Abstract
Prescribing errors (PEs) can lead to patient harm. Prediction tools are
available to detect patients at risk but are not ideal. We investigated
whether doctors can identify hospitalized patients at risk of
medication-related harm by assessing the prevalence of PEs.
This matched case-control study was carried out on three clinical wards
(Internal Medicine, Upper GI Surgery, and Otolaryngology & Oncology) in
an academic hospital in the Netherlands. A total of 387 patients with
5191 prescriptions were included. A multidisciplinary in-hospital
pharmacotherapeutic stewardship team detected 799 PEs affecting 279
patients (72.1%). Most (58.8%) PEs occurred during hospitalization.
Doctors identified 40 patients (cases) as needing a clinical medication
review (CMR). These patients were matched by age (±10 years) and the
number of prescriptions at the time of CMR (±1), 1:1 with patients not
selected for CMRs (controls). There were no significant differences in
age, number of prescriptions, sex, renal function, or documented
allergies or intolerances between the matched cases and controls or
between controls and other patients who did not received a CMR. The
incidence of PEs was higher among cases than controls, and more cases
than controls had one or more PEs (97.5% versus 72.5% (OR=14.8, 95%
CI [1.8 – 121.1], p=0.002)). The rate of PEs was three times higher
in cases than in controls (IRR=3.0, 95% [2.3 – 4.0],
p<0.001).
In conclusion, clinical ward doctors can effectively identify patients
with PEs and thus at risk of medication-related harm. This may be a new
and interesting selecting strategy for targeted PE-mitigating
interventions.