gms | German Medical Science

Objective: Medication errors (MEs) are common among the inpatient population and overall 2% of patients admitted to hospitals are harmed as a result of MEs. Prescribing errors (PEs) are the most common type of ME and affect 2–15% of medication orders. Various interventions and strategies have been proposed to reduce the frequency of Pes, one of which is clinical pharmacist (CP) medication review. This study sought to determine the annual prevalence and nature of PEs in an academic neurosurgical department including its high-dependency unit (HDU). Moreover, the impact of weekly prescribing drug review by a CP and a combined surgeon-CP ward round was characterised.

Methods: During the observation period, weekly CP medication review and a combined surgeon-CP ward round took place on the 38-bed standard-care neurosurgical ward and the 10-bed HDU. PEs were determined by the CP following discussion with the surgical team. The focus of the evaluation was on drug dosing (therapeutic range, dosing interval, dose adjustment in cases of organ dysfunction). In addition, a comprehensive medication interaction check flagged interactions, which were evaluated for severity and clinical relevance. Time trends were evaluated to explore whether the CP intervention led to overall improved surgeon prescribing patterns and reduced PE rates over time.

Results: The CP identified 995 PEs across the 1795 neurosurgical patients (1370 normal ward, 425 HDU) over the 12 months. On the HDU ward, there were 0.68 PEs per patient, compared to 0.52 PEs on the normal ward. PE types identified were similar in both the normal ward and HDU settings. The most frequent PE was unclear or no longer relevant indication (17%) followed by drug interaction (12%), double prescribing (9%) and incorrect dosing interval (10%). The drugs most commonly associated with PEs were pantoprazole (5%), amlodipine (3%) and ciprofloxacin (3%).

Conclusion: Errors in drug prescribing and administration are common and arise from multiple interacting causes. The routine involvement of a clinical pharmacist for medication review led to prompt identification of a range of PEs in the normal ward and HDU environments, seemed to enhance surgeons’ knowledge and prescribing skills and has the potential to impact on the safety of neurosurgical care.