data.AnalysisIncidence and incidence rate ratio (IRR) of CIMEs (intervention vs. control) using multivariable Poisson regression modeling.Key resultsA total of 561 patients (281 intervention and 280 control patients) contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs (0.95 per 100 person-days). Failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs were the most common anticoagulant-related CIMEs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients (IRR 1.17; 95% CI 0.98-1.42) or non-anticoagulant-related CIMEs (IRR 1.05; 95% CI 0.80-1.37).ConclusionA multi-component intervention in which clinical pharmacists implemented an evidence-based DOAC Checklist did not reduce CIMEs.Nih trial numberNCT04068727.

Dataset Information

Pharmacist intervention on prescribing errors: Use of a standardized approach in the inpatient setting.

Purpose

Methods

Results

Conclusion

Publications

Pharmacist intervention on prescribing errors: Use of a standardized approach in the inpatient setting.

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