Analysis of Clinical Interventions and the Impact of Pediatric Pharmacists on Medication Error Prevention in a Teaching Hospital

Blank Children's Hospital, Des Moines, Iowa.
The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG 10/2012; 17(4):365-73. DOI: 10.5863/1551-6776-17.4.365
Source: PubMed


Research has shown that the potential risk for medication errors within the pediatric inpatient population is about 3 times as high as for adults; however, there is limited information regarding the impact of a pediatric pharmacist's contribution to decreasing medication errors and adverse drug events (ADEs). The purpose of this study was to record and analyze all interventions during a 2-month time span in a pediatric teaching hospital to determine the benefit of having a pediatrics-trained clinical pharmacist on the floor.
Pediatric pharmacists prospectively collected data for all interventions and medication errors made between July 1 and August 31, 2010. The pediatric hospital comprises 87 beds, and data were collected during the influx of new pediatric resident interns on the general pediatric ward and pediatric and neonatal intensive care units.
During the study period, 1315 interventions were recorded, which is an average of 21 interventions per day. Most interventions were made through order entry. Errors made up 24.5% of all interventions, with the most common cause of error being prescribing. Physicians with the least amount of training made the most errors. Of order pages scanned, 5.9% contained an error in the order; however, only 0.2% of all errors reached the patient.
This study highlighted the impact a pediatric pharmacist can make on prevention of ADEs and medication errors. Only 0.2% of all errors made during the study period reached the patient owing to interventions made by the pediatric pharmacists, which shows a vast improvement in patient safety.

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    • "DIs are one of the highest occurring drug-related problems in the ICUs and the intensivists give lesser priority to its significance compared to pharmacists.[10] Medication errors shall be a potential reason for drug related problems.[11] "
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    ABSTRACT: Intensive care unit is a potential area for drug-related problems. As many of the patients treated are complex patients, clinical pharmacy intervention could find drug therapy problems. Drug information liaisons daily attended ward rounds with intensivists and screened the patient for drug therapy assessment using the American Society for Health-System Pharmacists clinical skills competition DTA format. This was a prospective study done for 6 months from August 2012 to January 2013. Simple statistics were used to tabulate the drug-related problems assessed. A total of 72 patients were screened for drug therapy problems, for which 947 drug doses were prescribed in the study period. The total number of prescriptions was 148. The average number of drugs per prescription was 6.39 and the average number of drugs per patient was 13.15. A total of 243 problems were identified; on an average, 1.67 problems were present per prescription. The total number of drug interactions identified was N = 192 (78.2%); majority of them (61.4%) were of type C (not serious). So, 55.73% of them were monitored and not stopped or substituted. The second type of problem was a correlation between drug therapy and medical problem (7.4%). Appropriate drug selection and drug regimen was the third problem, and the adverse drug reactions and therapeutic duplications accounted for approximately 2% of the drug-related problems identified. Drug interactions constituted the major problem of ICUs, but not many were serious or significant. Consensus in assessment of drug-related problems and convincing intensivists with good quality evidences are required for better acceptance of interventions.
    Full-text · Article · Jun 2013
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    ABSTRACT: The aim of this research study was to map nursing diagnoses and interventions documented and observed in a neonatal ICU to the Clinical Care Classification system and to validate the translation of these mapped diagnoses and interventions into Persian. This descriptive research used directed content analysis to map diagnoses and interventions to the Clinical Care Classification. Documentation reports of nursing care were extracted from a paper-based documentation system for infants hospitalized in April, May, and June 2011. Observations of care were conducted and compared with documentation to itemize any interventions not included in the documented record. Documented reports of nurses' care and recorded observations were analyzed through directed content analysis, and obtained expressions were mapped to the diagnoses and intervention coding system of the Clinical Care Classification and translated into Persian. Validation of the subsequent code translation was obtained from nursing experts using the Delphi method in two rounds. Findings showed the most frequent nursing diagnoses were related to respiratory condition of infants such as mechanical ventilation dependency (21.1%), and the most frequent nursing interventions were related to completing physician orders such as blood sampling and medication administration (23.9%). Only 47.8% of Clinical Care Classification diagnoses and interventions codes were reflected in the data set. The relatively low rate of nursing care documented in therecords could be due to both the lack of a nursingcare delivery framework, such as the nursing process, and the lack of any framework or standardization in the documentation system in this setting. Using a framework for care delivery and a coding system for documentation of care such as the ClinicalCare Classification would allow for the more complete documentation of nursing care and subsequently the ability to track and analyze this care.
    Full-text · Article · Jan 2014 · Computers, informatics, nursing: CIN
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    ABSTRACT: BACKGROUND: Medication safety is an essential component of patient safety in health care delivery. Providing strategies to effectively prevent medication errors and adverse drug events in hospitals has gained international recognition. OBJECTIVE: The aim of this paper was to review systematically the research literature on the various interventions for providing medication safety in hospitals. METHOD: Eight healthcare databases were searched for full research articles written in English. Reference lists of included studies were also searched. Research studies involving delivery of interventions in hospitals with the aim of preventing or reducing medication errors and adverse drug events were examined. RESULTS: Forty-two studies were selected. Most of the studies were before and after designs without comparative control groups. Forty studies identified interventions contributing to the prevention and reduction of medication errors. Six broad types of interventions were identified: computerized physician order entry with or without clinical decision support systems, automation, computer assisted, barcode technology, pharmacist role, training and system designs. CONCLUSION: Though studies have provided evidence for individual interventions, there are concerns about the extent of their effectiveness. This has implications for policymakers and clinicians to adopt multifaceted approach in providing medication safety in their hospitals.
    No preview · Article · Sep 2014 · The International journal of risk & safety in medicine
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