title: Prescriptions analysis by clinical pharmacists in the post-operative period: a 4-year prospective study.
abstract: BACKGROUND
  Clinical pharmacists can help prevent medication errors. However, data are scarce on their role in preventing medication prescription errors in the post-operative period, a high-risk period, as at least two prescribers can intervene, the surgeon and the anesthetist. We aimed to describe and quantify clinical pharmacist' intervention (PIs) during validation of drug prescriptions on a computerized physician order entry system in a post-surgical and post-transplantation ward. We illustrate these interventions, focusing on one clearly identified recurrent problem.
  
  
  METHODS
  In a prospective study lasting 4 years, we recorded drug-related problems (DRPs) detected by pharmacists and whether the physician accepted the PI when prescription modification was suggested.
  
  
  RESULTS
  Among 7005 orders, 1975 DRPs were detected. The frequency of PIs remained constant throughout the study period, with 921 PIs (47%) accepted, 383 (19%) refused and 671 (34%) not assessable. The most frequent DRP concerned improper administration mode (26%), drug interactions (21%) and overdosage (20%). These resulted in a change in the method of administration (25%), dose adjustment (24%) and drug discontinuation (23%) with 307 drugs being concerned by at least one PI. Paracetamol was involved in 26% of overdosage PIs. Erythromycin as prokinetic agent, presented a recurrent risk of potentially severe drug-drug interactions especially with other QT interval-prolonging drugs. Following an educational seminar targeting this problem, the rate of acceptation of PI concerning this DRP increased.
  
  
  CONCLUSIONS
  Pharmacists detected many prescription errors that may have clinical implications and could be the basis for educational measures.
authors.affiliation: Laboratory ThEMAS TIMC UMR CNRS, Joseph Fourier University Grenoble, France. bruno.charpiat@chu-lyon.fr
authors.forename: B
authors.initials: B
authors.lastname: Charpiat
authors.forename: S
authors.initials: S
authors.lastname: Goutelle
authors.forename: M
authors.initials: M
authors.lastname: Schoeffler
authors.forename: F
authors.initials: F
authors.lastname: Aubrun
authors.forename: J-P
authors.initials: JP
authors.lastname: Viale
authors.forename: C
authors.initials: C
authors.lastname: Ducerf
authors.forename: G
authors.initials: G
authors.lastname: Leboucher
authors.forename: B
authors.initials: B
authors.lastname: Allenet
mesh_terms: D004347:Drug Interactions; D016903:Drug Monitoring; D062787:Drug Overdose / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D004364:Pharmaceutical Preparations