Background Prescribing errors in emergency settings occur frequently. Knowing which patients have the highest risk of errors could improve patient outcomes. Objective The aim of this study was to test an algorithm designed to assess prescribing error risk in individual patients, and to test the feasibility of medication reviews in high-risk patients. Setting The study was performed at the Acute Admissions Unit at Aarhus University Hospital, Denmark. Methods The study was an interventional pilot study. Patients included were assessed according to risk of prescribing errors with the aid of an algorithm called 'Medication Risk Score' (MERIS). Based on the score, high-risk patients were offered a medication review. The clinical relevance of the medication reviews was assessed retrospectively. Main outcome measure The number and nature of prescribing errors during the patients' hospitalisation. Results The study included 103 patients, all of whom could be risk assessed with the algorithm MERIS. MERIS stratified 38 patients as high-risk patients and 65 as low-risk patients. The 103 patients were prescribed a total of 848 drugs in which 88 prescribing errors were found (10.4 %). Sixty-two of these were found in patients in the high-risk group. In general, the medication reviews were found to be clinically relevant and approximately 50 % of recommendations were implemented. Conclusion MERIS was found to be applicable in a clinical setting and stratified most patients with prescribing errors into the high-risk group. The medication reviews were feasible and found to be clinically relevant by most raters.
Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record.Prescribing errors are considered a major problem in healthcare systems [1]. A review reported prescribing errors in approximately 15% of handwritten prescriptions and in 8% of electronic prescriptions [2]. One method to lower the prevalence of prescribing errors is to review the medicine charts and prescriptions. In UK hospitals, pharmacists have, since the 1980s, been reviewing medicine charts and have made recommendations to prescribers [3]. In medication reviews, there is an underlying assumption that if evidence-based medication counselling is provided, the prescriber will, in turn, implement these recommendations [4]. Adherence to pharmacists' medication counselling varies in studies between 39 and 100% [5][6][7][8][9][10][11]. Similar challenges in adherence have been noticed in, for example, geriatric consultation where recommendations are implemented in approximately half of the cases [12]. Furthermore, a review on adherence to treatment recommendations from consulting psychiatrists showed that medication advice was followed in 68-98% of cases [13].Facilitators in collaboration in medication counselling seem to be related to trustworthiness, role specification and routine face-to-face interaction [14]. Factors that seem to enhance adherence to medication counselling are as follows: feedback by personal contact, the education of the medication counselling provider, ward type and time spent at the ward [15][16][17]. Previous studies of pharmaceutical interventions have revealed that physicians are satisfied with the intervention [18,19]. All of the aforementioned studies are performed retrospectively after implementation of medication counselling or after ...
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