Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review

  • Jaime David Navarro Cárdenas Technologies and Health Policies Assessment Group (GETS-Grupo de Evaluación de Tecnologías y Políticas en Salud), Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0001-6346-0803
  • María Cristina Alarcón Nieto Technologies and Health Policies Assessment Group (GETS-Grupo de Evaluación de Tecnologías y Políticas en Salud), Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0001-6231-7036
  • María Paula Bernal Vargas Technologies and Health Policies Assessment Group (GETS-Grupo de Evaluación de Tecnologías y Políticas en Salud), Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0002-4132-3119
  • Kelly Estrada-Orozco a. Technologies and Health Policies Assessment Group (GETS-Grupo de Evaluación de Tecnologías y Políticas en Salud), Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. b. Institute of Clinical Research, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0001-5022-5572
  • Hernando Gaitán Duarte a. Technologies and Health Policies Assessment Group (GETS-Grupo de Evaluación de Tecnologías y Políticas en Salud), Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. b. Institute of Clinical Research, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0003-2939-3648
Keywords: Medication errors, Electronic prescription, Inappropriate prescribing, Medical errors, Drug prescriptions

Abstract

Introduction: A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years.

Objective: to establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals.

Methodology: A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143.

Results: 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach.

Conclusions: The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.

References

Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377-84. doi: http://www.doi.org/10.1056/NEJM199102073240605.

Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370-6. doi: http://www.doi.org/10.1056/NEJM199102073240604.

de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216-23. doi: http://www.doi.org/10.1136/qshc.2007.023622.

Aranaz-Andrés JM, Aibar-Remón C, Limón-Ramírez R, Amarilla A, Restrepo FR, Urroz O, Sarabia O, García-Corcuera LV, Terol-García E, Agra-Varela Y, Gonseth-García J, Bates DW, Larizgoitia I, IBEAS team. Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS). BMJ Qual Saf. 2011;20(12):1043-51. doi: http://www.doi.org/10.1136/bmjqs.2011.051284.

Montserrat-Capella D, Suárez M, Ortiz L, Mira JJ, Duarte HG, Reveiz L, AMBEAS Group. Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study. Int J Qual Health Care. 2015;27(1):52-9. doi: http://www.doi.org/10.1093/intqhc/mzu100.

Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care. 2010;22(6):507-18. doi: http://www.doi.org/10.1093/intqhc/mzq059.

About Medication Errors. What is a Medication Error? [Internet]. NCC MERP. 1998 [citado: 2021 ene. 4]. Disponible en: https://www.nccmerp.org/about-medication-errors

Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274(1):29-34.

Avery AA, Barber N, Ghaleb M, Dean Franklin B, Armstrong S, Crowe S, et al. Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study. General Medical Council, 2012. 227 p.

Dean B, Barber N, Schachter M. What is a prescribing error? BMJ Quality & Safety. 2000;9:232-7.

Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, Hanlon JT. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173-84. doi: http://www.doi.org/10.1016/S0140-6736(07)61091-5.

Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890-8. doi: http://www.doi.org/10.1001/jamainternmed.2014.949.

Ross S, Loke YK. Do educational interventions improve prescribing by medical students and junior doctors? A systematic review. Br J Clin Pharmacol. 2009;67(6):662-70. doi: http://www.doi.org/10.1111/j.1365-2125.2009.03395.x.

Teixeira Rodrigues A, Roque F, Piñeiro-Lamas M, Falcão A, Figueiras A, Herdeiro MT. Effectiveness of an intervention to improve antibiotic-prescribing behaviour in primary care: a controlled, interrupted time-series study. J Antimicrob Chemother. 2019;74(9):2788-96. doi: http://www.doi.org/10.1093/jac/dkz244.

Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, Gnjidic D, Del Mar CB, Roughead EE, Page A, Jansen J, Martin JH. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-34. doi: http://www.doi.org/10.1001/jamainternmed.2015.0324.

van den Bemt PM, Postma MJ, van Roon EN, Chow MC, Fijn R, Brouwers JR. Cost-benefit analysis of the detection of prescribing errors by hospital pharmacy staff. Drug Saf. 2002;25(2):135-43. doi: http://www.doi.org/10.2165/00002018-200225020-00006.

Patanwala AE, Sanders AB, Thomas MC, Acquisto NM, Weant KA, Baker SN, Merritt EM, Erstad BL. A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. Ann Emerg Med. 2012;59(5):369-73. doi: http://www.doi.org/10.1016/j.annemergmed.2011.11.013.

Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. Am J Geriatr Pharmacother. 2008;6(2):119-29. doi: http://www.doi.org/10.1016/j.amjopharm.2008.06.001.

Stanger S, Dahill M, Hillary C, Whitham R, Tasker A. Improving analgesia prescription for trauma inpatients. BMJ Open Qual. 2018;7(4):e000397. doi: http://www.doi.org/10.1136/bmjoq-2018-000397.

Donyai P, O'Grady K, Jacklin A, Barber N, Franklin BD. The effects of electronic prescribing on the quality of prescribing. Br J Clin Pharmacol. 2008;65(2):230-7. doi: doi: http://www.doi.org/10.1111/j.1365-2125.2007.02995.x

Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, Berenholtz S, Dorman T, Lipsett P. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003;18(4):201-5. doi: http://www.doi.org/10.1016/j.jcrc.2003.10.001.

Bayoumi I, Howard M, Holbrook AM, Schabort I. Interventions to improve medication reconciliation in primary care. Ann Pharmacother. 2009;43(10):1667-75. doi: http://www.doi.org/10.1345/aph.1M059.

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. doi: http://www.doi.org/10.1136/bmj.j4008.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. doi: http://www.doi.org/10.1007/s10488-010-0319-7.

Acheampong F, Anto BP, Koffuor GA. Medication safety strategies in hospitals--a systematic review. Int J Risk Saf Med. 2014;26(3):117-31. doi: http://www.doi.org/10.3233/JRS-140623.

Austin J, Barras M, Sullivan C. Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record. Int J Med Inform. 2020;135:104066. doi: http://www.doi.org/10.1016/j.ijmedinf.2019.104066.

Dalton K, O'Brien G, O'Mahony D, Byrne S. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis. Age Ageing. 2018;47(5):670-8. doi: http://www.doi.org/10.1093/ageing/afy086.

Hansen CR, O'Mahony D, Kearney PM, Sahm LJ, Cullinan S, Huibers CJA, Thevelin S, Rutjes AWS, Knol W, Streit S, Byrne S. Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta-analysis. Br J Clin Pharmacol. 2018;84(12):2716-28. doi: http://www.doi.org/10.1111/bcp.13742.

Manias E, Williams A, Liew D. Interventions to reduce medication errors in adult intensive care: a systematic review. Br J Clin Pharmacol. 2012;74(3):411-23. doi: http://www.doi.org/10.1111/j.1365-2125.2012.04220.x.

Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS. Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016;41(2):158-69. doi: http://www.doi.org/10.1111/jcpt.12372.

Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013;20(3):470-6. doi: http://www.doi.org/10.1136/amiajnl-2012-001241.

Roque F, Herdeiro MT, Soares S, Teixeira Rodrigues A, Breitenfeld L, Figueiras A. Educational interventions to improve prescription and dispensing of antibiotics: a systematic review. BMC Public Health. 2014;14:1276. doi: http://www.doi.org/10.1186/1471-2458-14-1276.

van der Linden CM, Jansen PA, Grouls RJ, van Marum RJ, Verberne MA, Aussems LM, Egberts TC, Korsten EH. Systems that prevent unwanted represcription of drugs withdrawn because of adverse drug events: a systematic review. Ther Adv Drug Saf. 2013;4(2):73-90. doi: http://www.doi.org/10.1177/2042098613477125.

Walsh KA, O'Riordan D, Kearney PM, Timmons S, Byrne S. Improving the appropriateness of prescribing in older patients: a systematic review and meta-analysis of pharmacists' interventions in secondary care. Age Ageing. 2016;45(2):201-9. doi: http://www.doi.org/10.1093/ageing/afv190. Epub 2016 Jan 10.

Hopkins RE, Bui T, Magliano D, Arnold C, Dooley M. Prescriber education interventions to optimize opioid prescribing in acute Care: A systematic review. Pain Physician. 2019;22(6):E551-62. doi: https://doi.org/10.36076/ppj/2019.22.E551

Kaur S, Mitchell G, Vitetta L, Roberts MS. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging. 2009;26(12):1013-28. doi: http://www.doi.org/10.2165/11318890-000000000-00000.

Iankowitz N, Dowden M, Palomino S, Uzokwe H, Worral P. The effectiveness of computer system tools on potentially inappropriate medications ordered at discharge for adults older than 65 years of age: a systematic review. JBI Library of Systematic Reviews. 2012;10(13):798-831. DOI: http://www.doi.org/10.11124/jbisrir-2012-68.

Page N, Baysari MT, Westbrook JI. A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety. Int J Med Inform. 2017;105:22-30. doi: http://www.doi.org/10.1016/j.ijmedinf.2017.05.011.

Wagner B, Filice GA, Drekonja D, Greer N, MacDonald R, Rutks I, Butler M, Wilt TJ. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol. 2014;35(10):1209-28. doi: http://www.doi.org/10.1086/678057.

Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Decruyenaere J. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial. Crit Care. 2006;10(1):R21. doi: http://www.doi.org/10.1186/cc3983.

How to Cite
1.
Navarro Cárdenas JD, Alarcón Nieto MC, Bernal Vargas MP, Estrada-Orozco K, Gaitán Duarte H. Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review . Colomb. J. Anesthesiol. [Internet]. 2021Jul.12 [cited 2021Oct.25];49(4). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/997

Downloads

Download data is not yet available.
Published
2021-07-12
How to Cite
1.
Navarro Cárdenas JD, Alarcón Nieto MC, Bernal Vargas MP, Estrada-Orozco K, Gaitán Duarte H. Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review . Colomb. J. Anesthesiol. [Internet]. 2021Jul.12 [cited 2021Oct.25];49(4). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/997
Section
Systematic review

More on this topic