The Pharmacotherapy-Team: A New Intervention Strategy to Improve Rational Pharmacotherapy and Reduce Prescribing Errors in a Hospital Setting

Abstract

Prescribing errors account for a substantial proportion of medication errors, resulting in patient harm and high costs.1,2 Several interventions to reduce prescribing errors by promoting rational prescribing have been introduced in Dutch primary care.3 Although these interventions are promising, a thorough and structural approach to promote rational prescribing in a hospital setting is still lacking. Given the increasing complexity of patients in hospitals (e.g., polypharmacy, multimorbidity, older age), the demanding working environment, and the large number of drugs prescribed, new strategies to improve rational prescribing in this setting are urgently needed. We developed a new intervention strategy to improve rational prescribing and reduce prescribing errors in a hospital setting. Because of the complexity of the prescribing process, interventions to improve rational prescribing are more likely to be effective if they include a multidisciplinary and multifaceted strategy. Therefore, we set up a Pharmacotherapy-team consisting of 2 physician-clinical pharmacologists, a hospital pharmacist, an internist, a quality consultant and 2 medical students. We use Participatory Action Research (PAR), combining qualitative and quantitative methods (e.g., medication chart review, online survey) to investigate the complex nature of prescribing in hospital settings. This strategy is characterized by the participation of local employers (senior and junior physicians, nurses) in investigating opportunities to improve practice and the subsequent intervention development and implementation. The Pharmacotherapy-team performs in depth prevalence measurements of prescribing errors on wards before and after the intervention phase. Interventions developed in collaboration with local employers, focus on organization-based (e.g., redesigning working process), discipline-based (e.g., improving guideline accessibility), and individual-based (e.g., education) aspects. A multidisciplinary Pharmacotherapy-team with active participation of local employers is a new and unique strategy to thoroughly investigate the complex prescribing process. With this tailored approach we hope to develop effective and sustainable interventions to improve rational prescribing in hospital settings.