Descriptive data for pharmacist intervention
| Number of interventions(n=991) | Most common drug involved, n (%) | |
|---|---|---|
| Severity of medication error, n (%) | ||
| Potentially lethal | 0 (0) | – |
| Serious | 49 (4.9) | Digoxin and ciprofloxacin, 4 (8.2) |
| Significant | 523 (52.8) | Omeprazole, 47 (9) |
| Least | 302 (30.5) | Escitalopram, 19 (6.3) |
| No error | 117 (11.8) | Levofloxacin, 5 (4.3) |
| Relevance of pharmacist intervention, n (%) | ||
| Extremely significant | 0 (0) | – |
| Highly significant | 69 (7) | Enoxaparin, 9 (13) |
| Significant | 574 (57.9) | Omeprazole, 48 (8.4) |
| Little significant | 301 (30.4) | Escitalopram, 18 (6) |
| Insignificant | 46 (4.6) | Digoxin and levodopa, 3 (6.5) |
| Injurious intervention | 1 (0.1) | Urapidil, 1 (100) |
| Medication errors, n (%) | ||
| Others | 16 (1.6) | – |
| High dose (normal dose ×1.5–4) of drugs with narrow therapeutic range | 5 (0.5) | Digoxin, 2 (40) |
| Illegible, ambiguous or non-standard abbreviations | 5 (0.5) | Digoxin, 1 (20) |
| The dose may result in potentially toxic concentrations | 6 (0.6) | Ciprofloxacin, 3 (50) |
| Too low dose of a medication for a serious disease | 13 (1.3) | Enoxaparin, insulin and levetiracetam, 2 (15.4) |
| The drug may exacerbate the condition of the patient | 16 (1.6) | Atorvastatin, 3 (18.8) |
| Cost savings | 18 (1.8) | Levofloxacin, 4 (22.2) |
| Therapeutic duplications | 20 (2) | Omeprazole, 5 (25) |
| Inadequate dosing interval | 26 (2.6) | Quetiapine, 3 (11.5) |
| Incomplete/not clear information in medical order | 32 (3.2) | Escitalopram and levothyroxine, 2 (6.3) |
| Pharmaceutical form unavailable or inappropriate | 59 (6.0) | Enoxaparin, 11 (18.6) |
| Dose too low | 60 (6.1) | Simvastatin, 9 (15.0) |
| High dose of drugs with normal therapeutic range | 70 (7.1) | Simvastatin, 12 (17.1) |
| Optimising therapy | 74 (7.5) | Omeprazole, 6 (8.1) |
| Drug not indicated | 86 (8.7) | Omeprazole, 30 (34.9) |
| Request for information or clarification of the medical prescription | 99 (10.0) | Methadone, 4 (4.0) |
| Omission of a drug in the medical prescription | 182 (18.4) | Simvastatin, 9 (4.9) |
| Drugs not included in the Hospital Drug Therapy Guide | 204 (20.6) | Pantoprazole and escitalopram, 17 (8.3) |
| Types of pharmacist intervention, n (%) | ||
| Drug monitoring | 10 (1) | Digoxin, 3 (30) |
| Change of administration route | 28 (2.8) | Levofloxacin, 8 (28.6) |
| Drug not changed | 44 (4.4) | Atorvastatin and pantoprazole, 5 (11.4) |
| Frequency change | 45 (4.5) | Quetiapine, 4 (8.9) |
| Change of dosage form | 63 (6.4) | Enoxaparin and levothyroxine, 10 (15.9) |
| Pharmaceutical query | 64 (6.5) | Ciprofloxacin, 4 (6.25) |
| Complete medication order | 85 (8.6) | Levodopa, 4 (4.7) |
| Discontinue drug | 132 (13.3) | Omeprazole, 35 (26.5) |
| Change dose | 140 (14.1) | Simvastatin, 21 (15) |
| Change drug | 189 (19.1) | Escitalopram, 19 (10.1) |
| Start treatment | 191 (19.3) | Simvastatin and calcium, 9 (4.7) |
| Pharmaceutical groups of drug involved, n (%) | ||
| Others | 8 (0.8) | – |
| Antineoplastic and immunomodulating agents | 15 (1.5) | Tacrolimus, 4 (26.7) |
| Muscle-skeletal system | 24 (2.4) | Acetaminophen, 5 (20.8) |
| Genitourinary system and sex hormone | 38 (3.8) | Solifenacin, 11 (28.9) |
| Systemic hormonal preparation | 42 (4.2) | Levothyroxine, 22 (52.4) |
| Sensory organs | 42 (4.2) | Timolol, 7 (16.7) |
| Respiratory system | 51 (5.2) | Budesonide, 10 (19.6) |
| Blood and blood-forming organs | 70 (7.1) | Enoxaparin, 28 (40) |
| Anti-infective for systemic use | 80 (8.1) | Levofloxacin, 15 (18.8) |
| Alimentary tract and metabolism | 171 (17.3) | Omeprazole, 55 (32.2) |
| Cardiovascular system | 212 (21.4) | Simvastatin, 38 (17.9) |
| Nervous system | 238 (24) | Levodopa, 24 (10.1) |
| Drugs included in ISMP High-Alert Medications list, n (%) | N=108 | |
| Others | 5 (4.6) | – |
| Antirheumatic drugs | 2 (1.9) | Methotrexate and leflunomide, 1 (50) |
| Antihypertensive drugs | 2 (1.9) | Atenolol and urapidil, 1 (50) |
| Oral anticoagulant | 2 (1.9) | Apixaban and dabigatran, 1 (50) |
| Oral cytostatic agents | 4 (3.7) | Bicalutamide, 2 (50) |
| Digoxin | 5 (4.3) | Digoxin, 5 (100) |
| Immunosuppressive agents | 6 (5.6) | Tacrolimus, 4 (66.7) |
| Opioids | 15 (13.9) | Fentanyl, 7 (46.7) |
| Insulin | 16 (14.8) | Short-acting insulin, 8 (50) |
| Oral hypoglycaemic agents | 19 (17.6) | Gliclazide, 6 (31.6) |
| Low molecular weight heparin | 32 (29.6) | Enoxaparin, 28 (87.5) |