Adv Pharm Bull. 2019;9(1):174-179.
doi: 10.15171/apb.2019.020
  Abstract View: 135
  PDF Download: 170

Research Article

Detection and Management of Common Medication Errors inInternal Medicine Wards: Impact on Medication Costs and Patient Care

Kamal Boostani 1 ORCiD, Hamid Noshad 2, Farahnoosh Farnood 2, Haleh Rezaee 3, Soheil Teimouri 4, Taher Entezari-Maleki 3, Reyhane Najafiazar 5, Azam Hassanpouri-Olia 5, Afshin Gharekhani 6 * ORCiD

1 Drug Applied Research Center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
2 Chronic Kidney Disease Research Center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Drug Applied Research Center, Department of Clinical Pharmacy (Pharmacotherapy), Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
4 Department of Internal Medicine, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
5 Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
6 Drug Applied Research Center, Department of Clinical Pharmacy (Pharmacotherapy), Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Introduction: Medication errors (MEs) are a leading cause of morbidity and mortality, yet they have remained as confusing and underappreciated concept. The complex pharmacotherapy in hospitalized patients and sometimes serious clinical consequences of MEs necessitate continued report and surveillance of MEs as well as persistent pharmaceutical care for patients at medical wards. This study evaluated the frequency, types, clinical significance, and costs of MEs in internal medicine wards.

Method: In this 8-month prospective and cross-sectional study, an attending clinical pharmacist, as an integral member of a health care team, visited the patients during each physician's ward round at the morning. All MEs including prescription, transcription, and administration errors were detected, recorded, and subsequently appropriate corrective interventions were proposed during these rounds. The changes in the medications' cost after implementing clinical pharmacist's interventions were compared to the calculated medications' cost, assuming that the MEs would not have been detected by clinical pharmacist and continued up to discharge time of the patients.

Results: 89% of the patients experienced at least one ME during their hospitalization. A mean of 2.6 errors per patient or 0.2 errors per ordered medication occurred in this study. More than 70% of MEs happened at the prescription stage by treating physicians. The most prevalent prescription errors were inappropriate drug selection, unauthorized drugs and untreated indication. The highest MEs occurred on cardiovascular agents followed by antibiotics, and vitamins, minerals, and electrolytes. Total number of MEs showed a marked correlation with the total number of ordered medications and patients’ length of hospitalization. The net effect of clinical pharmacist’s contributions in medication therapy management was to decline medications’ costs by 33.9%. None of the MEs caused the patients harm.

Conclusion: The role of clinical pharmacy services in detection, prevention and reducing the cost of MEs is of paramount importance to internal medicine wards. Key words: clinical pharmacist; medication errors; pharmaceutical care; internal medicine.

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Submitted: 06 Jun 2018
Revised: 22 Oct 2018
Accepted: 22 Dec 2018
First published online: 21 Feb 2019
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