Background and importance The use of unit dose (UD) has been proved to be a critical tool in supporting the phases of prescription, preparation and administration of therapies, and most importantly in the management of the COVID-19 emergency. All drugs managed in the UD are screened and validated by the pharmacist; during this stage, if any prescription presents a potential risk of adverse events for a patient, the pharmacist is required to insert notes requesting modification of the prescription. These notes provide information about the risk of potential errors such as therapy duration, dosage, administration frequency, interactions, therapeutic indications, dilution, type of formulation and double prescriptions.
Aim and objectives The aim of this work was to demonstrate the key role that pharmacists play in patient safety and clinical risk management, particularly in the prescription of hydroxychloroquine (HCQ) for COVID-19 patients.
Material and methods We analysed therapies from all patients managed with UD in the period 1 March 2020 to 31 July 2020, and reviewed the notes entered by the pharmacists. These notes were further divided based on the potential risk of event/error, latent/active and high and low risk (HR, LW), where high risk refers to potentially harmful events for the patient.
Results During the observed period, hospitalised patients receiving the UD regimen were 4649 patients, 413 resulting from COVID-19, including 231 men and 182 women, with a median age of 70 (20–99) years and average number of hospitalisation days of 19 (SD±17). In 334 (81%) prescriptions for these patients, one or more notes were reported from the pharmacist, including 283 HR and 51 LR. The total number of notes entered were 445, with 322 (72%) related to HCQ interactions as follows: (1) 67% medicines that prolong the QT interval which can induce heart rhythm disorders (class IA and III antiarrhythmics, tricyclic antidepressants, antipsychotics, macrolides and quinolones); (2) 3% digoxin; (3) 20% antidiabetics; and (4) 10% antiepileptics.
Conclusion and relevance This study showed that in 72% of notes reported in advance by the pharmacist in the prescription, there was a HR of potential adverse events resulting from the interaction with HCQ. This led to interruption in the use of this drug, as subsequently confirmed by the decision of the EMA (29 May 2020) to recommend its use only in clinical trials.
Conflict of interest No conflict of interest
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