Effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations in an acute care setting in Saudi Arabia: a quasi-experimental study

Abstract

ObjectivesTo evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals.DesignQuasi-experimental study consisting of a single group before-and-after study design.SettingA public emergency hospital in Mecca, Saudi Arabia.Participants660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed.InterventionThe intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011.Main outcomeReduction in the incidence of HRAs use from the preintervention to postintervention study period.FindingsThe five most common abbreviations recorded prior to the interventions were ‘IJ for injection’ (28.6%), ‘SC for subcutaneous’ (17.4%), drug name and dose running together (9.7%), ‘OD for once daily’ (5.8%) and ‘D/C for discharge’ (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%).ConclusionsPharmacist-led educational interventions can significantly reduce the use of HRAs by healthcare providers. Future research should investigate the long-term effectiveness of such educational interventions through a randomised controlled trial.

A Systematic Review on the Strategies and Techniques for Decreasing Prescribing Errors

“…Haseeb et alconsidered the pharmacist intervention through a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of high-risk abbreviations (HRAs), awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. 46 From these studies, we can conclude that the pooled analysis supported the role of pharmacists in reducing preventable ADEs and prescribing errors. Because, these studies show different methods of interventions by the clinical pharmacists to decrease the prescribing errors, in addition to the promising effects of the expansion of the role of the pharmacist in the prescribing process and the pharmacist's interventions due to CPOE for decreasing the prescription errors.…”

“…Most studies suggested that engaging pharmacists in these ways can be beneficial, but few studies have explored the best ways to integrate pharmacists into teams and the interprofessional factors to be considered. [39][40][41][42][43][44][45][46] The intervention of the pharmacist differs between the studies, for example,Kaushal et al addressed full-time pharmacists participation in physician rounds and provided physicians with timely information and advice on ADEs; drug interactions; and appropriate dosages, dose intervals, and routes of administration. 39 Klopotowska et alreviewed the interventional role of two hospital pharmacistswith 10 years of experience who completed 4 weeks of training in the ICU before the start of this study to guarantee the quality of intervention.…”

Uso de abreviaturas inseguras en la prescripción médica y errores de medicación: una revisión narrativa

“…Los de alto riesgo se refirieron a las abreviaturas contenidas en la lista que emitió el ISMP 9 . Según un estudio realizado en Arabia Saudita el año 2016, la incidencia del uso de abreviaturas de alto riesgo en la prescripción médica correspondió a 72,7% 20 , se trató de abreviaturas que pudieron causar consecuencias mortales en los pacientes, tales como "u o iu", las que pudieron ser erróneamente confundidas por un 0 o por un 4, con riesgo de multiplicar por 10 o más la dosis (por ejemplo, 4U pudo haberse confundido con 40) 21 . Autores señalaron, que independiente si las abreviaturas eran de alto o bajo riesgo, éstas debían ser evitadas 4 .…”

“…Sumado a lo previo, existió consenso entre los profesionales prescriptores, de que la utilización de abreviaturas en su trabajo diario economizaba su tiempo, no obstante, estaban en conocimiento de que éstas podían ser mal interpretadas o podían tener más de un significado para los lectores. Además de ello, los profesionales médicos asumieron desconocer las abreviaturas que podían causar un gran daño al paciente 11,15,20,24 .…”

“…Un estudio efectuado en Arabia Saudita señaló que la ejecución de intervenciones educativas por parte de un Farmacéutico disminuyó significativamente la incidencia de abreviaturas de alto riesgo en salud (53,6% vs 25,5%; p = 0,001) 20 . Así también, existe evidencia de que la responsabilidad de la terapia farmacológica era multidisciplinaria, por lo que resultaba necesario que la prescripción no fuese vista a penas como un documento, sino más bien, como un instrumento de comunicación entre los profesionales 16,24 .…”