REDUCING PRESCRIBING ERRORS
Why reducing prescribing errors?
Prescribing errors account for a substantial proportion of medication related harm.1 In the Netherlands, 16.838 medication-related incidents were reported to the Central Medication Incidents Registration (CMR) in 2014.2 A third of these incidents were due to prescribing errors. Additionally, the HARM study showed that 2.4% of all hospital admissions and 5.6% of all acute admissions in Dutch hospitals were related to medication errors.3 Almost half (46%) of these admissions were potentially preventable. One or more prescribing errors were detected in most (71%) of the preventable admissions. Given the increasing complexity of patients in hospitals (e.g. polypharmacy, multimorbidity, older age), the demanding working environment, and the large number of drugs prescribed, new strategies to reduce prescribing errors in this setting are urgently needed.
How to reduce prescribing errors?
Because of the complexity of the prescribing process (e.g. working environment, hierarchy), interventions to reduce prescribing errors are more likely to be effective if they include a multifaceted (two or more components) and multidisciplinary strategy. With a view to developing a multifaceted strategy, we hypothesize that Participatory Action Research (PAR) would be a suitable approach to reduce prescribing errors in hospitals. PAR is a research approach that combines qualitative and quantitative methods to investigate complex problems in healthcare systems.4 It is characterized by the involvement of local stakeholders in the identification of opportunities to improve practice, the subsequent development and implementation of tailored interventions directed at these opportunities, and the evaluation of the implemented interventions. We hypothesize that a multidisciplinary team including a clinician and a hospital pharmacist, working together with local stakeholders, can make a valuable contribution to reduce prescribing errors.
Since September 2015, the pharmacotherapy team is operational in the VU University Medical Cente and has started on several wards with a high volume of prescriptions written out. First, the team starts to evaluate the number of prescribing errors by means of medication chart review. Second, they discuss the results with the ward team using the PAR-method to identify facilitators and barriers to reduce prescribing errors. On the basis of the identified facilitators and barriers, they work together to develop and select a ‘package’ of interventions. Six to ten months after implementation of these interventions, medication chart reviews are carried out to evaluate the effect of the interventions.
Based on the results of the individual wards, hospital-wide interventions are developed including:
- eLearning covering important prescribing topics (e.g. pain/fluid management, anticoagulation) for junior doctors;
- Optimising hospital guidelines for drug prescribing;
- Increasing the role of the clinical pharmacologist and the hospital pharmacist in clinical practice.
 Hoonhout L, de Bruijne M, Wagner C, Asscheman H, van der Wal G, van Tulder M. Nature, occurrence and consequences of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug Saf 2010;33:853-864.
 Dutch Hospital Pharmacist Association. Centrale Medicatiefouten Registratie (CMR). Annual rapport 2014. The Hague, The Netherlands.
 Leendertse A, Egberts A, Stoker L, van den Bemt P. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;22:1890-1896.
 van Buul L, Sikkens J, van Agtmael M, Kramer M, van der Steen J, Hertogh C. Participatory action research in antimicrobial stewardship: a novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities. J Antimicrob Chemother 2014;69:1734-1741.