Optimisation de la validation des prescriptions d’anti-infectieux : Une collaboration entre le back-office, le front-office et les technologies informatiques

Details

Supervisors

Maes, Julie ; Marrant, Erwin ; Van Bambeke, Françoise

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

Background and objective By 2050, without changes, antimicrobial resistance could claim 10 million lives yearly. Urgent action is needed to enhance hospital prescription practices. This research, based on the GlobalPPS study's medication error analysis, aims to optimize the roles of validation teams and clinical pharmacists in infectious diseases, while assessing future technological contributions. Methods This project consists of two phases. The initial phase involved analyzing medication prescribing errors and assessing the severity of these potential errors. The second phase focuses on developing an action plan to enhance prescriptions. It includes immediate actions like implementing a questionnaire, providing training, developing pharmaceutical validation support documents and involving the clinical pharmacist. Additionally, proposed information technology implementation involve introducing a new electronic prescription system and clinical decision support software. Results 381 errors were identified among 173 prescriptions, averaging 2.19 errors per prescription. The top four errors were missing information (219), aberrant dose intervals (50), disagreement with recommendations (28), and major drug interactions (4). The errors were divided into three severity levels: 60.9% are minor, 27.6% significant and 11.5% serious. Error rates were compared between prescriber groups, services, and medications but were not statistically significant. 56 participants attended training after scoring 65.7% on the pre-training questionnaire (38% on administration techniques). Proposed improvements include creating documents on intravenous administration and dosage summaries, prioritizing medications by problematic results, for clinical pharmacists and analyzing software parameterization options. Discussion and conclusion This study showed a rate of fully compliant prescriptions similar to what is found in the literature (37.5%). Regarding the choice of anti-infective agents, 16.1% of prescriptions were not in line with recommendations, a percentage also found in published studies. After the first phase, 27.0% of prescribing errors can be corrected, 71.1% with an exhaustive medical file. By the end of the second phase, only 10.2% of errors will not be covered by the action plan. Thanks to this study, it has been possible to direct the clinical pharmacist towards the antiinfectives for which an intervention will most increase the number of appropriate prescriptions in the hospital.