Advertisement

International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1188–1202 | Cite as

Detection and correct handling of prescribing errors in Dutch hospital pharmacies using test patients

  • Marieke M. Beex-Oosterhuis
  • Ed M. de Vogel
  • Heleen van der Sijs
  • Hetty G. Dieleman
  • Patricia M. L. A. van den BemtEmail author
Research Article

Abstract

Background Hospital pharmacists and pharmacy technicians play a major role in detecting prescribing errors by medication surveillance. At present the frequency of detected and correctly handled prescribing errors is unclear, as are factors associated with correct handling. Objective To examine the frequency of detection of prescribing errors and the frequency of correct handling, as well as factors associated with correct handling of prescribing errors by hospital pharmacists and pharmacy technicians. Setting This study was conducted in 57 Dutch hospital pharmacies. Method Prospective observational study with test patients, using a case–control design to identify factors associated with correct handling. A questionnaire was used to collect the potential factors. Test patients containing prescribing errors were developed by an expert panel of hospital pharmacists (a total of 40 errors in nine medication records divided among three test patients; each test patient was used in 3 rounds; on average 4.5 prescribing error per patient per round). Prescribing errors were defined as dosing errors or therapeutic errors (contra-indication, drug–drug interaction, (pseudo)duplicate medication). The errors were selected on relevance and unequivocalness. The panel also defined how the errors should be handled in practice using national guidelines and this was defined as ‘correct handling’. The test patients had to be treated as real patients while conducting medication surveillance. The pharmacists and technicians were asked to report detected errors to the investigator. Main outcome measure The percentages of detected and correctly handled prescribing errors were the main outcome measures. Factors associated with correct handling were determined, using multivariate logistic regression analysis. Results Fifty-nine percent of the total number of intentionally added prescribing errors were detected and 57 % were handled correctly by the hospital pharmacists and technicians. The use of a computer system for medication surveillance compared to no computer system was independently associated with correct handling [odds ratio (OR) 15.39 (95 % confidence interval (CI) 3.62–65.50] for computerized physician order entry system; OR 15.40 (95 % CI 3.61–65.70) for order entry by pharmacy technicians), but because the reference category contained only one hospital these results can’t be interpreted. Furthermore, manual screening of dosages in children with or without computerized surveillance compared to no dosage checks for children [OR 2.02 (95 % CI 1.06–3.84)], qualified pharmacy technicians compared to no qualified pharmacy technicians [OR 1.32 (95 % CI 1.03–1.67)] and pharmacy technicians using protocols compared to ones not using protocols [OR 1.30 (95 % CI 1.04–1.61)] were independently associated with correct handling. Conclusion This study showed that the quality of medication surveillance in Dutch hospital pharmacies can be subject to improvement and the identified factors may give direction to such improvements.

Keywords

Computerized physician order entry system Hospital pharmacist Medication surveillance Netherlands Potentially inappropriate medication Presciption errors Quality 

Notes

Acknowledgments

We would like to thank all participating hospital pharmacies. Robert ten Broeke is kindly acknowledged for joining the authors of this article in contributing to the development of the cases as a member of the expert panel.

Funding

None.

Conflicts of interest

No author reported any conflicts of interest.

References

  1. 1.
    Boyko WL Jr, Yurkowski PJ, Ivey MF, Armitstead JA, Roberts BL. Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital. Am J Health Syst Pharm. 1997;54:1591–5.PubMedGoogle Scholar
  2. 2.
    Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166:955–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Buurma H, De Smet PA, Leufkens HG, Egberts AC. Evaluation of the clinical value of pharmacists’ modifications of prescription errors. Br J Clin Pharmacol. 2004;58:503–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Kohn L, Corrigan J, Donaldson M, editors. To err is human—building a safer health system. Washington, DC: Institute of Medicine, National Academy Press; 2000. ISBN 0-309-26174-0.Google Scholar
  5. 5.
    Otero P, Leyton A, Ceriani Cernadas JM, Mariani G, Patient Safety Committee. Medication errors in pediatric inpatients: prevalence and results of a prevention program. Pediatrics. 2008;122:e737–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Gijssel-Wiersma DG, Van den Bemt PM, Walenbergh-van Veen MC. Influence of computerised medication charts on medication errors in a hospital. Drug Saf. 2005;28:1119–29.PubMedCrossRefGoogle Scholar
  7. 7.
    Van den Bemt PM, Egberts TC, de Jong-van den Berg LT, Brouwers JR. Drug-related problems in hospitalized patients—a review. Drug Saf. 2000;22:321–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Kopp BJ, Erstad BL, Allen ME, Theodorou AA, Priestley G. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med. 2006;34:415–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Moyen E, Camiré E, Stelfox HT. Clinical review: medication errors in critical care. Crit Care. 2008;12:208.PubMedCrossRefGoogle Scholar
  10. 10.
    Kfuri TA, Morlock L, Hicks RW, Shore AD. Medication errors in obstetrics. Clin Perinatol 2008;35:101–17, viii–ix.Google Scholar
  11. 11.
    Wong IC, Wong LY, Cranswick NE. Minimising medication errors in children. Arch Dis Child. 2009;94:161–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30:379–407.PubMedCrossRefGoogle Scholar
  13. 13.
    Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P, Durieux P. Evaluation of drug administration errors in a teaching hospital. BMC Health Serv Res. 2012;12:60.PubMedCrossRefGoogle Scholar
  14. 14.
    Fernandez-Llamazares CM, Calleja-Hernández MA, Manrique-Rodríguez S, Pérez-Sanz C, Durán-García E, Sanjurjo-Sáez M. Prescribing errors intercepted by clinical pharmacists in paediatrics and obstetrics in a tertiary hospital in Spain. Eur J Clin Pharmacol. 2012;68:1339–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Dean Franklin B, Vincent C, Schachter M, Barber N. The incidence of prescribing errors in hospital inpatients: an overview of the research methods. Drug Saf. 2005;28:891–900.PubMedCrossRefGoogle Scholar
  16. 16.
    Dean B, Schachter M, Vincent C, Barber N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care. 2002;11:340–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Schiff GD, Klass D, Peterson J, Shah G, Bates DW. Linking laboratory and pharmacy: opportunities for reducing errors and improving care. Arch Intern Med. 2003;163:893–900.PubMedCrossRefGoogle Scholar
  18. 18.
    Harinstein LM, Kane-Gill SL, Smithburger PL, Culley CM, Reddy VK, Seybert AL. Use of an abnormal laboratory value-drug combination alert to detect drug-induced thrombocytopenia in critically Ill patients. J Crit Care. 2012;27:242–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293:1197–203.PubMedCrossRefGoogle Scholar
  20. 20.
    Van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13:138–47.PubMedCrossRefGoogle Scholar
  21. 21.
    Jani YH, Barber N, Wong IC. Characteristics of clinical decision support alert overrides in an electronic prescribing system at a tertiary care paediatric hospital. Int J Pharm Pract. 2011;19:363–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282:267–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.PubMedCrossRefGoogle Scholar
  24. 24.
    Van Roon EN, Flikweert S, le Comte M, Langendijk PN, Kwee-Zuiderwijk WJ, Smits P, et al. Clinical relevance of drug–drug interactions: a structured assessment procedure. Drug Saf. 2005;28:1131–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Van der Sijs H, Bouamar R, van Gelder T, Aarts J, Berg M, Vulto A. Functionality test for drug safety alerting in computerized physician order entry systems. Int J Med Inform. 2010;79:243–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Thies BJ, Van der Hoeven RT, Egberts AC. Patient interventions in the Dutch hospital pharmacy. Pharm Weekbl. 2003;138:1318–22 (in Dutch).Google Scholar
  27. 27.
    Donyai P, O’Grady K, Jacklin A, Barber N, Franklin BD. The effects of electronic prescribing on the quality of prescribing. Br J Clin Pharmacol. 2008;65:230–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Sanghera N, Chan PY, Khaki ZF, Planner C, Lee KK, Cranswick NE, et al. Interventions of hospital pharmacists in improving drug therapy in children: a systematic literature review. Drug Saf. 2006;29:1031–47.PubMedCrossRefGoogle Scholar
  29. 29.
    Davis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91.PubMedCrossRefGoogle Scholar
  30. 30.
    Kadmon G, Bron-Harlev E, Nahum E, Schiller O, Haski G, Shonfeld T. Computerized order entry with limited decision support to prevent prescription errors in a PICU. Pediatrics. 2009;124:935–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Shaughnessy AF, D’Amico F. Long-term experience with a program to improve prescription-writing skills. Fam Med. 1994;26:168–71 (Abstract).PubMedGoogle Scholar
  32. 32.
    Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. JAMA. 1997;277:312–7.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Marieke M. Beex-Oosterhuis
    • 1
  • Ed M. de Vogel
    • 1
  • Heleen van der Sijs
    • 2
  • Hetty G. Dieleman
    • 1
  • Patricia M. L. A. van den Bemt
    • 2
    Email author
  1. 1.Department of Hospital PharmacyAlbert Schweitzer HospitalDordrechtThe Netherlands
  2. 2.Department of Hospital PharmacyErasmus University Medical CenterRotterdamThe Netherlands

Personalised recommendations