IJPP 2003, 11: 19–24
© 2003 Int J Pharm Pract
Received May 07, 2002
Accepted October 10, 2002
DOI 10.1211/002235702829
ISSN 0961-7671
North Tyneside Hospital,
England
Alison Dale, clinical services
pharmacist
Richard Copeland, head of
pharmacy
Roger Barton, reader in medicine
Correspondence:
Ms Dale,
Pharmacy Department,
Sunderland Royal Hospital, Kayll
Road, Sunderland, England SR4
7TP.
E-mail:
alison.dale@chs.northy.nhs.uk
Acknowledgments:
The research
was supported by a clinical
pharmacy research award from
the United Kingdom Clinical
Pharmacy Association. We are
grateful to the all those staff and
patients of North Tyneside
General Hospital who helped
make this study possible.
Original Papers
Prescribing errors on medical wards and the impact of clinical pharmacists
Alison Dale, Richard Copeland and Roger Barton
AbstractObjectives To assess the incidence of prescribing errors, predict patient outcome from clinical pharmacists’ recommendations made in response to identified prescribing errors, and evaluate the influence of clinical pharmacists on recommendation implementation.
Method Clinical pharmacy activities were conducted on two wards, one of which had an existing clinical pharmacy service (intervention ward) while the other did not (control ward). For the control ward, prescribing errors were documented but not followed up unless a potentially life-threatening problem was identified. Prescribing errors were identified and recommendations made by pharmacists. A consultant physician and pharmacist conducted an independent, blinded assessment of these recommendations to predict the impact on patient outcome if implemented. Recommendations were communicated to medical staff or implemented by the pharmacist on the intervention ward only. The proportion of recommendations implemented for intervention and control group patients were recorded.
Setting Two medical wards in a UK district general hospital. The study was carried out over 12 weeks.
Key findings There were 740 errors recorded for 235 patients. Fourteen recommendations could not be assessed. For all recommendations, the consultant and pharmacist predicted patient outcomes with life-saving (one consultant vs three pharmacist), major (186 vs 318), minor (328 vs 324), neutral (211 vs 85) or harmful (five vs five) impact respectively. For the intervention group, 79% of recommendations were implemented, including 81 of 92 (88%) predicted by the consultant to have major impact on patient outcomes. In the control group, only 18% of recommendations were spontaneously implemented, including only 10 of 94 (11%) recommendations predicted by the consultant to have major impact.
Conclusion Ward-based clinical pharmacists identified large numbers of prescribing errors and made clinically significant recommendations. Implementation of recommendations was predicted to improve the outcome of patient care. Further research, specifically assessing the outcome of pharmacists’ recommendations on patient care, is warranted.