Pharmacists at the Forefront: Identifying and Addressing Prescription Errors in Outpatient Settings of Tertiary Care Hospitals in Pakistan

Abstract

Objective: The study sought to quantify the frequency and categorize the types of prescribing errors occurring in outpatient settings while evaluating the efficacy of pharmacist interventions in mitigating such errors. Methodology: This study was a cross-sectional, retrospective interventional study conducted over a one-year period from September 1, 2017, to August 31, 2018, at the outpatient departments of one government and one private tertiary care hospital in Hyderabad, Pakistan. A total of 2,552 outpatient prescriptions were randomly collected and evaluated by the researchers to identify prescribing errors, using the British National Formulary (BNF) as a reference guide. The study rigorously adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring comprehensive reporting, transparency in methodology, analysis, and interpretation of the observational research findings Results: The collected data were analyzed using chi-square tests in SPSS version 25 to assess statistical significance. Among the 2,552 outpatient prescriptions examined, 12,501 (40.4%) prescribing errors were identified. The error rate was higher in the government hospital (6,672; 42.8%) compared to the private hospital (5,829; 38.0%). The most prevalent errors occurred during the subscription stage (2,302; 45.1%), with 1,245 (48.1%) and 1,057 (42.0%) errors in the government and private hospitals, respectively. This was followed by errors in the inscription (3,447; 45.0%), superscription (5,156; 40.4%), and transcription (1,596; 31.3%) stages. Common interventions during the subscription stage addressed incomplete patient information (age, weight, etc.), missing consultant signatures, and stamps. For the inscription stage, frequent interventions involved incorrect drug doses and strengths.Typical interventions for the subscription and inscription stages included adding missing therapy durations and usage instructions, respectively. Pharmacist interventions were accepted at a higher rate in private hospitals (3,669; 62.9%) compared to government hospitals (3,675; 55.1%), with a total of 7,344 (58.7%) interventions accepted. Conclusion: The study revealed a high prevalence of prescribing errors across all stages of the outpatient prescription process, with the subscription stage being the most error-prone. The findings highlight the critical role of pharmacist-led prescription interventions in mitigating prescribing errors, thereby enhancing prescribing practices, optimizing therapeutic outcomes, and safeguarding patient safety.