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01.10.2010 | Research | Ausgabe 5/2010 Open Access

Critical Care 5/2010

On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

Zeitschrift:
Critical Care > Ausgabe 5/2010
Autoren:
Joanna E Klopotowska, Rob Kuiper, Hendrikus J van Kan, Anne-Cornelie de Pont, Marcel G Dijkgraaf, Loraine Lie-A-Huen, Margreeth B Vroom, Susanne M Smorenburg
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc9278) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

JEK was responsible for data collection, analysis of the data, statistical analysis and drafting of the manuscript. RK and HJvK were responsible for conceiving the study, data collection and critical revision of the manuscript. A-CdP and LL-A-H facilitated the data collection and were responsible for critical revision of the manuscript. MGD helped with statistical analysis, drafting of the article and critical revision of the manuscript. MBV was responsible for conceiving the study and critical revision of the manuscript. SMS was responsible for conceiving the study, helped to draft the manuscript and was responsible for critical revision of the manuscript. All authors read and approved the final manuscript.

Abstract

Introduction

Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting.

Methods

A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians.

Results

During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost €3, but might have saved €26 to €40 by preventing ADEs.

Conclusions

On-ward participation of a hospital pharmacist in a Dutch ICU was associated with significant reductions in prescribing errors and related patient harm (preventable ADEs) at acceptable costs per monitored patient-day.

Trial registration number

ISRCTN92487665
Zusatzmaterial
Authors’ original file for figure 1
13054_2010_8771_MOESM1_ESM.pdf
Authors’ original file for figure 2
13054_2010_8771_MOESM2_ESM.pdf
Authors’ original file for figure 3
13054_2010_8771_MOESM3_ESM.pdf
Authors’ original file for figure 4
13054_2010_8771_MOESM4_ESM.pdf
Literatur
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