title: Adding value through pharmacy validation: a safety and cost perspective.
abstract: OBJECTIVE
  Prescribing errors (PE) are frequent, cause significant harm to patients and prove costly. Few studies demonstrate the impact of pharmacist interventions. The objectives of this study were to characterize the severity and cost of the potential outcome of PE that pharmacists can prevent and to develop an economic analysis.
  
  
  METHODS
  We performed a non-randomized, prospective, observational study of all prescriptions made to adult patients admitted to a 1300-bed tertiary teaching hospital in Madrid (Spain) by means of a computerized physician order entry tool combined with a clinical decision support system. We analysed PE intercepted through the pharmacist validation process between January and June 2013. An independent team determined the severity of the potential adverse drug event (ADE) and the probability of causing an ADE (PAE). We estimated the cost avoidance and performed an economic analysis. A kappa statistic was used to verify inter-observer agreement.
  
  
  RESULTS
  484 PE were intercepted: 36.2% of PE were classified as being of minor severity, 59.1% as moderate and 4.7% as serious. The most common type of moderate-serious PE found was excessive dose (30%, 94/309), followed by insufficient dose (20%, 62/309), and omission (19%, 58/309). The most frequent families of drugs involved in moderate-serious PE were antineoplastic agents (22.3%, 69/309) and antimicrobials (17.2%, 53/309). The PAE was higher than 40% in 49% of PE. We estimated a cost avoidance of €291,422 and a return on investment of €1.7 for each €1 spent on a pharmacist's salary. The overall inter-rater agreement for the participants was moderate for severity (κ = 0.57; P <0.005) and strong for the PAE (κ = 0.77; P <0.005).
  
  
  CONCLUSIONS
  Pharmacists add important value in preventing PE, and their interventions are financially beneficial for the institution.
authors.affiliation: Chief of the Hospital Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Ibáñez-Garcia
authors.affiliation: Chief of the Hospital Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Carmen Guadalupe
authors.initials: CG
authors.lastname: Rodriguez-Gonzalez
authors.affiliation: Chief of the Hospital Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Martin-Barbero
authors.affiliation: Chief of the Hospital Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanjurjo-Saez
authors.affiliation: Chief of the Hospital Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Herranz-Alonso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000145:classification / Q000191:economics* / Q000517:prevention & control*; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration*; D024382:Professional Role; D011446:Prospective Studies; D013030:Spain
keywords: adverse drug event; clinical pharmacists; economic analysis; interventions; medication errors; severity