Background Laveran Military Hospital (Marseille, France) contains 18 clinical units (300-bed capacity). Every day, pharmacists analyse computerised prescriptions and formulate pharmaceutical interventions (PIs) defined by the French Society of Clinical Pharmacy as “a change in drug treatment initiated by the pharmacist”.
Purpose To determine the most common medicines errors and to evaluate the clinical impact of pharmaceutical validation.
Materials and Methods A prospective study included all patients hospitalised in four medical units (internal medicine, pneumology-oncology, tropical and infectious diseases and orthopaedic surgery) from 14 May to 31 August 2012. Doctors were either notified of PIs by phone and/or by clinical staff interventions and/or by electronic notification (by Pharma software). Medical acceptance was defined as changing the prescription. Drug switches or drug discontinuations in case of unavailability in the hospital pharmacy were not included so as not to overestimate the acceptance rate.
Results In 16 weeks, pharmacists analysed 3334 prescriptions, which led to 247 PIs The main problems were overdose (34.4%), inappropriate administration (19.4%), non-conformity or contraindication (11.7%). The solutions most often suggested by pharmacists were dose adjustment (36.4%), optimization of administration (28.4%) and drug discontinuation (21.6%). The drugs most frequently involved were: antithrombotics (12.1%), antibacterials for systemic use (7.7%) and analgesics (6.1%). During the study period, 58.7% of PIs were accepted by the prescribers. This result depended on the different means of interventions: 81.3% and 72.2% of staff interventions or phone calls were accepted respectively, versus 48.7% for electronic notification. The acceptance rates were comparable to the studies reported in the literature .
Conclusions This study shows the superiority of oral notification and encourages a pharmaceutical presence in care units. Later, it would be interesting to identify the causes of non-acceptance, in particular for electronic notification.
Bedouch P et al, Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists’ interventions. J Eval Clin Pract. 2012;18(4):911–8.
Gaillard K. et al, Evaluation of pharmaceutical interventions at Sainte-Anne military hospital as part of a unit dose drug daily distribution system. J Pharm Clin 2006;25(1):39–47.
No conflict of interest.
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