Effect analysis of clinical pharmacists′ intervention on medication errors in the prescription of oral anticoagulants for inpatients
10.3760/cma.j.cn114015-20211202-01215
- VernacularTitle:临床药师对住院患者口服抗凝药物处方环节用药错误干预的成效分析
- Author:
Can CHEN
1
;
Zhangzhang CHEN
1
;
Jing LI
1
;
Yanli LI
1
;
Xiaoye LI
1
;
Qing XU
1
;
Xiaoyu LI
1
;
Qianzhou LYU
1
Author Information
1. 复旦大学附属中山医院药剂科，上海 200032
- Publication Type:Journal Article
- Keywords:
Pharmacists;
Anticoagulants;
Safety management;
Medication errors
- From:
Adverse Drug Reactions Journal
2022;24(7):353-359
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of clinical pharmacist-led safety management in clinical use of oral anticoagulants (OACs) on reducing medication errors (MEs) in hospitalized patients.Methods:On July 1st, 2018, the working group on the safe application of anticoagulants, composing clinical pharmacists majoring in cardiology, cardiac surgery, neurology, geriatrics, orthopedics, respiratory, and vascular surgery, was established at the Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University to comprehensively strengthen the intervention in the OACs prescription MEs for inpatients in relevant departments. Two percent of patients who were treated with OACs and aged ≥18 years during hospitalization in the above departments were screened using stratified sampling method and divided into pre-intervention group (patients were admitted in January 2017 to June 2018) and post-intervention group (patients were admitted in July 2018 to December 2019). The medical records of patients in the 2 groups were collected using the hospital information system, and the occurrence of MEs in the prescription link was analyzed retrospectively.Results:A total of 296 and 325 patients were included in the pre- and post-intervention groups respectively. There was no significant difference in terms of gender, age, inpatient department, anticoagulation indications, OACs class, comorbidities, and concomitant medications in patients between the 2 groups (all P>0.05). The most frequently used anticoagulants in the 2 groups both were warfarin, which was used in 75.3% (223/296) and 71.4% (232/325) of the patients respectively, and followed by rivaroxaban, which was used in 17.6% (52/296) and 23.7% (77/325) of the patients respectively. Among the 296 patients in the pre-intervention group, 75 times of MEs related to OACs were found in the prescription for 72 (24.3%) patients, of which 30, 39, 5, and 1 times of MEs graded C, D, E, and F in severity respectively, and the incidence of severe MEs (grade E and F) was 2.0% (6/296). Among the 325 patients in the post-intervention group, 49 times of MEs related to OACs were found in the prescription for 47 (14.5%) patients, of which 22 times of MEs were grade C and 27 were grade D, and no severe ME was found. The incidences of overall MEs and severe MEs in the post-intervention group were significantly lower than those in the pre-intervention group (all P<0.05). Four types of MEs were all found in the prescription of OACs in the 2 groups, including choosing inappropriate drugs (all presented as not selecting drugs based on drug interactions), wrong drug dose, drug omission, and wrong dosing frequency. The incidences of the above 4 types of MEs were 11.5% (34/296), 8.1% (24/296), 4.7% (14/296), and 0.7% (2/296) in the pre-intervention group, and 5.5% (18/325), 6.2% (20/325), 3.1% (10/325), and 0.3% (1/325) in the post-intervention group, respectively. The incidence of choosing inappropriate drugs in the post-intervention group was significantly lower than that in the pre-intervention group [5.5% (18/325) vs. 11.5% (34/296), χ2=7.143, P=0.008]. Conclusion:The safety management of OACs in clinical application led by clinical pharmacists can reduce the MEs in prescriptions of OACs for inpatients, especially the incidence of severe MEs and choosing inappropriate drugs, and improve the safety of OACs in application.
