Abstract
Aim
Our hospital is a referral center for Bone and Joint Infection (BJI) with a 15-bed orthopedic unit. Patients benefit from a multidisciplinary team management (surgeons, anesthetists, infectious disease physicians, microbiologists, dietician etc.). Computerized drug prescriptions are performed by anesthetists, surgical residents, surgeons and infectious disease physicians. Since 2015, a pharmacist has been included in ward rounds and in weekly multidisciplinary consultative meetings, where antibiotic treatment strategies are decided for hospitalized patients. This work aimed to assess the impact of a pharmacist in this unit to limit prescription errors.
Method
Prospective monocentric study of all pharmacist's advice or interventions during 15 weeks in 2016 and 2017. A complete pharmaceutical analysis of prescriptions is performed twice a week at least. This analysis is based on doses control and drug interactions, but also takes into account biological and clinical data of patients (patient history, renal function, symptoms, adverse effects…). In case of a prescription error, a computerized message and/or a phone call is sent to the prescriber. Each pharmacist's intervention is recorded and classified according to the French Society of Clinical Pharmacy. The pharmacist collected the number of pharmaceutical advice (when spontaneously solicited by any member of the multidisciplinary team), the different types of prescription errors, the pharmacological class associated to these errors, the types of pharmacist's interventions and their impact on prescriptions.
Results
During ward rounds, 24 pharmaceutical advices were asked spontaneously by physicians about drug treatment optimization, predominantly about preparation and administration of injectable antibiotics or about doses adaptation. Regarding medication problems detected by the pharmacist, there were 145 prescription errors: inappropriate dose (38/145), too long-duration treatment (24/145), drug omission (18/145), drug overlap (13/145), inappropriate route (13/145), drug interaction (10/145), non-adherence to guidelines (15/145), omission of specific monitoring (4/145), other (10/145). The main pharmacist's interventions were drug discontinuations (53/145, 37%) and dose adjustments (37/145, 26%). In this specific BJI unit, 67/145 (46%) pharmacist's interventions were related to antibiotic drugs, 29/145 (20%) to drugs for digestive disorders and 16/145 (11%) to cardiovascular drugs. Most of pharmacist's interventions were accepted by prescribers (123/145, 85%), with immediate correction of prescriptions.
Conclusions
Most prescription errors concerned doses and durations of treatments. Antibiotic prescriptions were often susceptible to errors. The involvement of a pharmacist in this bone and joint infection unit allows a better medication safety.
