Antibiotic Monitoring Programs Can Avert Potential Errors in Prescribing

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 Chemotherapy (ICAAC).

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. Guglielmo said.

A study from the Albany Medical Center Hospital, NY, showed that pharmacists there also averted many problems by reviewing antimicrobial prescriptions.

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 prescribed medications.

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.