NEW ORLEANS--Monitoring programs in which hospital pharmacists
double-check physicians' orders for antibiotics are proving effective
in averting potential problems of safety or efficacy, researchers
reported at the 36th Inter-science Conference on Antimicrobials and
At the University of California Medical Center, San Francisco,
hospital pharmacists intervened a total of 3,344 times over a 2-year
period; these interventions represent 5% of the total number of
antibiotic prescriptions during that time.
Of these interventions, 858 were classified as "high level,"
including 471 to avoid potential drug toxicity and 387 to enhance
efficacy, reported B. Joseph Guglielmo, PharmD, professor of clinical pharmacy.
"Antimicrobial monitoring programs are common at academic
medical centers, but they are not as well established throughout the
hospital industry, which I think is unfortunate," he commented.
"In addition to enhancing safety, prescription monitoring also
saves money because better treatment circumvents complications."
In the San Francisco monitoring system, pharmacists and consulting
infectious disease specialists probably prevented 31 to 68 cases of
kidney toxicity and 13 to 40 cases of hearing damage by intervening
to recommend substitution or reduction of an aminoglycoside dose, Dr.
A study from the Albany Medical Center Hospital, NY, showed that
pharmacists there also averted many problems by reviewing
Laurie Briceland, PharmD, and Daniel Stein, MD, reported that, over a
20-month period, hospital pharmacists detected and avoided 1,048
potential errors in antibiotic prescriptions in this large teaching
institution, where most prescriptions are written by house staff.
Of these errors, 16% were classified as having the potential to
produce "severe or life-threatening" consequences, such as
anaphylactic reactions; 14% were judged to have the potential for
"serious" consequences; and 70% for "significant" consequences.
Dosing errors were most frequent (62%), followed by ordering
antibiotics to which the patient was known to be allergic (20%). Most
errors occurred for parenteral antibiotics. Beta-lactams were the
most frequently implicated (46%), followed by aminoglycosides,
macrolides, and antifungals, Dr. Briceland said.
Consider Specific Conditions
Most errors occurred because physicians did not account for some
specific condition (51%), such as impaired renal function, she added.
While averting prescription errors was the focus of the first two
studies, a third study looked at whether hospitalized patients
actually get their medications as prescribed.
Blake E. Max, PharmD, followed 29 patients on an HIV ward at Cook
County Hospital, Chicago, for 18 days. He calculated a medication
error rate of 20% and found that some patients never received their
Dr. Max reviewed nursing medication administration records daily, and
collected data on oral and IV medications delivered to the ward and
returned to the pharmacy. Errors included dose not given, unordered
dose given, and extra doses given.
The error rate per patient ranged from 3% to 37%. Errors were most
likely to occur in patients receiving the greatest number of
medications, he said.