On-site Pharmacist Research Articles

Analysis of Medication-Related Malpractice Claims: Causes, Preventability, and Costs

Because adverse drug events (ADEs) may cause serious injury and lead to malpractice claims, 2040 claims records from a New England malpractice insurance company were reviewed. The goals were to identify contributing humanfactors and estimate the preventability of these events. Of the cases reviewed, from 1990 through 1999, 129 (6.3%) represented ADEs. Two physician reviewers expert in judging adverse events independently reviewed the case abstracts. When they disagreed, a third reviewer was consulted. Nearly three fourths of the ADEs (73%) were considered to be preventable. Thirty-nine events, 30% of the total, were judged to be life-threatening, and 21 (16%) did result in death. One fourth of the preventable events deviated little if at all from accepted practice patterns, but 60% deviated moderately or markedly; the rest were indeterminate. Preventable ADEs were nearly equally divided between inpatients and outpatients. The primary defendant was most often a physician; nurses were next, and then pharmacists. Numerous types of medication were implicated. Preventable ADEs in hospitalized patients were most often associated with anesthetics, anxiolytic or sedative drugs, and potassium supplements. Usually more than one individual or systems-related failure led to patient harm. Operational systems failures included poor team communication, incorrect handoffs, supervisory failures, lack of well-trained staff, and a failure to use consultants appropriately. Also contributing were managerial system failures, such as poor interdisciplinary communication and inexperienced professionals. Of 50 preventable inpatient events, an estimated 40% would have been avoided by computerized entry of physician orders with decision support. The same was true for 36% of preventable outpatient ADEs. On-site clinical pharmacists might have prevented 64% of inpatient events. Other measures with the potential to prevent ADEs include staff training and planning, better standardization of processes, and the use of built-in design redundancies. Two thirds of ADEs in this review were considered preventable, including many that resulted in considerable harm or death. The high cost of ADEs should be an incentive to develop effective strategies for preventing errors.

Survey of clinical pharmacy services in United Kingdom National Health Service hospitals

The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent certain clinical pharmacy services were provided were mailed to all NHS hospital pharmacies in 1992. The questionnaires also requested information about the hospital and the number and qualifications of pharmacists employed. The results were compared with those of a survey of pharmaceutical services in the United States. Of 508 questionnaires mailed, 416 usable responses were returned. Services commonly provided were inpatient drug therapy monitoring (96%), clinical trials support (92%), formulary management (89%), participation in drug and therapeutic committees (97%), and an on-site drug information center (60%). Services infrequently provided were therapeutic drug monitoring (21%), medication history-taking (16%), and a 24-hour on-site pharmacist (10%). Several services were associated with pharmacies that employed many pharmacists, pharmacists with advanced education, or specialist clinical pharmacists and pharmacies located in medical school teaching hospitals. U.K. hospital pharmacies provided fewer patient-oriented services and more drug information, therapy monitoring, and pharmacist education services than U.S. hospital pharmacies. Provision of clinical pharmacy services in the United Kingdom was associated with employment of many pharmacists, pharmacy clinical specialists, and pharmacists with advanced education.