Outpatient anti-epileptic drug prescribing errors in a Children's Hospital: An audit and literature review

Murphy, AP; Bentur, H; Dolan, Catherine; Bugembe, T; Gill, Andrea; Appleton, Richard

doi:10.1016/j.seizure.2014.06.010

Cited by 10 publications

(5 citation statements)

References 53 publications

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“…[4] Children considered vulnerable to medication prescribing errors because of their different ages, weights, and metabolism of drugs, in addition to the risk factors that contributes these types of errors; weight-based dosing, units' conversions from pound to kilograms, and decreased communication ability with the patients and to some extent with the parents. [6][7][8][9] Study shows that 16% of children received their outpatient prescription had at least one prescribing error. Most of the detected MEs were related to prescribing error (improper dosing [8%], inappropriate frequency [3%], dosage strength [3%], and inappropriate abbreviation used 20%), while in Pharmacopeia MEDMARX database, the prescribing error rate was reported to be around 8% in an outpatient pediatric clinics due to illegible handwriting, improper dose, and confused drug name.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prescribing medication errors in a pediatric outpatient pharmacy

Sulaiman¹,

Al-Jeraisy²,

Alharbi³

et al. 2017

Int J Med Sci Public Health

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Section: Introductionmentioning

confidence: 99%

Evaluation of prescribing medication errors in a pediatric outpatient pharmacy

Sulaiman¹,

Al-Jeraisy²,

Alharbi³

et al. 2017

Int J Med Sci Public Health

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“…Medication management of neurologic disorders in the ambulatory care clinic setting can be complicated by numerous medication‐related issues, including complex titration and taper schedules, use of dual agents, unique monitoring parameters, and a broad range of potential side effects. Antiepileptic medications are just one example of a medication class that requires close monitoring as both overdosing and underdosing can pose harm to patients . Effective initiation and optimization of medication regimens for specific neurologic diagnoses can be challenging and is an area where close follow‐up may be needed.…”

Section: Introductionmentioning

confidence: 99%

Interventions associated with implementation of a pharmacist‐led neurology pharmacotherapy clinic in an ambulatory care setting

Martin

Heberle

Knight

2018

J Am Coll Clin Pharm

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Objectives Medication management of neurologic disorders can present challenges in an ambulatory care setting. Clinical pharmacy specialists (CPSs) may be uniquely positioned to assist with the medication adjustments and monitoring that is often necessary for these conditions. While pharmacist‐led clinics are well established in some areas of ambulatory care, few examples have been described within neurology. This project aims to describe the interventions associated with a pharmacist‐led neurology clinic within a Veterans Affairs (VA) Medical Center. Methods A pharmacist‐led neurology clinic was implemented to assist with medication management of various neurologic conditions and increase access to the neurology service. This retrospective chart review included patients referred to the CPS clinic during a 6‐month period, with a minimum follow‐up of 3 months. The number of medication changes, nonpharmacologic interventions, and adverse drug events (ADEs) managed by the CPS was determined. The number of interim pharmacist‐led visits was used as an estimate of neurology provider time saved. Results One hundred sixty‐four patients were included in the analyses. During the 9‐month period assessed, patients had a total of 307 visits in the pharmacist‐led neurology clinic. Patients were referred for multiple neurologic conditions, with headache, neuropathy, Parkinson's disease, non‐Parkinson's tremor, and seizure disorders being the most common. The CPS made 175 dose adjustments, 139 medication additions or discontinuations, and 135 nonpharmacologic interventions. In addition, 41 ADEs were identified and/or managed during CPS encounters. Patients had an average of two visits with the CPS in between scheduled neurology clinic appointments; this allowed for an estimated 34 appointment slots/month to remain open in the neurology provider clinics. Conclusions The implementation of a pharmacist‐led neurology clinic allowed for CPS management of medications for multiple neurologic conditions, including the management of ADEs, and increased access to the neurology ambulatory care service at this VA facility.

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“…A recent study demonstrated that up to 72.1% of outpatient antiepileptic drugs (AEDs) prescriptions are inadequately completed. 4 In the United Kingdom shared care protocols exist whereby the responsibility for managing the prescribing of antiepileptic medications in children is shared between a specialist in secondary or tertiary care and a GP in primary care. This patient management style means that GPs are heavily reliant on specialist letters for AEDs prescribing instructions.…”

Section: Introductionmentioning

confidence: 99%

Comprehensiveness of Pediatric Antiepileptic Prescribing in Clinic Letters: Are We Communicating Well?

Butler

Babiker

2017

J Pediatr Epilepsy

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This study aims to determine the comprehensiveness of pediatric epilepsy outpatient clinic letters in a tertiary pediatric neurology center with particular focus on the prescribing instructions. A retrospective study was conducted for all pediatric outpatient epilepsy clinic letters between August and October 2016. This study was undertaken in a tertiary pediatric neurology department at the Bristol Royal Hospital for Children, United Kingdom. A total of 160 patients were identified during the time period and included in the study. Letters were evaluated for the following information: patient demographics, inclusion of problem list, and medication details including the clarity of prescribing instructions. The comprehensiveness of letters was scored out of nine based on the nine categories; weight, diagnosis list, medication list, dose in milligrams, dose equivalence in milligrams/kilograms/day, formulation, strength or concentration of medication, if applicable is the volume of medication provided and is the trade name provided. A total of 94% of letters had a diagnosis or problem list provided which was clear. Only 68% letters had a separate medication list provided. The dose of antiepileptic drugs (AEDs) in milligrams was provided in 95% of letters. The formulation of the AED was provided in only 30% of letters. Only 24% of letters where a category 1 AED was prescribed had the trade name provided. This study has demonstrated significant omissions from outpatient pediatric epilepsy letters. The omissions presented in this study may culminate in inefficient communication and increased morbidity. We share practice improving learning points for writing comprehensive letters which we believe can be generalized to other pediatric specialties.

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Outpatient anti-epileptic drug prescribing errors in a Children's Hospital: An audit and literature review

Cited by 10 publications

References 53 publications

Evaluation of prescribing medication errors in a pediatric outpatient pharmacy

Evaluation of prescribing medication errors in a pediatric outpatient pharmacy

Interventions associated with implementation of a pharmacist‐led neurology pharmacotherapy clinic in an ambulatory care setting

Comprehensiveness of Pediatric Antiepileptic Prescribing in Clinic Letters: Are We Communicating Well?

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