Pharmaceutical validation : centralized or on-ward ?

Background: Prescription errors are the leading cause of adverse drug events in hospitalised patients. Clinical decision support systems (CDSS), integrated in clinical prescription order entry (CPOE), significantly reduce these errors and adverse drug events. Pharmaceutical validation, defined as the review of drug orders by a pharmacist, combined with CDSS, can further decrease medication errors. Whether onward validation lead to a higher rate of medication errors detection than central validation, acceptance of pharmaceutical interventions, type of errors detected and clinical impact for patients have not been studied yet by direct comparison. Objective: The aim of this study is to compare onward and central validation of medical prescriptions. Methods : Our retrospective observational study was conducted at the Cliniques universitaires Saint-Luc (Brussels, Belgium), a tertiary care hospital, in April and May 2019. Data were extracted from the local validation software and pharmacist’s charts. The “central validation” and “onward validation” groups referred to pharmaceutical validation made at the central hospital pharmacy in September and November 2018, and within the cardiology unit in February and March 2019, respectively. Each group validated all medical prescriptions of the cardiology unit on an everyday basis during the study period of data sources. They are compared in term of rate of pharmaceutical interventions due to medication errors, reasons for interventions (e.g. contra-indication, drug-drug interaction, overdosing, underdosing), their potential clinical impact according to two experts (a senior cardiologist and a senior clinical pharmacist) and their acceptance rate. Results: 2,9% (20/698) and 13,2% (93/701) of patients had interventions for medication errors in the group “central validation” and “onward validation” respectively (χ2 = 49,97, p <0,001). Interventions made at the central pharmacy were most of the time because of drug-drug interaction (25%), computerized-created error (20%) and overdosing (20%) while interventions made onward were for no valid indication (25%), overdosing (18%) and inadequate or non-optimal molecule choice regarding guidelines (11%). The group “onward validation” showed a higher acceptance rate than the group “central validation” (84% and 65% respectively (Fisher’s test, p = 0,053)). Finally, according to the experts, there were similar proportions of interventions with significant or very significant clinical impact between the two groups (but the absolute number of interventions was higher onward), more interventions with potentially deleterious impact in the group “central validation” and interventions with vital impact were only made in the group “onward validation”. Conclusion: The benefit of onward validation of medical prescriptions is a higher rate of prescription errors detection, a better acceptance rate, and interventions about optimization of pharmacotherapy and not only about prescription errors such as drug-drug interactions or overdosing. Onward pharmaceutical validation must be considered as a complementary approach in targeted units to improve medication safety.

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Lagreula, J., Maes, F., Quennery, S., Wouters, D. M., Dalleur, O., & et al. (2020). Pharmaceutical validation : centralized or on-ward ? International Forum on quality and safety in healthcare, Copenhague. https://hdl.handle.net/2078.5/112097