Int J Pharm Pract 2002:10:161-170
Centre for Practice and Policy, The School of Pharmacy, University of London, England
Marisa Sagripanti, MSc, MRPharmS, research pharmacist
Nick Barber, PhD, MRPharmS, professor of the practice of pharmacy
Bryony Dean, PhD, MRPharmS, director, Academic Pharmacy Unit, Hammersmith Hospitals NHS Trust and The School of Pharmacy, University of London
Correspondence: Ms Sagripanti, Pharmacy Department, Guy's and St Thomas' Hospital NHS Trust, 2 Lambeth Palace Road, London, England SE1 7EH
Marisa.Sagripanti@gstt.sthames.nhs.uk
Int J Pharm Pract 2002;10:161-70
Original Papers
An evaluation of the process-related medication risks for elective surgery patients from pre-operative assessment to discharge
Marisa Sagripanti, Bryony Dean and Nick Barber
Aim
— To investigate where the process-related medication risks occur in an
elective surgery service with a pre-operative assessment clinic (PAC)
and make recommendations for how pharmacy services should best be provided.
Method — The study involved identification of discrepancies in
medication history taking, changes that occurred in patients' medication
between PAC and admission, and changes that occurred between admission
and discharge. Prescribing errors were identified and classified according
to whether they occurred on admission, during the inpatient stay or on
discharge, and whether they were identified and rectified by the existing
pharmacy service.
Setting — Seventy-six patients recruited from the nurse-led PAC
of a 580-bed London teaching hospital between May 2 and June 30, 2000.
Key findings — The PAC nurse omitted 27 per cent of medications
from the medication history; the admitting doctor omitted 37 per cent
from the medication history documented in the medical notes and 47 per
cent from the inpatient medication chart; the majority of the omissions
were complementary and over-the-counter preparations. Twenty-six per cent
of patients had changes made to their medication between PAC and admission,
and 85 per cent had changes made between admission and discharge. A total
of 177 prescribing errors were identified (median of 1 error per patient;
interquartile range 0-3), of which 38 per cent occurred on admission,
14 per cent during the inpatient stay and 48 per cent at discharge. Pharmacists
made interventions to rectify 59 per cent of the errors.
Conclusion — Given the large number of changes to patients' medication
that occurred between PAC and admission, we would not support the writing
of inpatient medication charts or the supply of medication at this stage.
For this group of patients in the study hospital, the greatest process-related
medication risks occurred on admission and discharge, and pharmacy services
should be provided accordingly.