Background Prescribing errors (PE) are frequent, cause significant harm and prove costly. It is well recognised that pharmacists are a key element for safe prescription of drugs through the interception of PE during the validation process. Few studies have demonstrated the impact of pharmacist interventions.
Purpose The objectives of this study were to characterise the severity and cost of the potential outcome of PE and to develop an economic analysis.
Material and methods We performed a prospective observational study of all prescriptions made over 6 months in a 1300 bed tertiary teaching hospital provided with a computerised physician order entry (CPOE) tool combined with a basic clinical decision support system (CDSS).
An independent team analysed the PE intercepted through pharmacist validation. The severity of each error was categorised using the NCC-MERP index. Each error was assigned a probability of causing an adverse drug event (PAE) in the patient: 0 (nil), 0.01 (very low), 0.1 (low), 0.4 (medium) or 0.6 (high). Cost avoidance was based on the product of the PAE and the cost of an adverse drug event (set at €6857, taken from a review conducted by the Spanish Ministry of Health).
An economic analysis was performed from the hospital perspective using the salary of a pharmacist and the cost avoidance estimated.
Results 484 PE were intercepted: 36.2% of PE were classified as being of minor severity, 59.1% as moderate and 4.7% as serious. The most common type of moderate-serious PE found was excessive dose (30%, 94/309), insufficient dose (20%, 62/309) and omission (19%, 58/309). The most frequent families of drugs involved were antineoplastic agents (22.3%, 69/309) and antimicrobials (17.2%, 53/309).
In the cost avoidance analysis, 57 of the interventions (49%) were assigned a PAE of 0.6, 12 (10%) a PAE of 0.4, 34 (29%) a PAE of 0.1, 10 (9%) a PAE of 0.01 and 3 (3%) a PAE of 0. These results led to a total cost avoidance of €291 422. The economic analysis showed a return on investment of 1.7.
The overall inter-rater agreement was moderate for the severity (k =0.57; p < 0.005) and strong for the PAE (k=0.77;p < 0.005).
Conclusion PE persisted despite the implementation of a CPOE system combined with a CDSS. Pharmacists add important value in preventing PE, and their interventions are financially beneficial for the institution.
References and/or Acknowledgements Team.
No conflict of interest.
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