Background and Importance Medication errors (MEs) occur in 5% of drug administrations in inpatients. Avoiding MEs is key to improve patient safety. Our centre implemented the Check of Medication Appropriateness (CMA), a back-office validation service, which significantly reduces potentially inappropriate prescriptions (PIPs). However, prescriptions for compounded medicines are lacking in this validation system.
Aim and Objectives The aim of this study was to evaluate which checks are currently performed in a spontaneous and implicit way for prescriptions of compounded medicines. These checks identify possibilities for future development of an explicit and standardised service called the ‘Check of Compounding Appropriateness’ (CCA).
Material and Methods An anonymous e-questionnaire was implemented at the compounding unit of our centre. Pharmacists and pharmacy technicians were asked to complete the e-questionnaire for every prescription of compounded medicines for which they performed implicit and spontaneous checks.
Results Data saturation was obtained after two months yielding registrations for 315 prescriptions, accounting for 30% of total compounded prescriptions. Top category formulations included capsules (n = 240) and ointments & creams (n = 26), accounting for 84%. Eighty-nine percent (n = 281) of the prescriptions were ordered electronically instead of paper prescriptions. In total 1002 (clinical) checks were performed for the 315 prescriptions leading to the identification of 120 PIPs (38.1%). Ninety-four PIPs accounted for a logistic problem, mainly substitution (n = 58) or double order (n = 11); 25 were clinical PIPs, mainly incorrect dosing (n = 15); one PIP contained both a clinical and logistic problem. In 67.5% of PIPs, colleagues were contacted. In prescriptions with PIPs, the final action included cancellation of the preparation because of substitution to a commercially available drug/stock preparation (50.0%), cancellation of the preparation due to other reasons than substitution (23.3%), compounding of an adapted prescription (13.3%) and compounding of the original prescription (13.3%).
Conclusion and Relevance PIPs also occur in prescriptions for compounded medicines. At our centre, these PIPs mainly include logistic and dosing problems. Next to the set-up of back-office CCA, this survey revealed that prescribing support, such as a substitution or dosing module, should be implemented to increase the efficiency at the compounding unit and patient safety.
Conflict of Interest No conflict of interest
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