THE IMPACT OF CLINICAL PHARMACIST IN DETECTION OF
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This study analyzed medical records from 80 patients at an internal medicine department in Zagazig, Egypt to identify drug-related problems. The study found that 66.2% of patients experienced drug-drug interactions, with the most common being moderate in severity and fair reliability. Errors included high doses, inappropriate frequencies, and wrong or duplicate drugs. The study recommends including clinical pharmacists in prescribing and monitoring to reduce errors and establish treatment guidelines.
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This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
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Presentation (1)
1. A patient was prescribed the wrong dose of phenytoin due to brand substitution and received 1025 mg instead of 270 mg, resulting in abnormal CT changes and prolonged drowsiness.
2. Dispensing and administration errors can occur from issues like confusing drug names, incorrect dosages, wrong drugs or routes of administration.
3. It is important for healthcare providers to have proper training, follow safe procedures, double check medications, and report any errors to prevent harm to patients.
Medication errors
This document discusses medication errors, including their definition, causes, types, and strategies to prevent them. Some key points:
- Medication errors are preventable events that may cause harm and can occur at any stage from prescribing to administration. They are common but underreported.
- Errors are often due to look-alike or sound-alike drug names, miscommunication, lack of knowledge, and environmental factors like interruptions.
- Common types of errors include prescribing errors, dispensing errors, and administration errors. Analgesics, antibiotics, anticoagulants are high-risk drug classes.
- Prevention strategies include education, standardized processes, double checks, limiting distractions, clear
Polypharmacy
Polypharmacy, defined as taking multiple medications, is common in the elderly population. Over half of people aged 65 and older take 5-9 medications, while 18% take 10 or more. The prevalence is higher in women due to longer lifespans and more frequent doctor visits. Polypharmacy can lead to adverse drug events, with risk exponentially increasing with more medications. Common signs include dizziness, confusion, and fatigue. Solutions include reducing unnecessary medications, simplifying dosing schedules, and increasing medication management support and provider education to curb this significant health issue in aging populations.
Prescription Patterns
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
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This document summarizes a study on polypharmacy among patients in South India. The study defined polypharmacy as using 2-4 drugs as minor polypharmacy and 5 or more drugs as major polypharmacy. It found that 59.82% of patients had major polypharmacy, occurring most in cardiovascular diseases. Polypharmacy was more prevalent in males and in ages 19-60 years. Hospital stays were longer for major polypharmacy. The study suggests simplifying treatment regimens by eliminating unnecessary drugs and dosages to reduce problems from polypharmacy.
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This document provides an introduction to pharmacoepidemiology. It defines pharmacoepidemiology as the study of drug use and effects in large populations. It discusses study designs used in pharmacoepidemiology including randomized trials, cohort studies, case-control studies, and case reports. Reasons for performing pharmacoepidemiology studies include fulfilling regulatory and legal obligations, assessing drug safety, and generating or testing hypotheses. Sources of data include spontaneous adverse event reporting, prescription databases, and electronic health records. The document also briefly discusses molecular pharmacoepidemiology, bioethics, pharmacoeconomics, and measuring quality of life outcomes.
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The document discusses the principles and importance of rational drug therapy and essential drug concepts, which aim to maximize treatment effectiveness and safety while minimizing costs by prescribing the most appropriate medications. It outlines factors that contribute to irrational drug use and the role pharmacists can play in counseling patients and physicians, reporting adverse drug reactions, procuring cost-effective drugs, and promoting rational drug utilization. The document also provides examples of commonly used essential drugs and steps that can improve rational prescribing.
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A study was conducted at a community pharmacy in Madrid, Spain to evaluate dispensing errors over a 3-month period. Investigators observed over 12,000 prescriptions and identified 55 dispensing errors. The most common errors were dispensing the wrong drug strength (31.5% of errors) and dispensing the wrong quantity (25.9% of errors). Pharmacy technicians were found to make errors more frequently than pharmacists. The study aims to help identify ways to reduce dispensing errors and improve patient safety.
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The study evaluated the impact of a clinical pharmacist intervention in a nephrology unit between 2012 and 2013. The number of pharmacist interventions increased significantly from 824 in 2012 to 1977 in 2013. This resulted in estimated cost savings of $52,072 in 2012 and $144,138 in 2013. Estimated cost avoidance of preventable adverse drug events increased from $3,383,700 in 2012 to $7,342,200 in 2013. The benefit-cost ratio doubled from 4.29 to 9.36 after the pharmacist's involvement. Overall, the study demonstrated that a clinical pharmacist can reduce medication errors and healthcare costs while preventing adverse events.
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This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
- High-risk medications like anticoagulants require special precautions. Healthcare professionals should know drugs well, use memory aids, and develop checking habits to minimize errors.
- Encouraging patient involvement, thorough documentation, learning from past errors, and clear communication can also
Presentation (1)
1. A patient was prescribed the wrong dose of phenytoin due to brand substitution and received 1025 mg instead of 270 mg, resulting in abnormal CT changes and prolonged drowsiness.
2. Dispensing and administration errors can occur from issues like confusing drug names, incorrect dosages, wrong drugs or routes of administration.
3. It is important for healthcare providers to have proper training, follow safe procedures, double check medications, and report any errors to prevent harm to patients.
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This document discusses medication errors, including their definition, causes, types, and strategies to prevent them. Some key points:
- Medication errors are preventable events that may cause harm and can occur at any stage from prescribing to administration. They are common but underreported.
- Errors are often due to look-alike or sound-alike drug names, miscommunication, lack of knowledge, and environmental factors like interruptions.
- Common types of errors include prescribing errors, dispensing errors, and administration errors. Analgesics, antibiotics, anticoagulants are high-risk drug classes.
- Prevention strategies include education, standardized processes, double checks, limiting distractions, clear
Polypharmacy
Polypharmacy, defined as taking multiple medications, is common in the elderly population. Over half of people aged 65 and older take 5-9 medications, while 18% take 10 or more. The prevalence is higher in women due to longer lifespans and more frequent doctor visits. Polypharmacy can lead to adverse drug events, with risk exponentially increasing with more medications. Common signs include dizziness, confusion, and fatigue. Solutions include reducing unnecessary medications, simplifying dosing schedules, and increasing medication management support and provider education to curb this significant health issue in aging populations.
Prescription Patterns
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
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An observational study of medication
administration errors in old-age
psychiatric inpatients
CAMILLA HAW, JEAN STUBBS AND GEOFF DICKENS
St. Andrew’s Hospital, Billing Road, Northampton, NN1 5DG, United Kingdom.
Abstract
Background. Relatively little is known about medication administration errors in mental health settings.
Objective. To investigate the frequency and nature of medication administration errors in old-age psychiatry. To assess the
acceptability of the observational technique to nurse participants.
Method. Cross-sectional study technique using (i) direct observation, (ii) medication chart review and (iii) incident reports.
Setting. Two elderly long-stay wards in an independent UK psychiatric hospital.
Participants. Nine nurses administering medication at routine medication rounds.
Main outcome measures. Frequency, type and severity of directly observed medication administration errors compared with
errors detected by retrospective chart review and incident reports.
Results. Using direct observation 369 errors in 1423 opportunities for errors (25.9%) were detected vs. chart review detected
148 errors and incident reports none. Most errors were of doubtful or minor severity. The pharmacist intervened on four
occasions to prevent an error causing patient harm. The commonest errors observed were unauthorized tablet crushing or
capsule opening (111/369, 30.1%), omission without a valid reason (100/369, 27.1%) and failure to record administration
(87/369, 23.6%). Among the nurses observed, the error rate varied widely from no errors to one error in every two doses
administered. Of the seven nurses who completed the post-observation questionnaire, all said they would be willing to be
observed again.
Conclusion. Medication administration errors are common and mostly minor. Direct observation is a useful, sensitive
method for detecting medication administration errors in psychiatry and detects many more errors than chart review or inci-
dent reports. The technique appeared to be acceptable to most of the nursing staff that were observed.
Keywords: administration, adverse drug events, elderly, medication errors, mental health, observation, psychiatry
Medication errors (prescribing, transcribing, dispensing and
administration errors) are an important cause of patient mor-
bidity and mortality [1]. Medication administration errors are
a common sub-type of medication errors and accounted for
34% of errors in one large USA study conducted in medical
and surgical units [2]. Observational studies in general hospi-
tals have yielded error rates varying between 3.5 and 27% of
doses [3–8]. Direct observation detects medication adminis-
tration errors at a much higher rate than chart review or inci-
dent report review [9]. The observational method has been
demonstrated to be valid and reliable [10].
Less research on medication errors has been conducted
in mental health settings, and little is known about the
incidence of medication admi ...
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An observational study of medicationadministration errors in.docx
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THE IMPACT OF CLINICAL PHARMACIST IN DETECTION OF
- 1. By Islam Shallal. Wednesday. April 3, 2012 Pharm D student.
- 2. 1. Aim of the work. 2. Patients and methods. 3. Results and discussion. 4. Limitations. 5. Recommendations.
- 3. Detection and evaluation of drug related problems commonly encountered during drug prescription in hospitalized Internal medicine patients at General Hospital of Zagazig. Thus an establishment of recommendations and advices for inappropriate medication use in the hospital would be performed.
- 4. Eighty patients were included in this study randomly, from the medical record section of the Internal medicine department. The study was conducted retrospectively. No exclusion criteria as any patients at IM department entered in this study.
- 5. Data collection sheet. • Patient history. • chief compliant. • Currents diseases. • Complete physical examination. • Laboratory investigations. • Treatment prescribed by treating physician.
- 6. 1- Drug -drug interactions. 2-Wrong dose : (high dose/ low dose/ inappropriate frequency) 3- Wrong or inappropriate drugs: (Drugs duplications,Wrong drug, Drugs written without medical problem stated) 4- Drug needed(Medical problem but no drug is prescribed, Medication is unavailable, Prophylaxis drugs ) 5- Writing problems.
- 7. 1) Drug interactions . Use Lexi.comp program. 2) Other encountered medications errors a) detect medical conditions b) read the guidelines from textbooks then uptodate site 3) Writing problems and unavailable medications are detected at time of data collection.
- 8. Morbidity Number Percentage Chronic liver diseases 24 30.0% hypertension 22 27.5% Diabetes 21 26.2% Renal failure 13 16.2% Stroke 12 15.0% Respiratory disease 12 15.0% Ischemic heart disease 10 12.5% Anemia 10 12.5% Arrhythmia 3 3.7% Heart failure 2 2.5%
- 9. Drugs’ group No. ( %) Antibiotic drugs. 68(85%) Anti acids drugs. 47(58.7%) IV fluids drugs. 39(48.7%) Anticoagulants. 27(33.7%) Antihypertensive drugs. 21(26.2%) Hepatic support drugs. 19(23.7%) Anti hemorrhagic drugs. 16(20%) Heart diseases drugs. 16(20%) Anti hyperlipidemia drugs. 15(18.7%) Analgesic and anti-inflammatory drugs. 15(18.7%)
- 10. Patient No. Number. Percentage. Total No. of patients with drugs interactions 53 66.2 % Total No of patients without drug interactions. 27 33.7% It was calculated that 124 drug-drug interactions were encountered among the 53 patients who were suffering drug- drug interactions
- 11. Severity rating No. Perecentage. Major 23 18.5 Moderate 100 80.6 Minor 1 0.8 Reliability No. Percentage. Excellent. 15 12.0 Good. 32 25.8 Fair. 67 54.0 Poor. 10 8.0 classifications of drug interactions presented in the studied patients according to their reliability:
- 12. Action needed. No. Percentage. X: avoid combination. 1 0.8 D: consider drug modifications. 13 10.4 C: monitor therapy closely. 107 86.2 B: no action needed. 3 2.5 It is so clear most of drug interactions were C in significance, moderate in severity, and fair in documentation
- 13. Age Drug interaction (+ve) Drug interactions (-ve) 18-30 2(28.5) 5(71.5) 31-40 1(50.0) 1(50.0) 41-50 13(72.3) 5(27.7) 51-60 18(72) 7(28) 61-70 8(61.5) 5(38.5) 71-80 9(81.8) 2(18.2) 81-90 2(50.0) 2(50.0)
- 14. No of prescribed drugs. Drug interactions (+ve) Drug interactions (-ve) 1 - - 2 0(0%) 1(100%) 3 - - 4 - - 5 1(33.3%) 2(66.7%) 6 3(42.8%) 4(57.2%) 7 5(45.5%) 6(54.5%) 8 5(71.4%) 2(28.5%) 9 11(73.3%) 4(26.6%) 10 8(80.0%) 2(20.0%) 11 12(85.8%) 2(14.2%) 12 3(75%) 1(25%) 13 3(75%) 1(25%) 14 2(100%) 0(0.0%)
- 15. Errors. No. of patients Percentage high dose 11 13.7 Low dose 23 28.7 Inappropriate frequency 39 48.7 Errors. No. of patients Percentage Duplication of the therapy. 16 20.0 Wrong drug. 8 10.0 Drug written without medical problem stated 54 67.5 wrong and inappropriate drugs presented in studied patients:
- 16. Error. No. of patients Percentage. Unavailable medication. 23 28.7 Medical problem but no drug written. 34 42.5 Prophylaxis/prevention drugs. 20 25.0 Error. No. of patients Percentage. misspelling 45 56.2 Bad hand writing 40 50.0 Inappropriate abbreviation. 47 58.7 Writing problems distribution in patients:
- 17. 1) no intervention was done as it retrospective observational study. 2) depended mainly on an observational experience which is more subjective and may be a source of bias. 3) The study was restricted to one hospital; therefore it cannot be assumed that the results are representative of other MOH hospitals. 4) Many of medications orders did not contain complete information about current diseases and some demographic data like weight and pregnancy status.
- 18. 1) It is recommended to include the clinical pharmacist in the overseeing of the quality of the entire drug distribution chain, before prescribing, drug choice, dispensing and preparation to the administration of the drugs 2) Using documented drug information data, books, PDA, or database to be able to know accurate and up- to-date data about prescribed drugs (dose, side effects, drug interactions, precautions, contraindications). 3) Clinical pharmacist has a role in implementing and updating the guidelines for different disease state .
- 19. 4) It is advisable to use drug therapy only when it is essential and assess risk benefit ratio, thus the number of drugs prescribed should be kept to a minimum by health care providers 5) Prescription orders should specify indication for use (e.g., for cough). 6) It is preferable to avoid the use of abbreviations. Prescriptions should always include specific and clear instructions for use and avoid "As Directed". 7) It is recommended to All prescriptions must be legible and in plain language. Prescribers, whenever possible should adopt a direct computerized order entry system which will aid to decrease drug related problems.