Drug-related problems in hospitals: A review of the recent literature

Hospital Pharmacy, Regionalspital Emmental, Burgdorf, Switzerland.
Drug Safety (Impact Factor: 2.82). 02/2007; 30(5):379-407.
Source: PubMed


Problems associated with pharmacotherapy (in particular, medication errors and adverse drug events) are frequent and are associated with increased costs for treatment. Analysis of original publications published between 1990 and 2005 on the topics of medication errors and/or adverse drug events in hospitalised patients, focusing on the frequency of, risk factors for and avoidance of such problems associated with pharmacotherapy, indicated that medication errors occurred in a mean of 5.7% of all episodes of drug administration, but with a high variability among the 35 studies retrieved. This variability was explained by the methods by which medication errors were detected (systematic screening of patients versus chart review or spontaneous reporting) and by the way drugs were administered (intravenously administered drugs are associated with the highest error frequencies). Errors occurred throughout the whole medication process, with administration errors accounting for more than half of all errors. Important risk factors included insufficient pharmacological knowledge of health professionals, errors in the patient charts or documentation by nurses and inadequate pharmacy services.Adverse events or reactions, on the other hand, affected 6.1 patients per 100 hospitalised and also showed a high variability among the 46 studies retrieved. This variability could also be explained by the different methods of assessment of the frequency of adverse drug events or reactions, as well as by the different wards on which the studies were performed. Important risk factors for adverse drug events or reactions included polypharmacy, female sex, drugs with a narrow therapeutic range, renal elimination of drugs, age >65 years and use of anticoagulants or diuretics. Since medication errors are strong risk factors for preventable adverse drug events or reactions, strategies have to be put in place for their reduction. Such strategies include ensuring that all persons involved in the medication process (nurses, pharmacists and physicians) have good pharmacological knowledge, computerisation of the entire medication process, and the engagement of a sufficient number of clinical pharmacists on the wards.

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    • "En France, l'Afssaps et l'HAS ont mis en place des actions pour prévenir et organiser la gestion des erreurs médicamenteuses et sécuriser le circuit du médicament en établissement de santé. Outre la mise en place d'une structure de recueil des erreurs (le guichet des erreurs médicamenteuses) [9], l'Afssaps a mis en oeuvre deux plans d'harmonisation des étiquetages (en 2006 et 2009) pour 46 substances actives [19]. L'agence a établi une liste « d'évènements qui ne devraient jamais arriver » : ce sont des événements indésirables graves évitables si des mesures de prévention avaient été mises en place. "
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    ABSTRACT: Purpose The safe medication practices at the hospital constitute a major public health problem. Drug supply chain is a complex process, potentially source of errors and damages for the patient. SHAM insurances are the biggest French provider of medical liability insurances and a relevant source of data on the health care complications. Methods The main objective of the study was to analyze the type and cause of medication errors declared to SHAM and having led to a conviction by a court. We did a retrospective study on insurance claims provided by SHAM insurances with a medication error and leading to a condemnation over a 6-year period (between 2005 and 2010). Results Thirty-one cases were analysed, 21 for scheduled activity and 10 for emergency activity. Consequences of claims were mostly serious (12 deaths, 14 serious complications, 5 simple complications). The types of medication errors were a drug monitoring error (11 cases), an administration error (5 cases), an overdose (6 cases), an allergy (4 cases), a contraindication (3 cases) and an omission (2 cases). Intravenous route of administration was involved in 19 of 31 cases (61%). The causes identified by the court expert were an error related to service organization (11), an error related to medical practice (11) or nursing practice (13). Only one claim was due to the hospital pharmacy. Conclusion The claim related to drug supply chain is infrequent but potentially serious. These data should help strengthen quality approach in risk management.
    Annales Pharmaceutiques Françaises 08/2014; 73(2). DOI:10.1016/j.pharma.2014.07.001
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    • "During this process, errors can be made. Medication errors (MEs) are reported to occur in a mean of 5.7% (range 0–49%) of all episodes of medication administration [1]. Prescription errors form a considerable part of these errors. "
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    ABSTRACT: Introduction: Prescribing medication is an important aspect of almost all in-hospital treatment regimes. Besides their obviously beneficial effects, medicines can also cause adverse drug events (ADE), which increase morbidity, mortality and health care costs. Partially, these ADEs arise from medication errors, e.g. at the prescribing stage. ADEs caused by medication errors are preventable ADEs. Until now, medication ordering was primarily a paper-based process and consequently, it was error prone. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) is considered to enhance patient safety. Limited information is available on the balance between the health gains and the costs that need to be invested in order to achieve these positive effects. Aim of this study was to study the balance between the effects and costs of CPOE/CDSS compared to the traditional paper-based medication ordering. Methods: The economic evaluation was performed alongside a clinical study (interrupted time series design) on the effectiveness of CPOE/CDSS, including a cost minimization and a cost-effectiveness analysis. Data collection took place between 2005 and 2008. Analyses were performed from a hospital perspective. The study was performed in a general teaching hospital and a University Medical Centre on general internal medicine, gastroenterology and geriatric wards. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) was compared to a traditional paper based system. All costs of both medication ordering systems are based on resources used and time invested. Prices were expressed in Euros (price level 2009). Effectiveness outcomes were medication errors and preventable adverse drug events. Results: During the paper-based prescribing period 592 patients were included, and during the CPOE/CDSS period 603. Total costs of the paper-based system and CPOE/CDSS amounted to €12.37 and €14.91 per patient/day respectively. The Incremental Cost-Effectiveness Ratio (ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70, indicating the extra amount (€) that has to be invested in order to prevent one medication error or one pADE. Conclusions: CPOE with basic CDSS contributes to a decreased risk of preventable harm. Overall, the extra costs of CPOE/CDSS needed to prevent one ME or one pADE seem to be acceptable.
    International Journal of Medical Informatics 08/2014; 83(8). DOI:10.1016/j.ijmedinf.2014.05.003 · 2.00 Impact Factor
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    • "ASHP advises the pharmacist to participate in appropriate organizational committees of the RCF and to work with physicians , nurses, administrators, and others to examine and improve systems to ensure that medication processes are safe (American Society of Hospital Pharmacists, 1993). Moreover, in hospital and nursing home settings, it has been described that pharmacists (participating in multidisciplinary teams, participating during ward rounds, or reviewing medication records) can optimize pharmacotherapy of the patient and prevent medication errors, hence improving patient safety (Bondesson et al., 2012; Brown et al., 2008; Kaboli, Hoth, McClimon, & Schnipper, 2006; Krahenbuhl-Melcher et al., 2007; Kucukarslan, Peters, Mlynarek, & Nafziger, 2003; Spinewine, Fialova, & Byrne, 2012). Although we cannot extrapolate these results to our setting, it does support the involvement of a pharmacist within the MMP. "
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    ABSTRACT: Organizational aspects of the medication management process (MMP) have been investigated in hospital and nursing home settings. However, the amount of literature on medication management in residential care facilities (RCF) for individuals with ID is limited to two studies from the Netherlands, focusing only on drug administration errors. To assess the organization of the MMP in Belgian RCFs for people with ID, the authors undertook a cross-sectional observational study in 34 Belgian RCFs for people with ID. Structured interviews were performed using a questionnaire: the first part (for the RCF directors) addressed administrative and policy issues. The second (for unit employees) and third parts (for medical office employees) addressed practical aspects of the MMP. The fourth part (for physicians) focused on the physician's role in the MMP, on the therapeutic drug formulary, and on communication with staff and delivering pharmacist. Standard operating procedures concerning the MMP were not available in 32% of the RCFs. About one-quarter of the RCFs did not have a medication error reporting system, and most RCFs did not systematically (i.e., at least annually) review their MMP for failures. Only two participating RCFs were equipped with an electronic prescribing system. The role of the pharmacist was mainly limited to delivery of medication. Medication was mostly administered by nonmedically qualified staff (e.g., educators). Most frequently cited problems by the interviewees were problems in the medication preparation and administration stage. Most frequently cited possible improvement actions were education/sensitization of staff and improved communication among all stakeholders. The authors note that as this study revealed operational inadequacies, problem areas can be identified and targeted quality improvement actions can be undertaken.
    Journal of Policy and Practice in Intellectual Disabilities 03/2014; 11(1). DOI:10.1111/jppi.12064 · 0.97 Impact Factor
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