International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1157–1163 | Cite as

Risk of prescribing errors in acutely admitted patients: a pilot study

  • Dorthe Krogsgaard BonnerupEmail author
  • Marianne Lisby
  • Eva Aggerholm Sædder
  • Charlotte Arp Sørensen
  • Birgitte Brock
  • Ljubica Andersen
  • Anette Gjetrup Eskildsen
  • Lars Peter Nielsen
Research Article


Background Prescribing errors in emergency settings occur frequently. Knowing which patients have the highest risk of errors could improve patient outcomes. Objective The aim of this study was to test an algorithm designed to assess prescribing error risk in individual patients, and to test the feasibility of medication reviews in high-risk patients. Setting The study was performed at the Acute Admissions Unit at Aarhus University Hospital, Denmark. Methods The study was an interventional pilot study. Patients included were assessed according to risk of prescribing errors with the aid of an algorithm called ‘Medication Risk Score’ (MERIS). Based on the score, high-risk patients were offered a medication review. The clinical relevance of the medication reviews was assessed retrospectively. Main outcome measure The number and nature of prescribing errors during the patients’ hospitalisation. Results The study included 103 patients, all of whom could be risk assessed with the algorithm MERIS. MERIS stratified 38 patients as high-risk patients and 65 as low-risk patients. The 103 patients were prescribed a total of 848 drugs in which 88 prescribing errors were found (10.4 %). Sixty-two of these were found in patients in the high-risk group. In general, the medication reviews were found to be clinically relevant and approximately 50 % of recommendations were implemented. Conclusion MERIS was found to be applicable in a clinical setting and stratified most patients with prescribing errors into the high-risk group. The medication reviews were feasible and found to be clinically relevant by most raters.


Acute admissions unit Medication reviews Medication risk score Denmark Prescribing errors 



None of the authors have received funding for the study.

Conflicts of interest

None of the authors declare competing interests.

Supplementary material

11096_2016_345_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)


  1. 1.
    Nielsen TR, Andersen SE, Rasmussen M, Honore PH. Clinical pharmacist service in the acute ward. Int J Clin Pharm. 2013;35(6):1137–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Basey AJ, Krska J, Kennedy TD, Mackridge AJ. Prescribing errors on admission to hospital and their potential impact: a mixed-methods study. BMJ Qual Saf. 2014;23(1):17–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Tully MP. Prescribing errors in hospital practice. Br J Clin Pharmacol. 2012;74(4):668–75.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74(4):573–80.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.CrossRefPubMedGoogle Scholar
  6. 6.
    Lisby M, Thomsen A, Nielsen LP, Lyhne NM, Breum-Leer C, Fredberg U, et al. The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. Basic Clin Pharmacol Toxicol. 2010;106(5):422–7.PubMedGoogle Scholar
  7. 7.
    Hellstrom LM, Bondesson A, Hoglund P, Midlov P, Holmdahl L, Rickhag E, et al. Impact of the lund integrated medicines management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Bondesson A, Eriksson T, Kragh A, Holmdahl L, Midlov P, Hoglund P. In-hospital medication reviews reduce unidentified drug-related problems. Eur J Clin Pharmacol. 2013;69(3):647–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol. 2013;112(6):359–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Sakuma M, Bates DW, Morimoto T. Clinical prediction rule to identify high-risk inpatients for adverse drug events: the JADE study. Pharmacoepidemiol Drug Saf. 2012;21(11):1221–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom WP, Somers A, et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older the GerontoNet ADR risk score. Arch Intern Med. 2010;170(13):1142–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Du W, Lehr VT, Lieh-Lai M, Koo W, Ward RM, Rieder MJ, et al. An algorithm to detect adverse drug reactions in the neonatal intensive care unit. J Clin Pharmacol. 2013;53(1):87–95.CrossRefPubMedGoogle Scholar
  13. 13.
    Trivalle C, Burlaud A, Ducimetiere P, IMEPAG Grp. Risk factors for adverse drug events in hospitalized elderly patients: a geriatric score. Eur Geriatr Med. 2011;2(5):284–9.CrossRefGoogle Scholar
  14. 14.
    Hohl CM, Yu E, Hunte GS, Brubacher JR, Hosseini F, Argent CP, et al. Clinical decision rules to improve the detection of adverse drug events in emergency department patients. Acad Emerg Med. 2012;19(6):640–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Falconer N, Nand S, Liow D, Jackson A, Seddon M. Development of an electronic patient prioritization tool for clinical pharmacist interventions. Am J Health Syst Pharm. 2014;71(4):311–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Saedder EA, Lisby M, Nielsen LP, Rungby J, Andersen LV, Bonnerup DK, et al. Detection of patients at high risk of medication errors: development and validation of an algorithm. Basic Clin Pharmacol Toxicol. 2016;118(2):143–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Saedder EA, Brock B, Nielsen LP, Bonnerup DK, Lisby M. Identifying high-risk medication: a systematic literature review. Eur J Clin Pharmacol. 2014;70(6):637–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review. Br J Clin Pharmacol. 2015;80(4):808–17.CrossRefPubMedGoogle Scholar
  19. 19.
    Lisby M, Nielsen LP, Brock B, Mainz J. How should medication errors be defined? development and test of a definition. Scand J Public Health. 2012;40(2):203–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Graabæk T, Bonnerup DK, Kjeldsen LJ, Rossing C, Pottegård A. Pharmacist-led medication review in an acute admissions unit: a systematic procedure description. Eur J Hosp Pharm. 2015;22:202.CrossRefGoogle Scholar
  21. 21.
    Mogensen CB, Thisted AR, Olsen I. Medication problems are frequent and often serious in a Danish emergency department and may be discovered by clinical pharmacists. Dan Med J. 2012;59(11):A4532.PubMedGoogle Scholar
  22. 22.
    Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Frazier SC. Health outcomes and polypharmacy in elderly individuals: an integrated literature review. J Gerontol Nurs. 2005;31(9):4–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Beers MH, Ouslander JG. Risk factors in geriatric drug prescribing: a practical guide to avoiding problems. Drugs. 1989;37(1):105–12.CrossRefPubMedGoogle Scholar
  25. 25.
    Higashi T, Shekelle PG, Solomon DH, Knight EL, Roth C, Chang JT, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004;140(9):714–20.CrossRefPubMedGoogle Scholar
  26. 26.
    Bonnerup DK, Lisby M, Eskildsen AG, Saedder EA, Nielsen LP. Medication counselling: physicians’ perspective. Basic Clin Pharmacol Toxicol. 2013;113(6):425–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Larsen MD, Rosholm JU, Hallas J. The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol. 2014;70(2):233–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Hatoum HT, Hutchinson RA, Witte KW, Newby GP. Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988;22(3):252–9.PubMedGoogle Scholar
  29. 29.
    Bondesson A, Holmdahl L, Midlov P, Hoglund P, Andersson E, Eriksson T. Acceptance and importance of clinical pharmacists’ LIMM-based recommendations. Int J Clin Pharm. 2012;34(2):272–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56(23):2444–50.PubMedGoogle Scholar
  31. 31.
    Bosma L, Jansman FGA, Franken AM, Harting JW, Van Den Bemt PMLA. Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharm World Sci. 2008;30(1):31–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Buurma H, De Smet PA, Leufkens HG, Egberts AC. Evaluation of the clinical value of pharmacists’ modifications of prescription errors. Br J Clin Pharmacol. 2004;58(5):503–11.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Dale MA, Copeland R, Barton R. Prescribing errors on medical wards and the impact of clinical pharmacists. Int J Pharm Pract. 2003;11(1):19–24.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Dorthe Krogsgaard Bonnerup
    • 1
    Email author
  • Marianne Lisby
    • 2
  • Eva Aggerholm Sædder
    • 3
  • Charlotte Arp Sørensen
    • 1
  • Birgitte Brock
    • 3
  • Ljubica Andersen
    • 3
  • Anette Gjetrup Eskildsen
    • 1
  • Lars Peter Nielsen
    • 3
  1. 1.Hospital PharmacyCentral Denmark RegionRanders NØDenmark
  2. 2.Research Centre for Emergency MedicineAarhus University HospitalAarhusDenmark
  3. 3.Department of Clinical PharmacologyAarhus University HospitalAarhusDenmark

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