Ensuring safe prescribing practices is essential to high-quality patient care in hospital settings. Prescribing errors represent a significant proportion of medication errors and may lead to patient harm, increased morbidity or added healthcare costs. With the increasing adoption of computerised physician order entry (CPOE) systems and clinical decision support systems (CDSS), hospitals have reduced the incidence of such errors. However, further improvements are achieved when hospital pharmacists are integrated into clinical teams. Specialised hospital pharmacists, familiar with the therapeutic needs of particular patient groups, review alerts, advise prescribers and ensure medication safety. At Erasmus MC in the Netherlands, a study was conducted to determine whether the resolution of prescribing errors differs when addressed by specialised hospital pharmacists versus substitute pharmacists who step in during their absence.
Study Context and Approach
Erasmus MC, a large academic teaching hospital, implemented a model in which each clinical ward has an assigned hospital pharmacist specialised in the pharmacotherapy of its patients. These pharmacists, who attend ward rounds and participate in clinical decision-making, work alongside pharmacy technicians and use CDSS alerts to identify prescribing issues. When specialised pharmacists are unavailable, a substitute pharmacist, often specialised in another ward, handles the alerts. The study involved a retrospective cross-sectional analysis of all inpatient prescriptions issued or modified in June 2021. It excluded non-drug prescriptions and cases lacking sufficient follow-up data.
Prescribing errors were defined as alerts requiring pharmacist intervention to prevent harm or optimise treatment. The researchers classified errors by type, including administrative issues, dosage errors, contraindications and interactions, and evaluated clinical, economic and organisational impact using the CLEO tool. The primary measure was whether the prescribing error was resolved within 24 hours of detection. Errors could be corrected by prescribers, hospital pharmacists or pharmacy technicians, in accordance with local protocols. The sample size was calculated to ensure sufficient statistical power, and analysis was performed using standard categorical tests.
Key Findings on Resolution Rates and Influences
A total of 145,574 prescriptions were reviewed, from which 1,914 alerts were retained for pharmacist review. After exclusions, 417 prescribing errors were analysed, with 392 resolved within 24 hours, yielding an overall resolution rate of 94.0%. There was no statistically significant difference between the resolution rate of errors addressed by specialised pharmacists (94.4%) and substitute pharmacists (91.9%). This suggests that both types of pharmacists are effective in resolving prescribing issues.
Most prescribing errors were of moderate clinical impact. No correlation was observed between resolution rate and pharmacist experience level, prescriber background or medication type. However, certain patterns emerged. Administrative prescribing errors had the lowest resolution rate at 78.6%. Errors concerning patients aged over 80 years were less often resolved than those for younger patients. Errors addressed during weekends also had lower resolution rates compared with those handled on weekdays. Specifically, weekend interventions by specialised pharmacists showed the lowest rate at 66.7%, though this figure was based on a small sample size and may be incidental.
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The high-resolution rate overall was attributed to the structured pharmacist involvement, the CDSS alert system, and the shared responsibility between prescribers and pharmacy staff. Around 55% of the corrected errors were resolved by prescribers themselves, and hospital pharmacists and technicians resolved the remainder. Among pharmacists who directly corrected prescriptions, 55.3% were specialised pharmacists, and 44.7% were substitutes.
Interpretation and Implications for Practice
This study demonstrates that the introduction of specialised hospital pharmacists into ward teams can enhance the quality of prescribing practices. However, in their absence, substitute pharmacists also contribute to maintaining high standards of care. The similarity in resolution rates suggests that a well-organised system, supported by effective communication and protocols, enables substitute pharmacists to manage prescribing errors effectively despite limited ward-specific expertise.
The high-resolution rate in this study surpasses figures reported in earlier research conducted in the same hospital under different staffing models and aligns with international studies combining CDSS with pharmacist presence on wards. The integration of pharmacists into daily clinical practice, the consistent use of CDSS and established communication procedures all appear to have contributed to the high resolution of prescribing issues.
Some limitations were noted. The study took place in a single centre and results may not generalise to other institutions. Communication methods used by pharmacists were not documented, though previous studies suggest that mode of communication influences outcomes. The high-resolution rate, while positive, limited the ability to statistically examine associations with various predictors.
The resolution of prescribing errors was high at Erasmus MC, regardless of whether they were addressed by specialised or substitute hospital pharmacists. This supports the model of integrating pharmacists into ward teams while reassuring that care quality remains consistent during temporary staff absences. Administrative errors, weekend prescriptions and errors involving older patients may require further attention, but overall, the findings highlight the robustness of hospital pharmacy systems in safeguarding prescribing practices.
Source: European Journal of Hospital Pharmacy
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