Pharmacy World & Science

, Volume 32, Issue 1, pp 59–65 | Cite as

Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward

  • Ghazal VessalEmail author
Research Article


Objective: To determine the impact of a clinical pharmacist on detection and prevention of prescription errors at the nephrology ward of a referral hospital. Setting: Nephrology ward of a major referral hospital in Southern Iran. Method: During a 4-month period, a clinical pharmacist was assigned to review medication order sheets and drug orders three times a week at the nephrology ward. Besides chart review, the clinical pharmacist participated in medical rounds once a week. The occurrence of prescribing errors, and related harm was determined on hospitalized patients in this ward during the 4 month period. When an error was detected, intervention was made after agreement of the attending physician. Main outcome measures: Number and types of prescribing errors, level of harm, and number of interventions were determined. Results: Seventy six patient charts were reviewed during the 4-month period. A total of 818 medications were ordered in these patients. Eighty six prescribing errors were detected in 46 hospital admissions. The mean age of the patients was 47.7 ± 17.2. Fifty five percent were male while 45% were female. Different types of prescribing errors and their frequencies were as follows: wrong frequency (37.2%), wrong drug selection (19.8%), overdose (12.8%), failure to discontinue (10.5%), failure to order (7 %), under- dose (3.5%), wrong time (3.5%), monitoring (3.5%), wrong route (1.2%), and drug interaction (1.2 %). The attending physician agreed to 96.5% of the prescription errors detected, and interventions were made. Although 89.5% of the detected errors caused no harm, 4(4.7%) of the errors increased the need for monitoring, 2 (2.3%) increased length of stay, and 2 (2.3%) led to permanent patient harm. Conclusion: presence of a clinical pharmacist at the nephrology ward helps in early detection of prescription errors, and therefore potential prevention of negative consequences due to drug administration.


Clinical pharmacist Iran Nephrology ward Prescription errors 



The author would like to thank Dr. Mohammad Mehdi Sagheb, Dr. Jamshid Roozbeh, and Dr. Shahrokh Ezat Zadegan (attending nephrologists) for their kind cooperation at the nephrology ward.



Conflict of Interest



  1. 1.
    Kohn L, Corrigan J, Donaldson M, To err is human: building a safer health system. Institute of Medicine, 1999.Google Scholar
  2. 2.
    Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155:1949–56.CrossRefPubMedGoogle Scholar
  3. 3.
    Best Practices for Hospital and Health-System Pharmacy. Position and guidance documents of ASHP. American Society of Health-System pharmacists, 2005–2006.Google Scholar
  4. 4.
    van Doormaal JE, van den Bemt PM, Mol PG, Zaal RJ, Egberts AC, Haaijer-Ruskamp FM, et al. Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Care. 2009;18:22–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274:29–34.CrossRefPubMedGoogle Scholar
  6. 6.
    Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Bond CA, Raehl CL, Franke T. Clinical pharmacy services and hospital mortality rates. Pharmacotherapy. 1999;19:556–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158:1641–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282:267–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med. 2003;163:2014–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bond CA, Raehl CL, Pitterle ME, Franke T. Health care professional staffing, hospital characteristics, and hospital mortality rates. Pharmacotherapy. 1999;19:130–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166:955–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Centor R, Marchetti P, Donnell R, Poses R. How can physicians stay current on prescription drugs? Available at: Accessed 25 Aug 25 2009.
  14. 14.
    Brown JN, Barnes CL, Beasley B, Cisneros R, Pound M, Herring C. Effect of pharmacists on medication errors in an emergency department. Am J Health Syst Pharm. 2008;65:330–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Bosma L, Jansman FG, Franken AM, Harting JW, Van den Bemt PM. Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharm World Sci. 2008;30:31–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Bedouch P, Charpiat B, Conort O, Rose FX, Escofier L, Juste M, et al. Assessment of clinical pharmacists’ interventions in French hospitals: results of a multicenter study. Ann Pharmacother. 2008;42:1095–103.CrossRefPubMedGoogle Scholar
  17. 17.
    Kaushal R, Bates D, McKenna K, J Soukup J, Landrigan C, Goldmann D. Ward-based clinical pharmacists and serious medication errors in pediatric inpatients. Available at: Abstr AcademyHealth Meet 2003;20.
  18. 18.
    Vasileff HM, Whitten LE, Pink JA, Goldsworthy SJ, Angley MT. The effect on medication errors of pharmacists charting medication in an emergency department. Pharm World Sci. 2009;31:373–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Bracey G, Miller G, Franklin BD, Jacklin A, Gaskin G. The contribution of a pharmacy admissions service to patient care. Clin Med. 2008;8:53–7.PubMedGoogle Scholar
  20. 20.
    Case LL, Paparella S. Safety benefits of a clinical pharmacist in the emergency department. J Emerg Nurs. 2007;33:564–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Kopp BJ, Mrsan M, Erstad BL, Duby JJ. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm. 2007;64:2483–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Kaushal R, Bates DW, Abramson EL, Soukup JR, Goldmann DA. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. Am J Health Syst Pharm. 2008;65:1254–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Wang HY, Chan AL, Chen MT, Liao CH, Tian YF. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics. Transplant Proc. 2008;40:2319–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Fahimi F, Abbasi Nazari M, Abrishami R, Sistanizad M, Mazidi T, Faghihi T, et al. Transcription errors observed in a teaching hospital. Arch Iran Med. 2009;12:173–5.PubMedGoogle Scholar
  25. 25.
    Fahimi F, Ariapanah P, Faizi M, Shafaghi B, Namdar R, Ardakani MT. Errors in preparation and administration of intravenous medications in the intensive care unit of a teaching hospital: an observational study. Aust Crit Care 2008;21:110–6.Google Scholar
  26. 26.
    Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;47:117–21.PubMedGoogle Scholar
  27. 27.
    Kaplan B, Mason NA, Shimp LA, Ascione FJ. Chronic hemodialysis patients. Part I: Characterization and drug-related problems. Ann Pharmacother. 1994;28:316–9.PubMedGoogle Scholar
  28. 28.
    Kaplan B, Shimp LA, Mason NA, Ascione FJ. Chronic hemodialysis patients. Part II: Reducing drug-related problems through application of the focused drug therapy review program. Ann Pharmacother. 1994;28:320–4.PubMedGoogle Scholar
  29. 29.
    Skoutakis VA, Acchiardo SR, Martinez DR, Lorisch D, Wood GC. Role-effectiveness of the pharmacist in the treatment of hemodialysis patients. Am J Hosp Pharm. 1978;35:62–5.PubMedGoogle Scholar
  30. 30.
    Tang I, Vrahnos D, Hatoum H, Lau A. Effectiveness of clinical pharmacist interventions in a hemodialysis unit. Clin Ther. 1993;15:459–64. discussion 32.PubMedGoogle Scholar
  31. 31.
    Koecheler JA, Abramowitz PW, Swim SE, Daniels CE. Indicators for the selection of ambulatory patients who warrant pharmacist monitoring. Am J Hosp Pharm. 1989;46:729–32.PubMedGoogle Scholar
  32. 32.
    US Renal Data System: USRDS 1999 Annual Data Report. The National Institute of Health, National institute of Diabetes, Digestive and Kidney diseases, 1999.Google Scholar
  33. 33.
    US Renal Data System: USRDS 1998 Annual Data Report. The National Institute of Health, National institute of Diabetes, Digestive and Kidney diseases, 1998.Google Scholar
  34. 34.
    Cullen DJ, Sweitzer BJ, Bates DW, Burdick E, Edmondson A, Leape LL. Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med. 1997;25:1289–97.CrossRefPubMedGoogle Scholar
  35. 35.
    Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL, et al. Factors associated with medication-related problems in ambulatory hemodialysis patients. Am J Kidney Dis. 2003;41:386–93.CrossRefPubMedGoogle Scholar
  36. 36.
    Manley HJ, Drayer DK, Muther RS. Medication-related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol. 2003;4:10.CrossRefPubMedGoogle Scholar
  37. 37.
    Reeder T, Mutnick A. Pharmacist-versus physician-obtained medication histories. Am J Health Syst Pharm. 2008;65:857–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Fertleman M, Barnett N, Patel T. Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Qual Saf Health Care. 2005;14:207–11.CrossRefPubMedGoogle Scholar
  39. 39.
    Chisholm MA, Vollenweider LJ, Mulloy LL, Jagadeesan M, Wade WE, DiPiro JT. Direct patient care services provided by a pharmacist on a multidisciplinary renal transplant team. Am J Health Syst Pharm. 2000;57:1994–6.PubMedGoogle Scholar
  40. 40.
    Galt KA. Cost avoidance, acceptance, and outcomes associated with a pharmacotherapy consult clinic in a Veterans Affairs Medical Center. Pharmacotherapy. 1998;18:1103–11.PubMedGoogle Scholar
  41. 41.
    Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis. 2005;46:669–80.CrossRefPubMedGoogle Scholar
  42. 42.
    Tavakol M, Murphy R, Torabi S. Medical education in Iran: an exploration of some curriculum issues. Med Educ Online 2006;11.Google Scholar
  43. 43.
    Karimi A, Nateghian A. Medical education and autonomy in teaching hospitals. Iranian J Med Educ. 2002;2:32–3.Google Scholar
  44. 44.
    Engum SA, Breckler FD. An evaluation of medication errors-the pediatric surgical service experience. J Pediatr Surg. 2008;43:348–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyShiraz University of Medical SciencesShirazIran

Personalised recommendations