Open Access

Drug-related problems and their clinical interventions in a Ghanaian teaching hospital

Safety in Health20162:15

DOI: 10.1186/s40886-016-0050-5

Received: 24 October 2016

Accepted: 10 November 2016

Published: 30 November 2016

Abstract

Background

Errors occur frequently in the use of medicines. Pharmacists play a key role in error identification and make appropriate interventions as they work with other healthcare professionals. These error recovery roles of pharmacists contribute to patient safety. This study was to evaluate the clinical interventions made to drug-related problems at a tertiary care setting.

Method

This involved a retrospective review of clinical intervention reports submitted by pharmacists working over the period January 2011 to December 2013.

Results

The 24 pharmacists submitted 529 handwritten reports; of these, 448 reports had complete data. The most frequently reported drugs with error were warfarin (9.5%), potassium chloride (6.0%) and potassium citrate (5.5%). The pharmacists made 1019 clinical interventions and recommendations. The average intervention per report was 2.5 (S.D ± 0.67). The interventions and recommendations made were categorised as drug regimen change (76.1%), monitoring required (13.0%), communication (5.4%), counselling required (5.0%) and adverse drug reporting (0.6%). Majority (90.5%) of the recommendations and interventions made by pharmacists were accepted and implemented. Monitoring-required based interventions were significantly more likely to be accepted (130 vs 38; p <0.0001).

Conclusion

Pharmacists played a role in drug error recovery and prevented medication errors from reaching patients. These error mitigation efforts of pharmacists can serve as a priority in patient safety strategy.

Keywords

Medication errors Patient safety Pharmacist Clinical interventions Ghana

Background

A substantial proportion of hospitalised patients experience medication-related harm that is preventable [1]. Drug errors have been estimated to account for over a quarter of causes of adverse drug events [2]. Strategies to prevent such problems are being developed. One such strategy is the structured review of patient medication by pharmacists to identify patients with medication errors that may lead to harm. The advantage is that the complete clinical status of each patient is taken into account when identifying problems [3]. In a study, clinical pharmacists performed better than the decision support system in identifying drug–drug interactions clinical interventions [4]. The authors realised that clinical pharmacists looked at individual administration intervals and drug sequence to determine the clinical relevance of the interactions.

The Harvard Medical Practice Study analysed error recovery, i.e. the circumstances under which errors were detected and corrected. The study acknowledged the important role pharmacists play in identifying and correcting drug errors from reaching patients.

The Institute of Medicine’s report includes recommendations for health systems to implement error reporting reviews [5]. In the inpatient setting, clinicians have used various drug event reporting programs to better understand and prevent drug errors [6, 7]. The interception of medication errors is thus essential for improving patient safety. The aim of the study was therefore to evaluate the clinical interventions of hospital pharmacists.

Methods

The study was a retrospective review of reports, which had no names, nor personal information of patients. No consent was taken from patients since they could not be traced to any reports.

Study setting

The study took place at Korle Bu Teaching hospital which is a 2000 bed tertiary teaching hospital located in the capital city of Ghana. At the time of the study, the hospital had about 80 pharmacists. The main pharmacy services provided in the hospital were dispensing, clinical, drug information, research and small scale manufacturing. There were about 30 pharmacists who actively undertake clinical duties across the various wards of the hospital.

Data collection

To evaluate the clinical interventions of pharmacists working in the hospital, copies of reports for the period January 2011–December 2013 were made and relevant data extracted using a specially designed data collection sheet. Pharmacists had previously identified drug errors and manually reported the clinical interventions. The pharmacist interventions accepted and the actions taken were reported on the submitted manual reports. Pharmacists had discovered drug errors during their normal duties from review of patient medical records, laboratory reports, interactions with other health care professionals, patients, caregivers or family members.

Data analysis

The extracted clinical intervention data was entered into and analysed using SPSS (Statistical Package for Social Sciences) version 16 for Windows. Descriptive analysis was performed on all the data to obtain the frequency of clinical interventions, drug characteristics and pharmacist characteristics. Aggregate data were tabulated and summarized using frequency statistics such as count, range, mean and standard deviation. Descriptive analyses of all drug error types and related interventions were also tabulated. Pharmacist Clinical intervention data were compared between drug classifications, drug error types and whether pharmacist interventions were accepted or not using Chi square test dichotomous variables. Any p < 0.05 was considered as statistically significant.

Results

Study participants

The evaluation revealed that 24 pharmacists made 529 paper-based reports over the 3 years. Majority of them were female (70.8%) and more than half had less than 10 years experience (53.3%). The basic characteristics of pharmacists who made the reports are presented in Table 1.
Table 1

Characteristics of pharmacists involved in reporting (N = 24)

Characteristic

Number

Percent

Sex

 Male

7

29.2

 Female

17

70.8

Experience in practice (years)

 0–5

6

25.00

 >5–10

8

33.33

 >10–15

3

12.50

 >15–20

5

20.83

 >20

2

8.33

Education & training

 MSc in clinical pharmacy

8

33.3

 MSc Clinical Pharmacy (student)

3

12.5

 BPharm

13

54.2

Drug error reports

Of the 529 paper-based drug error reports, 448 contained complete information and hence were included in the study. Reasons for not including the 79 were no drug name (n = 67), no reason for error (n = 6) and no recommendation (n = 6). Drug errors were reported from all the units of the hospital that pharmacists worked; surgery (24%), medicine (22%), paediatric (21%), obstetrics and gynaecology (17%) and others (16%). Pharmacists discovered drug errors from review of patient medical records (74%), from other health care professionals (10%), laboratory reports (8%), patients (6%), caregivers (1%), and other unspecified sources (3%). The frequently occurring therapeutic drug categories with errors were cardiovascular (44.4%), infections (22.8%), nutrition (12.9%) and musculoskeletal (6.6%). Table 2 describes the therapeutic drug categories and the degree of acceptance. The five most frequently reported classes of drugs associated with drug errors were antibiotics (20.2%), anticoagulants (19.9), iron supplement (16.3%), diuretics (9.4%) and non-steroidal anti-inflammatory drugs (4.4%). The most frequently reported drugs with error were warfarin (9.5%), potassium chloride (6.0%) and potassium citrate (5.5%). The drug error types identified were categorised as prescribing, dispensing/implementing, administering/patient receiving and monitoring (see Table 3). Majority of reported drug errors were due to prescribing (70.9%) and least due to dispensing/implementing (2.0%). The most frequently reported drugs associated with prescribing errors included cardiovascular (42.6%), anti-infectives (22.9), and nutritional agents (10.5%). During dispensing or implementation, the frequently reported drug errors were anti-infectives (50.0%), endocrine (35.0%) and cardiovascular (15.0%). The most frequently reported drug category associated with administration or patient receiving included anti-infectives (45.5%), cardiovascular (22.7%) and central nervous system (15.2%). The common reasons pharmacists provided for drug errors included untreated indication (18.9%), wrong dose prescribed (12.5%), wrong drug prescribed (11.4%), medicine interactions (10.7%) and duplication of therapy (9.8%).
Table 2

Therapeutic category of drugs with intervention reports

Drug category

Indication

Number of recommended interventions

*p-value

Accepted

Not accepted

Cardiovascular (n = 451[44.3%])

Anticoagulant

181

22

0.053

Diuretic

87

9

<0.001

Calcium channel blockers

16

8

<0.001

Beta blockers

20

2

0.037

ACE inhibitors

14

2

0.003

Statin

17

3

<0.001

Antiplatelet

15

1

0.001

Nitrates

4

0

0.061

Angiotensin receptor blockers

3

0

<0.001

Others

41

6

0.004

Infections (n = 231[22.7%])

Antibiotics

180

18

0.019

Antimalarials

26

0

0.009

Antivirals

5

0

0.101

Antifungal

2

0

0.023

Nutrition (129 [12.7%])

Iron supplement

106

13

0.037

Others

10

0

<0.001

Musculoskeletal (70 [6.9%])

NSAIDS

52

3

0.010

Systemic Corticosteroids

11

0

<0.001

Others

4

0

<0.001

Central Nervous System (51[5%])

Opiod analgesic

39

3

<0.001

Sedatives

6

0

<0.001

Antiepileptic

2

1

0.122

Gastro-Intestinal (50 [4.9%])

Proton pump inhibitor

27

3

0.027

Antacid

7

0

0.980

Laxative

5

0

0.001

Others

6

2

0.001

Endocrine (14 [1.4%])

Oral antidiabetics

9

1

0.076

Insulin

4

0

0.001

Respiratory (11 [1.1%])

Inhalational steroids

10

0

0.530

Antihistamine

1

0

0.890

Others (12 [1.2%])

 

12

0

<0.001

*Cross tabulation (χ 2 test) between accepted and not accepted interventions for each Indication and the rest

Table 3

Drug error types and reasons

Error type

Reasons

Number

Prescribing (n = 721)

Untreated indications

174

Wrong dose prescribed

127

Wrong drug prescribed

116

Medicine interactions

93

Duplication of therapy

84

Contraindications

78

Side effects

50

Failure to stop order

44

Omitted lab test

18

Others

15

Dispensing/implementing (n = 20)

Wrong drug dispensed

14

Wrong label

5

Others

1

Administering/patient receiving (n = 66)

Unavailability of drug

19

Wrong dose administered

16

Duplication

16

Failure to discontinue

7

Others

4

Wrong drug administered

3

Wrong dosage form

1

Monitoring (n = 212)

Laboratory test omitted

91

Blood glucose not monitored

77

Side effects not monitored

40

Others

19

Medicine-disease interactions not monitored

16

Culture and sensitivity omitted

14

BP not checked

11

Clinical interventions

The twenty most frequently drugs occurring in intervention reports and their potential risk are presented in Table 4. The pharmacists made 1019 interventions and recommendations in 448 handwritten reports. The average intervention per report was 2.5, standard deviation (±0.67), range (2–4), and mode (2). The interventions and recommendations made have been categorised as drug regimen change (76.1%), monitoring required (13.0%), communication (5.4%), counselling required (5.0%) and adverse drug reporting (0.6%). The intervention types have been summarised in Table 5. Monitoring-required based interventions were significantly more likely to be accepted (130 vs 38; p <0.0001). Drugs involving drug regimen adjustment by pharmacists included potassium citrate (n = 56), enoxaparin (n = 54), warfarin (n = 42), diclofenac (n = 40), and morphine (n = 37). Monitoring required interventions were made for potassium chloride (n = 46), frusemide (n = 22), warfarin (n = 20), gentamicin (n = 19) and metolazone (n = 14). Drugs requiring counselling included warfarin (n = 44), iron supplement (n = 12), inhaled steroid (n = 6), insulin (n = 4), and lamivudine (n = 3). Drugs involving communication between pharmacist and other healthcare professionals included frusemide (n = 31), diclofenac (n = 18), iron supplement (n = 16), warfarin (n = 11) and antacid (n = 7). Majority (90.5%) of the recommendations and interventions made by pharmacists were accepted by prescribers and other healthcare professionals (see Table 5). These interventions were communicated via the following means: verbal (76.4%), write in patient medical notes (16.3%), acted upon by reporting pharmacist (6.1%), prepare formal note (0.7%) and prescribe/procure for patient (0.5%).
Table 4

Drugs most frequently occurring in intervention reports and their potential risk

Drug

Number in reports, n (%)

Examples of potential risk

Outcome of intervention

Accepted

Not accepted

Warfarin

97 (9.5)

Bleeding

89

8

Slow K

61 (6.0)

Electrolyte imbalance

56

5

Gentamicin

60 (5.9)

Tinnitus

45

15

Potassium Citrate

56 (5.5)

Electrolyte imbalance

41

15

Enoxaparin

55 (5.4)

DVT

46

9

Diclofenac

43 (4.2)

Gastrointestinal bleeding

40

3

Heparin

39 (3.8)

Bleeding

34

5

Morphine

38 (3.7)

Respiratory depression

35

3

Frusemide

37 (3.6)

Electrolyte imbalance

29

8

Iron Supplement

37 (3.6)

Anaemia

34

3

Clindamycin

27 (2.6)

Diarrhoea

25

2

Metolazone

26 (2.6)

Electrolyte imbalance

26

0

Omeprazole

24 (2.4)

Gastrointestinal bleeding

21

3

Atenolol

20 (2)

Heart block

19

1

Hydrochlorthiazide

18 (1.8)

Electrolyte imbalance

18

0

Metronidazole

16 (1.6)

Increased hospital cost

14

2

Rosuvastatin

15 (1.5)

Cardiovascular event

15

0

Cefuroxime

13 (1.3)

Severe diarrhoea

13

0

Ciprofloxacin

13 (1.3)

Muscle weakness

13

0

Lisinopril

13 (1.3)

Neonatal mortality

11

2

Table 5

Types of pharmacist clinical interventions and degree of acceptance

Intervention type

Method

Number of reports

Acceptance

Yes, n (%)

No, n (%)

Drug regimen change (n=775[76.1%])

Verbal

643

730 (94)

45 (6)

Write in medical notes

109

Acted on by pharmacist

20

Prescribe/procure for patient

3

Monitoring required (n = 132 [13%])

Verbal

82

130 (98)

2 (2)

Write in patient medical notes

49

  

Write formal note

1

  

Counselling required (n = 52 [5.1%])

Verbal

9

49 (94)

3 (6)

Acted on by pharmacist

42

  

Prescribe/procure for patient

1

  

Communication (n = 54[5.3%])

Verbal

45

50 (93)

4 (7)

Write in medical notes

8

  

Prescribe/procure for patient

1

  

Adverse drug reporting (n = 6 [0.6%])

Write formal note

6

6 (100)

0 (0)

Discussion

This part of the study evaluated the clinical intervention reports submitted by pharmacists working in a tertiary hospital. The pharmacists identified drug related problems in the management of patients and made interventions to prevent these errors from reaching patients. Twenty-four pharmacists made 1019 clinical interventions in 448 handwritten reports. Majority of the interventions related to drug therapy changes. Though this study evaluated handwritten reports, it is comparable to evaluations done on electronic incident reports [8, 9].

The categories of drugs most often associated with drug error reports were similar to those reported from previous studies and included cardiovascular agents [10, 11], anti-infectives [11, 12], and central nervous system agents [10, 13], suggesting that future strategies for reducing drug errors could target these agents. This study also found challenges with the use of nutritional supplements. Most of the challenges with nutritional supplements had to do with untreated anaemia, which physicians had overlooked. Iron deficiency anaemia is a serious nutritional problem in developing countries given its impact on increased mortality or serious morbidity in patients [14].

The frequently reported drug was warfarin as found in other studies [15]. The use of warfarin presents substantial safety concerns for patients. Adverse events associated with warfarin therapy are common [16]. This will require prevention strategies targeted at the prescribing and monitoring stages of warfarin management.

Though this study concentrated on pharmacists identifying inpatient drug errors as in other studies, results are comparable with studies conducted in outpatients [11, 1720]. The drug errors assessed in this study were reports from only pharmacists although physicians [11, 21], nurses [22, 23] and others [24, 25] had reported drug errors in other studies.

The most frequently reported drug errors found in our study were drug regimen change and originated from drug prescribing. This finding is consistent with findings from other studies conducted in clinical centres [26], tertiary [27], hospital inpatient [28] and ambulatory care settings [11]. Inappropriate prescribing predicts the risk of adverse drug events [29]. The most commonly reported prescribing drug error was untreated indication. This was followed by prescribing wrong dose as seen in other studies [11, 30]. Children are particularly at risk of wrong dose errors [31].

The top two most frequently reported drug type associated with prescribing, dispensing and administration errors were cardiovascular and anti-infective agents. The most commonly reported dispensing error was dispensing wrong drug. Previous studies have reported dispensing wrong drugs in all types of inpatient settings [25, 3235]. Omission due to drug unavailability was also a common error identified. Drug unavailability is common and poses a major challenge to healthcare systems in transitional and developing countries [36, 37]. In addition to drug omissions, administering wrong drug followed by duplication were common reported administration errors. The most commonly reported monitoring error was omitting relevant laboratory test. Monitoring errors had been previously reported [11].

More than 90% of interventions and recommendations by pharmacists were accepted and implemented. Over 70% of the interventions involved drug regimen change. Studies have reported prescribing errors as a major contributor to patient harm in hospitals [10, 26, 28, 29, 38]. Most (76%) of the interventions were communicated verbally. This would require an operational collaborative working relationship between pharmacists and other healthcare professionals to enhance patient care [39]. Previous studies reported that pharmacists in a collaborative team in hospitals helped reduce adverse drug events by 30–86% [19, 4042]. Pharmacists’ close proximity with physicians provides opportunity for timely verbal communications on error interceptions. Some of the potential risk prevented by pharmacists included bleeding, anaemia, nephrotoxicity, electrolyte imbalance, severe diarrhoea etc.

Moreover, other interventions by pharmacists in this study related to patient counselling. It has been reported that patient counselling prevents adverse drug events during and after hospitalisation [43].

The study had some limitations. The study evaluated voluntary incident reports. Voluntary reports could be underreported and did not provide the actual frequency of the total denominator of errors that were detected and ameliorated. Secondly, reports did not contain information on whether errors reached patients and the effects of any harm. Moreover, the study could not assess the outcomes of the interventions performed by pharmacist.

Conclusions

Hospital pharmacists identified a lot of drug use challenges and subsequently prevented errors from reaching patients. Majority of pharmacist interventions and recommendations to prevent or ameliorate drug errors were accepted and implemented.

Declarations

Acknowledgements

Not applicable.

Funding

The study did not receive any external funding.

Availability of data and materials

Please contact author for data requests.

Authors’ contributions

FA was involved in conceptualization, research design, data collection, data analysis, statistical analysis and drafting of manuscripts. FAN was involved in data analysis and reviewing and editing of manuscripts. BPA was involved in study conceptualization, and editing of final manuscript. All authors read, reviewed and edited the final manuscript and approved the final manuscript in its current state.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The work was reviewed by the Internal Review Board of the Public Health Unit of Korle Bu Teaching Hospital and the Ethical and Protocol Review Committee of the University of Ghana Medical School (MS-Et/M.3-P3.1/2013-2014).

Informed consent

It was a retrospective review and did not require informed consent. However, codes were used to refer to patients such that the identity of participants were not known.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Korle Bu Teaching Hospital
(2)
Pharmacy Department, Korle Bu Teaching Hospital
(3)
Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology

References

  1. Brennan TA, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6.View ArticlePubMedGoogle Scholar
  2. Bates DW, et al. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10(4):199–205.View ArticlePubMedGoogle Scholar
  3. van Doormaal JE, et al. Comparison of methods for identifying patients at risk of medication-related harm. Qual Saf Health Care. 2010;19:26.View ArticleGoogle Scholar
  4. Cornu P, et al. Performance of a clinical decision support system and of clinical pharmacists in preventing drug–drug interactions on a geriatric ward. Int J Clin Pharm. 2014;36(3):519.Google Scholar
  5. Kohn LT, Corrigan J, Donaldson MS. Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington DC: National Academy Press; 2000.Google Scholar
  6. Aspden P, et al. Preventing medication errors: quality chasm series. Washington DC: National Academies Press; 2006.Google Scholar
  7. Bates DW, et al. The impact of computerized physician order entry on medication error prevention. JAMIA. 1999;6:313–21.PubMedPubMed CentralGoogle Scholar
  8. Budnitz DS, et al. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006;296(15):1858–66.View ArticlePubMedGoogle Scholar
  9. Tariq A, Georgiou A, Westbrook J. Medication incident reporting in residential aged care facilities: limitations and risks to residents' safety. BMC Geriatr. 2012;12:67.View ArticlePubMedPubMed CentralGoogle Scholar
  10. Lesar TS, Lomaestro BM, Pohl H. Medication-prescribing errors in a teaching hospital: a 9-year experience. Arch Intern Med. 1997;157(14):1569.View ArticlePubMedGoogle Scholar
  11. Kuo GM, et al. Medication errors reported by US family physicians and their office staff. Qual Saf Health Care. 2008;17(4):286–90.View ArticlePubMedGoogle Scholar
  12. Silva DC, et al. Adverse drug events in a paediatric intensive care unit: a prospective cohort. BMJ Open. 2013;3:e001868. doi:10.1136/bmjopen-2012-001868.
  13. Hansen RA, et al. Types of medication errors in North Carolina nursing homes: a target for quality improvement. Am J Geriatr Pharmacother. 2006;4(1):52–61.View ArticlePubMedGoogle Scholar
  14. DeMaeyer EM. Preventing and controlling iron defiency anaemia through primary health care: a guide for health administrators and programme managers. Geneva: World Health Organization; 1989.Google Scholar
  15. Gurwitz JH, et al. The safety of warfarin therapy in the nursing home setting. Am J Med. 2007;120(6):539–44.View ArticlePubMedGoogle Scholar
  16. Zhan C, et al. How useful are voluntary medication error reports? The case of warfarin-related medication errors. Jt Comm J Qual Patient Saf. 2008;34(1):36–45.View ArticlePubMedGoogle Scholar
  17. Aljadhey H, et al. Medication safety practices in hospitals: a national survey in Saudi Arabia. Saudi Pharm J. 2013;21(2):159–64.View ArticlePubMedGoogle Scholar
  18. Bourgeois FT, et al. Pediatric adverse drug events in the outpatient setting: an 11-year national analysis. Pediatrics. 2009;124(4):e744–50.View ArticlePubMedPubMed CentralGoogle Scholar
  19. Murray MD, et al. Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Intern Med. 2009;169(8):757–63.View ArticlePubMedGoogle Scholar
  20. Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011;46(5):1517–33.View ArticlePubMedPubMed CentralGoogle Scholar
  21. Scott HD, et al. Physician reporting of adverse drug reactions: results of the Rhode Island adverse drug reaction reporting project. JAMA. 1990;263(13):1785–8.View ArticlePubMedGoogle Scholar
  22. Bates DW, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274(1):29–34.View ArticlePubMedGoogle Scholar
  23. Pagnamenta A, et al. Adverse event reporting in adult intensive care units and the impact of a multifaceted intervention on drug-related adverse events. Ann Intensive Care. 2012;2(1):47.View ArticlePubMedPubMed CentralGoogle Scholar
  24. Hartwig SC, Denger SD, Schneider PJ. Severity-indexed, incident report-based medication error-reporting program. Am J Health Syst Pharm. 1991;48(12):2611–6.Google Scholar
  25. Costa LA, Valli C, Alvarenga AP. Medication dispensing errors at a public pediatric hospital. Rev Lat Am Enfermagem. 2008;16(5):812–7.View ArticlePubMedGoogle Scholar
  26. Franklin BD, et al. Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes. Postgrad Med J. 2011;87(1033):739–45.View ArticlePubMedGoogle Scholar
  27. Al-Jeraisy MI, Alanazi MQ, Abolfotouh MA. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia. BMC Res Notes. 2011;4(1):294.View ArticlePubMedPubMed CentralGoogle Scholar
  28. Dean B, et al. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care. 2002;11(4):340–4.View ArticlePubMedPubMed CentralGoogle Scholar
  29. Lund BC, et al. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44(6):957–63.View ArticlePubMedGoogle Scholar
  30. Raju TK, et al. Medication errors in neonatal and paediatric intensive-care units. Lancet. 1989;334(8659):374–6.View ArticleGoogle Scholar
  31. Fernandez-Llamazares CM, et al. Profile of prescribing errors detected by clinical pharmacists in paediatric hospitals in Spain. Int J Clin Pharm. 2013;35(4):638–46.View ArticlePubMedGoogle Scholar
  32. Rolland P. Occurrence of dispensing errors and efforts to reduce medication errors at the Central Arkansas Veteran’s Healthcare System. Drug Saf. 2004;27(4):271–82.View ArticlePubMedGoogle Scholar
  33. Roberts DE, et al. An analysis of dispensing errors in NHS hospitals. Int J Pharm Pract. 2002;10(S1):R6.View ArticleGoogle Scholar
  34. Facchinetti NJ, Campbell GM, Jones DP. Evaluating dispensing error detection rates in a hospital pharmacy. Med Care. 1999;37(1):39–43.View ArticlePubMedGoogle Scholar
  35. Bohand X, et al. Frequency, types, and potential clinical significance of medication-dispensing errors. Clinics. 2009;64(1):11–6.View ArticlePubMedPubMed CentralGoogle Scholar
  36. Agalu A, et al. Medication administration errors in an intensive care unit in Ethiopia. Int Arch Med. 2012;5(1):15.View ArticlePubMedPubMed CentralGoogle Scholar
  37. Nunes CFP, et al. A survey of medication error prevalence in a Brazilian Health Center. J Nurs Care Qual. 2013;28(1):92–7.View ArticleGoogle Scholar
  38. Lewis PJ, et al. Prevalence, incidence and nature of prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32(5):379–89.View ArticlePubMedGoogle Scholar
  39. McDonough PR, Doucette WR. Developing colloborative working relationship between pharmacists and physicians. J Am Pharm Assoc. 2001;41(5):682–92.View ArticleGoogle Scholar
  40. Patanwala AE, et al. A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. Ann Emerg Med. 2012;59(5):369–73.View ArticlePubMedGoogle Scholar
  41. Leape LL, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267–70.View ArticlePubMedGoogle Scholar
  42. Klopotowska JE, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care. 2011;14:174–85.View ArticleGoogle Scholar
  43. Schnipper JL, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71.View ArticlePubMedGoogle Scholar

Copyright

© The Author(s). 2016

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