The role of clinical pharmacy in preventing PEs in the emergency department of a governmental hospital in Jordan: a pre-post study

Derar Abdel Qader, Najlaa Saadi Ismael, Ahmad Al Meslamani, Abdullah Albassam, Asma A. El-Shara, Penny Lewis, Salim Hamadi, Nadia Al Mazrouei

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Clinical pharmacists have an emerging role in the hospital emergency department, intercepting prescribing errors and improving patient safety; however, their impact within a Jordanian emergency department has never been studied.
Objective
To evaluate the impact of clinical pharmacy services on prescribing errors and assess predictors of physicians' acceptance of clinical pharmacists' interventions upon prescribing errors.
Setting
This study was conducted in the emergency department (ED) of the largest governmental hospital in Jordan.
Method
This was a pre-post interventional study conducted over two months (October and November 2019) using a disguised direct observation method. The study was divided into two phases: a control phase where no clinical interventions were made, and an active phase where clinical pharmacists assigned to the ED prospectively observed, intervened and corrected errors. The clinical significance of detected errors was determined by a multidisciplinary committee. The Statistical Package for Social Science (SPSS) software Version 24 was used for data analysis.
Main outcome measure
Prescribing error incidence, error type, error severity, and predictors for physicians' acceptance.
Results
Of 18003 patients, 8732 were included in the control phase and 9271 in the active phase. Prescribing error incidence decreased from 24.6% to 5.4%. The proportion of contraindication, electronic drug selection, and wrong dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0 phase) to 12.6%, 0.0%, and 0.0% (P1 phase), respectively. Drug-Drug interaction, wrong drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively however this was not statistically significant. The proportion of significant and serious errors was significantly reduced from 68.7% and 3.0% (P0 phase) to 8.9% and 1.8% (P1 phase), respectively. During the P1 phase, most errors were deemed minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were; significant errors (OR 3.1; 95%CI 2.6-4.3; p=0.03) and non-busy physicians (OR 2.1; 95%CI 1.6-2.7; p=0.04).
Conclusion
Clinical pharmacists significantly reduced prescribing errors in the ED by 76%; most of their interventions were classed as significant. Policymakers should utilise our findings to implement active clinical pharmacy services in the ED.
Original languageEnglish
JournalHospital Pharmacy
Publication statusAccepted/In press - 10 Jun 2020

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