The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre

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Abstract

Centralized intravenous admixture service (CIVAS) centres, which are pharmaceutical departments found in Chinese hospitals, provide high-quality intravenous fluids and pharmaceutical services for patients, and errors in their working procedures can lead to adverse consequences. Pharmacists, the primary CIVAS centre personnel, play a role in risk control; however, to date, the effect of pharmacists’ participation in risk management has not been reported. The main aim of this study was to evaluate the pharmacist’s role in risk control and evaluate its impact. A retrospective observational study was designed to assess the principal working process in the CIVAS centre of a provincial healthcare setting. Errors in the main working process were identified, and intervention measures were formulated. The pharmacist intervention effect was evaluated by assessing the identification rate of improper prescriptions; the incidence rate of drug preparation, compounding, packaging and delivery process errors; and expenditures on wasteful drugs. There was a higher identification rate for improper prescriptions after the intervention ( P < 0.05), while the incidence of drug preparation ( P < 0.05), admixture ( P < 0.05), and packaging and delivery errors ( P < 0.01) was significantly lower; the total wasteful medication expenditure was also dramatically reduced. The potential creativity of pharmacists in error control can provide dependable intravenous drugs for patients and reduce the running expenditures for CIVAS.

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Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

Florence Ranchon, Gilles Salles, Hans-Martin Späth … (2011)

Background In spite of increasing efforts to enhance patient safety, medication errors in hospitalised patients are still relatively common, but with potentially severe consequences. This study aimed to assess antineoplastic medication errors in both affected patients and intercepted cases in terms of frequency, severity for patients, and costs. Methods A 1-year prospective study was conducted in order to identify the medication errors that occurred during chemotherapy treatment of cancer patients at a French university hospital. The severity and potential consequences of intercepted errors were independently assessed by two physicians. A cost analysis was performed using a simulation of potential hospital stays, with estimations based on the costs of diagnosis-related groups. Results Among the 6, 607 antineoplastic prescriptions, 341 (5.2%) contained at least one error, corresponding to a total of 449 medication errors. However, most errors (n = 436) were intercepted before medication was administered to the patients. Prescription errors represented 91% of errors, followed by pharmaceutical (8%) and administration errors (1%). According to an independent estimation, 13.4% of avoided errors would have resulted in temporary injury and 2.6% in permanent damage, while 2.6% would have compromised the vital prognosis of the patient, with four to eight deaths thus being avoided. Overall, 13 medication errors reached the patient without causing damage, although two patients required enhanced monitoring. If the intercepted errors had not been discovered, they would have resulted in 216 additional days of hospitalisation and cost an estimated annual total of 92, 907€, comprising 69, 248€ (74%) in hospital stays and 23, 658€ (26%) in additional drugs. Conclusion Our findings point to the very small number of chemotherapy errors that actually reach patients, although problems in the chemotherapy ordering process are frequent, with the potential for being dangerous and costly.

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The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.

Gang Cheng, Lynn Silver, Qingyue Meng … (2005)

In China, 44.4% of total health expenditures in 2001 were for pharmaceuticals. Containment of pharmaceutical expenditures is a top priority for policy intervention. Control of drug retail prices was adopted by the Chinese government for this purpose. This study aims to examine the impact of this policy on the containment of hospital drug expenditures, and to analyze contributing factors. This is a retrospective pre/post-reform case study in two public hospitals. Financial records were reviewed to analyze changes in drug expenditures for all patients. A tracer condition, cerebral infarction, was selected for in-depth examination of changes in prices, utilization, expenditures and rationality of drugs. In the two hospitals, a total of 104 and 109 cerebral infarction cases, hospitalized respectively before and after the reform, were selected. Prescribed daily dose (PDD) was used for measuring drug utilization, and the contribution of price and utilization to changes in drug expenditures were decomposed. Rationality of drug use post-reform was reviewed based on published literature. Drug expenditures for all patients still increased rapidly in the two hospitals after implementation of the pricing policy. In the provincial hospital, drug expenditures per patient for cerebral infarction cases declined, but not significantly. This was mainly attributable to reduced utilization. In the municipal hospital, drug expenditure per patient increased by 50.1% after the reform, mainly due to greater drug utilization. Three to five fold higher drug expenditure per inpatient day in the provincial hospital was due to use of more expensive drugs. Of the top 15 drugs for treating cerebral infarction cases after the reform, 19.5% and 46.5% of the expenditures, in the provincial and municipal hospitals, respectively, were spent on drugs with prices set by the government. A large proportion of expenditures for the top 15 drugs, at least 65% and 41% in the provincial and municipal hospitals, respectively, was spent on allopathic drugs without an adequate evidence base of safety and efficacy supporting use for cerebral infarction. Control of retail prices, implemented in isolation, was not effective in containing hospital drug expenditures in these two Chinese hospitals. Utilization, more than price, determined drug expenditures. Improvement of rational use of drugs and correcting the present incentive structure for hospitals and drug prescribers may be important additional strategies for achieving containment of drug expenditures.

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Incidence and prevalence of intravenous medication errors in the UK: a systematic review

Adam Sutherland, Michela Canobbio, Janine Clarke … (2018)

Objectives Medication error is the most common type of medical error, and intravenous medicines are at a higher risk as they are complex to prepare and administer. The WHO advocates a 50% reduction of harmful medication errors by 2022, but there is a lack of data in the UK that accurately estimates the true rate of intravenous medication errors. This study aimed to estimate the number of intravenous medication errors per 1000 administrations in the UK National Health Service and their associated economic costs. The rate of errors in prescribing, preparation and administration, and rate of different types of errors were also extracted. Methods MEDLINE, Embase, Cochrane central register of clinical trials, Database of Abstracts of Reviews of Effectiveness, National Health Service Economic Evaluation Database and the Health Technology Appraisals Database were searched from inception to July 2017. Epidemiological studies to determine the incidence of intravenous medication errors set wholly or in part in the UK were included. 228 studies were identified, and after screening, eight papers were included, presenting 2576 infusions. Data were reviewed and extracted by a team of five reviewers with discrepancies in data extraction agreed by consensus. Results Five of eight studies used a comparable denominator, and these data were pooled to determine a weighted mean incidence of 101 intravenous medication errors per 1000 administrations (95% CI 84 to 121). Three studies presented prevalence data but these were based on spontaneous reports only; therefore it did not support a true estimate. 32.1% (95% CI 30.6% to 33.7%) of intravenous medication errors were administration errors and ‘wrong rate’ errors accounted for 57.9% (95% CI 54.7% to 61.1%) of these. Conclusion Intravenous medication errors in the UK are common, with half these of errors related to medication administration. National strategies are aimed at mitigating errors in prescribing and preparation. It is now time to focus on reducing administration error, particularly wrong rate errors.

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Author and article information

Contributors

Hongxia Chen:

ORCID: http://orcid.org/0000-0001-8775-8831

chxgx008@126.com

Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2045-2322

Publication date (Electronic): 8 March 2021

Publication date PMC-release: 8 March 2021

Publication date Collection: 2021

Volume: 11

Electronic Location Identifier: 5445

Affiliations

[1 ]GRID grid.410652.4, ISNI 0000 0004 6003 7358, Department of Clinical Pharmacy, , People’s Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, 530021 Guangxi China

[2 ]GRID grid.410652.4, ISNI 0000 0004 6003 7358, Intravenous Admixture Services Centre, , People’s Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, 530021 Guangxi China

[3 ]GRID grid.410652.4, ISNI 0000 0004 6003 7358, Department of Pharmacy, , People’s Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, 530021 Guangxi China

Author information

Hongxia Chen http://orcid.org/0000-0001-8775-8831

Article

Publisher ID: 85077

DOI: 10.1038/s41598-021-85077-w

PMC ID: 7940617

PubMed ID: 33686207

SO-VID: 0750b6ad-96a1-4ed8-9879-ace7f898f06c

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 15 October 2020

Date accepted : 24 February 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003454, Guangxi Zhuang Region Health Department;

Award ID: Z20170382

Award Recipient : Hongxia Chen

Funded by: FundRef http://dx.doi.org/10.13039/501100009329, Scientific Research and Technology Development Program of Guangxi;

Award ID: 15277005

Award Recipient : Hualing Wei

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ScienceOpen disciplines: Uncategorized

Keywords: health occupations,risk factors

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ScienceOpen disciplines: Uncategorized

Keywords: health occupations, risk factors

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The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre

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Cardiovascular Innovations and Applications

Most cited references 17

Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.

Incidence and prevalence of intravenous medication errors in the UK: a systematic review

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