International Journal of Clinical Pharmacy

, Volume 35, Issue 4, pp 638–646 | Cite as

Profile of prescribing errors detected by clinical pharmacists in paediatric hospitals in Spain

  • Cecilia M. Fernández-LlamazaresEmail author
  • Maite Pozas
  • Begoña Feal
  • M. Josep Cabañas
  • Miquel Villaronga
  • Yolanda Hernández-Gago
  • Mercedes Ruiz de Villegas
  • Concha Álvarez-del-Vayo
Research Article


Background Pharmaceutical care involves three essential functions: identifying potential and real medication-related problems, solving real medication-related problems and preventing potential medication related problems. Objective To describe the profile of prescribing errors detected and prevented by paediatric clinical pharmacists in medical orders for inpatients in Spain. Settings and methods A prospective, descriptive, multicentre epidemiological study on medical orders for inpatients aged 1 day to 18 years, conducted between July and October 2011 at eight hospitals treating paediatric patients. Main outcome measure primary variables were most common errors, including clinical severity (according to a previously validated instrument), pharmacotherapeutic groups and drugs most commonly involved, the impact of pharmaceutical interventions, as well as the population receiving most interventions, and type of prescription (manual of electronic) and dispensation system (ward stock, unit-dose or automated dispensing cabinets) that are most involved in Spain. Results A total of 667 interventions related to quality of the prescription were recorded at eight sites. 21 were excluded. 41.2 % concerned manual prescribing systems, and 58.8 % electronic prescribing systems. The interventions were performed on patients with a mean age of 5 years (standard deviation 5.43). In interventions concerning prescribing errors, 212 different drugs were involved, mainly belonging to the group of anti-infectives. The main factor triggering pharmacist’s recommendations was dose errors of 1.5–10 times the recommended dose. Therefore, the main prescription errors are dosing errors (49.3 %). With regard to the clinical severity of these prescribing errors, 51.9 % (306 cases) were considered significant, 26.3 % (155 cases) of minor significance, 19.8 (117 cases) were clinically serious and 2.0 % (12 cases) were potentially fatal. There was a 95.4 % global acceptance rate for recommendations. The impact of accepted interventions showed that 64.7 % had a significant impact on patient health outcome, highlighting 1.1 % with a highly significant impact. The activity level of the paediatric clinical pharmacists was highly variable, with a median of 0.014 interventions/bed-day during the data collection period. Conclusion In view of the importance of the dosing errors in the prescription phase, and the clinical relevance of the errors detected, it seems to be necessary to implement measures as the development of decision support systems for paediatric dosing and strengthen the presence of pharmacists as a key element in preventing prescribing errors from reaching patients, thus ensuring that children receive effective, safe and efficient drug therapy.


Prescibing Drug therapy Medication errors Paediatrics Pharmacists Pharmacy service Hospital pharmacy Prospective studies Spain Standards 



We would also like to thank all the pharmacists at the eight participating sites who were not investigators but helped by collecting data for the study. And finally we would also like to thank José Mª Bellón for his invaluable statistical support.


We are grateful to Sociedad Española de Farmacia Hospitalaria [Spanish Society of Hospital Pharmacy], which awarded a grant to Grupo Español de Farmacia Pediátrica in order toconduct the research project within which this study has been developed.

Conflicts of interest

The authors declare to have no conflict of interest.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Cecilia M. Fernández-Llamazares
    • 1
    Email author
  • Maite Pozas
    • 2
  • Begoña Feal
    • 3
  • M. Josep Cabañas
    • 4
  • Miquel Villaronga
    • 5
  • Yolanda Hernández-Gago
    • 6
  • Mercedes Ruiz de Villegas
    • 7
  • Concha Álvarez-del-Vayo
    • 8
  1. 1.Clinical Pharmacist, Pharmacy ServiceHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Head of Pharmacy ServiceHospital Niño JesúsMadridSpain
  3. 3.Clinical Pharmacist, Pharmacy ServiceHospital Teresa Herrera CHUACA CoruñaSpain
  4. 4.Clinical Pharmacist, Pharmacy ServiceHospital Vall d’HebrónBarcelonaSpain
  5. 5.Clinical Pharmacist, Pharmacy ServiceHospital San Joan de Deu.BarcelonaSpain
  6. 6.Clinical Pharmacist, Pharmacy ServiceHospital Materno-Infantil de CanariasLas Palmas de Gran CanariaSpain
  7. 7.Clinical Pharmacist, Pharmacy ServiceHospital Carlos HayaMálagaSpain
  8. 8.Clinical Pharmacist, Pharmacy ServiceHospital Virgen del RocíoSevilleSpain

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