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      Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital

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          Abstract

          Background

          Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU) in a tertiary hospital in People’s Republic of China.

          Method

          A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed.

          Results

          During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2%) pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%), drug omission (n=83, 20.4%), and potential or actual occurrence of adverse drug reaction (n=54, 13.3%) were the three most commonly committed medication errors. Approximately 339 (83.4%) medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0%) were the most frequent type of medication associated with errors.

          Conclusion

          Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors.

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          Most cited references 19

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          Drug-related problems in hospitals: a review of the recent literature.

          Problems associated with pharmacotherapy (in particular, medication errors and adverse drug events) are frequent and are associated with increased costs for treatment. Analysis of original publications published between 1990 and 2005 on the topics of medication errors and/or adverse drug events in hospitalised patients, focusing on the frequency of, risk factors for and avoidance of such problems associated with pharmacotherapy, indicated that medication errors occurred in a mean of 5.7% of all episodes of drug administration, but with a high variability among the 35 studies retrieved. This variability was explained by the methods by which medication errors were detected (systematic screening of patients versus chart review or spontaneous reporting) and by the way drugs were administered (intravenously administered drugs are associated with the highest error frequencies). Errors occurred throughout the whole medication process, with administration errors accounting for more than half of all errors. Important risk factors included insufficient pharmacological knowledge of health professionals, errors in the patient charts or documentation by nurses and inadequate pharmacy services.Adverse events or reactions, on the other hand, affected 6.1 patients per 100 hospitalised and also showed a high variability among the 46 studies retrieved. This variability could also be explained by the different methods of assessment of the frequency of adverse drug events or reactions, as well as by the different wards on which the studies were performed. Important risk factors for adverse drug events or reactions included polypharmacy, female sex, drugs with a narrow therapeutic range, renal elimination of drugs, age >65 years and use of anticoagulants or diuretics. Since medication errors are strong risk factors for preventable adverse drug events or reactions, strategies have to be put in place for their reduction. Such strategies include ensuring that all persons involved in the medication process (nurses, pharmacists and physicians) have good pharmacological knowledge, computerisation of the entire medication process, and the engagement of a sufficient number of clinical pharmacists on the wards.
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            On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

            Introduction Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. Methods A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. Results During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost €3, but might have saved €26 to €40 by preventing ADEs. Conclusions On-ward participation of a hospital pharmacist in a Dutch ICU was associated with significant reductions in prescribing errors and related patient harm (preventable ADEs) at acceptable costs per monitored patient-day. Trial registration number ISRCTN92487665
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              Clinical review: Medication errors in critical care

              Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed twice as many medications as patients outside of the intensive care unit (ICU) and nearly all will suffer a potentially life-threatening error at some point during their stay. The aim of this article is to provide a basic review of medication errors in the ICU, identify risk factors for medication errors, and suggest strategies to prevent errors and manage their consequences.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2014
                09 October 2014
                : 10
                : 861-866
                Affiliations
                [1 ]Department of Pharmacy, Zhejiang University, Hangzhou, People’s Republic of China
                [2 ]Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
                Author notes
                Correspondence: Qing-Wei Zhao, Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, People’s Republic of China, Tel +86 571 8723 3411, Fax +86 571 8723 3411, Email qingweizhao66@ 123456yeah.net

                *These authors contributed equally to this work

                Article
                tcrm-10-861
                10.2147/TCRM.S69585
                4199561
                © 2014 Jiang et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Short Report

                Medicine

                severity, intensive care unit, prevalence rate, type, pharmacist, medication error

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