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International Journal of Clinical Pharmacy

, Volume 35, Issue 4, pp 638–646 | Cite as

Profile of prescribing errors detected by clinical pharmacists in paediatric hospitals in Spain

  • Cecilia M. Fernández-LlamazaresEmail author
  • Maite Pozas
  • Begoña Feal
  • M. Josep Cabañas
  • Miquel Villaronga
  • Yolanda Hernández-Gago
  • Mercedes Ruiz de Villegas
  • Concha Álvarez-del-Vayo
Research Article

Abstract

Background Pharmaceutical care involves three essential functions: identifying potential and real medication-related problems, solving real medication-related problems and preventing potential medication related problems. Objective To describe the profile of prescribing errors detected and prevented by paediatric clinical pharmacists in medical orders for inpatients in Spain. Settings and methods A prospective, descriptive, multicentre epidemiological study on medical orders for inpatients aged 1 day to 18 years, conducted between July and October 2011 at eight hospitals treating paediatric patients. Main outcome measure primary variables were most common errors, including clinical severity (according to a previously validated instrument), pharmacotherapeutic groups and drugs most commonly involved, the impact of pharmaceutical interventions, as well as the population receiving most interventions, and type of prescription (manual of electronic) and dispensation system (ward stock, unit-dose or automated dispensing cabinets) that are most involved in Spain. Results A total of 667 interventions related to quality of the prescription were recorded at eight sites. 21 were excluded. 41.2 % concerned manual prescribing systems, and 58.8 % electronic prescribing systems. The interventions were performed on patients with a mean age of 5 years (standard deviation 5.43). In interventions concerning prescribing errors, 212 different drugs were involved, mainly belonging to the group of anti-infectives. The main factor triggering pharmacist’s recommendations was dose errors of 1.5–10 times the recommended dose. Therefore, the main prescription errors are dosing errors (49.3 %). With regard to the clinical severity of these prescribing errors, 51.9 % (306 cases) were considered significant, 26.3 % (155 cases) of minor significance, 19.8 (117 cases) were clinically serious and 2.0 % (12 cases) were potentially fatal. There was a 95.4 % global acceptance rate for recommendations. The impact of accepted interventions showed that 64.7 % had a significant impact on patient health outcome, highlighting 1.1 % with a highly significant impact. The activity level of the paediatric clinical pharmacists was highly variable, with a median of 0.014 interventions/bed-day during the data collection period. Conclusion In view of the importance of the dosing errors in the prescription phase, and the clinical relevance of the errors detected, it seems to be necessary to implement measures as the development of decision support systems for paediatric dosing and strengthen the presence of pharmacists as a key element in preventing prescribing errors from reaching patients, thus ensuring that children receive effective, safe and efficient drug therapy.

Keywords

Prescibing Drug therapy Medication errors Paediatrics Pharmacists Pharmacy service Hospital pharmacy Prospective studies Spain Standards 

Notes

Acknowledgments

We would also like to thank all the pharmacists at the eight participating sites who were not investigators but helped by collecting data for the study. And finally we would also like to thank José Mª Bellón for his invaluable statistical support.

Funding

We are grateful to Sociedad Española de Farmacia Hospitalaria [Spanish Society of Hospital Pharmacy], which awarded a grant to Grupo Español de Farmacia Pediátrica in order toconduct the research project within which this study has been developed.

Conflicts of interest

The authors declare to have no conflict of interest.

References

  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  2. 2.
    Consensus panel. Third consensus of granada on drug related problems (DRP) and negative outcomes associated with medication (NOM). Ars Pharm. 2007;48(1):5–17.Google Scholar
  3. 3.
    American Society of Hospital Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm. 1993;50:305–14.Google Scholar
  4. 4.
    Allan EL, Barker KN. Fundamentals of medication error research. Am J Hosp Pharm. 1990;47:555–71.PubMedGoogle Scholar
  5. 5.
    National coordinating council for medication error reporting and prevention. NCCMERP taxonomy of medication errors [online]. Available from URL: http://www.nccmerp.org/medErrorTaxonomy.html. Accessed 2013 Mar 14.
  6. 6.
    Otero López MJ, Castaño Rodríguez B, Pérez Encinas M, Codina Jane C, Tames Alonso MJ, Sanchez Munoz T, et al. Updated classification for medication errors by the Ruíz-Jarabo 2000 Group. Farm Hosp. 2008;32:38–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH. Child Health Accountability Initiative. Assessing medication prescribing errors in pediatric intensive care units. Pediatr Crit Care Med. 2004;5:124–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Wong IC, Ghaleb MA, Franklin BD, Barber N. Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Saf. 2004;27:661–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Ann Pharmacother. 2006;40:1766–76.PubMedCrossRefGoogle Scholar
  10. 10.
    Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care. 2007;16:116–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Fernandez-Llamazares CM, Manrique-Rodriguez S, Perez-Sanz C, Duran-Garcia ME, Sanjurjo-Saez M, Calleja-Hernandez MA. Validation of a method for recording pharmaceutical interventions. J Clin Pharm Ther. 2012;37:459–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Fernandez-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Perez-Sanz C, Duran-Garcia E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97:564–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Fernandez-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Perez-Sanz C, Duran-Garcia E, Sanjurjo-Saez M. Prescribing errors intercepted by clinical pharmacists in paediatrics and obstetrics in a tertiary hospital in Spain. Eur J Clin Pharmacol. 2012;68:1339–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79:718–22.PubMedGoogle Scholar
  15. 15.
    Fernández-Llamazares CM, Hernández-Gago Y. Pozas del Río M. Paediatric pharmacy: training and information. Farm Hosp. 2011;35:103–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Echarri-Martinez L, Fernandez-Llamazares CM, Lopez-Herce J, Sanchez-Galindo A, Manrique-Rodriguez S, Sanjurjo-Saez M. Paediatric training for developing clinical activities. Farm Hosp. 2012;36:43–9.PubMedCrossRefGoogle Scholar
  17. 17.
    European Medicines Agency. ICH topic E11: Clinical investigation of medicinal products in the paediatric population- CPMP/ICH/2711/99 [online]. Available from http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500002926.pdf. Accessed 2013 Mar 13.
  18. 18.
    WHO Collaborating Centre for Drug Statistics Methodology. Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDD) [online] Available from http://www.whocc.no/atc_ddd_index/. Accessed 2013 Mar 14.
  19. 19.
    Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56:2444–50.PubMedGoogle Scholar
  20. 20.
    Davis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91.PubMedCrossRefGoogle Scholar
  21. 21.
    Blum KV, Abel SR, Urbanski CJ, Pierce JM. Medication error prevention by pharmacists. Am J Hosp Pharm. 1988;45:1902–3.PubMedGoogle Scholar
  22. 22.
    Lehmann CU, Conner KG, Cox JM. Preventing provider errors: online total parenteral nutrition calculator. Pediatrics. 2004;113:748–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113(1 Pt 1):59–63.PubMedCrossRefGoogle Scholar
  24. 24.
    McPhillips HA, Stille CJ, Smith D, Hecht J, Pearson J, Stull J, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr. 2005;147:761–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Kozer E, Scolnik D, Macpherson A, Keays T, Shi K, Luk T, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics. 2002;110:737–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95:113–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care. 2010;14:R174.PubMedCrossRefGoogle Scholar
  28. 28.
    Al-Jeraisy MI, Alanazi MQ, Abolfotouh MA. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia. BMC Res Notes. 2011;4:294.PubMedCrossRefGoogle Scholar
  29. 29.
    Zhang C, Zhang L, Huang L, Luo R, Wen J. Clinical pharmacists on medical care of pediatric inpatients: a single-center randomized controlled trial. PLoS ONE. 2012;7:e30856.PubMedCrossRefGoogle Scholar
  30. 30.
    Selbst SM, Fein JA, Osterhoudt K, Ho W. Medication errors in a pediatric emergency department. Pediatr Emerg Care. 1999;15:1–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Guy J, Persaud J, Davies E, Harvey D. Drug errors: what role do nurses and pharmacists have in minimizing the risk? J Child Health Care. 2003;7:277–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Hicks RW, Becker SC, Cousins DD. Harmful medication errors in children: a 5-year analysis of data from the USP’s MEDMARX program. J Pediatr Nurs. 2006;21:290–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Jonville AP, Autret E, Bavoux F, Bertrand PP, Barbier P, Gauchez AS. Characteristics of medication errors in pediatrics. DICP. 1991;25:1113–8.PubMedGoogle Scholar
  34. 34.
    Strong DK, Tsang GW. Focus and impact of pharmacists’ interventions. Can J Hosp Pharm. 1993;46:101–8.PubMedGoogle Scholar
  35. 35.
    Koren G, Haslam RH. Pediatric medication errors: predicting and preventing tenfold disasters. J Clin Pharmacol. 1994;34:1043–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285:2114–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Bordun LA, Butt W. Drug errors in intensive care. J Paediatr Child Health. 1992;28:309–11.PubMedCrossRefGoogle Scholar
  38. 38.
    Virani A, Crown N. The impact of a clinical pharmacist on patient and economic outcomes in a child and adolescent mental health unit. Can J Hosp Pharm. 2003;56:158–62.Google Scholar
  39. 39.
    Falck KA, Darsey EH, Naughton MJ. Pharmacy interventions in a multidisciplinary paediatric intensive care unit. J Paediatr Pharm Pract. 1997;2:162–7.Google Scholar
  40. 40.
    Krupicka MI, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30:919–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Cecilia M. Fernández-Llamazares
    • 1
    Email author
  • Maite Pozas
    • 2
  • Begoña Feal
    • 3
  • M. Josep Cabañas
    • 4
  • Miquel Villaronga
    • 5
  • Yolanda Hernández-Gago
    • 6
  • Mercedes Ruiz de Villegas
    • 7
  • Concha Álvarez-del-Vayo
    • 8
  1. 1.Clinical Pharmacist, Pharmacy ServiceHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Head of Pharmacy ServiceHospital Niño JesúsMadridSpain
  3. 3.Clinical Pharmacist, Pharmacy ServiceHospital Teresa Herrera CHUACA CoruñaSpain
  4. 4.Clinical Pharmacist, Pharmacy ServiceHospital Vall d’HebrónBarcelonaSpain
  5. 5.Clinical Pharmacist, Pharmacy ServiceHospital San Joan de Deu.BarcelonaSpain
  6. 6.Clinical Pharmacist, Pharmacy ServiceHospital Materno-Infantil de CanariasLas Palmas de Gran CanariaSpain
  7. 7.Clinical Pharmacist, Pharmacy ServiceHospital Carlos HayaMálagaSpain
  8. 8.Clinical Pharmacist, Pharmacy ServiceHospital Virgen del RocíoSevilleSpain

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