Abstract
Objective: Prescribing errors are a major cause of iatrogenic patient morbidity and therefore interventions aimed at preventing the adverse outcomes of these errors are likely to result in cost reduction. However, it is unclear whether the costs associated with these preventive measures are outweighed by the cost reductions (benefits). Therefore, a study was set up to analyse costs and benefits of detecting prescribing errors by hospital pharmacy staff.
Design: During 5 consecutive days in two Dutch hospitals in February 2000 all medication orders, in which prescribing errors were detected, were analysed. A cost-benefit analysis was performed, based on direct medical costs only. The benefit-to-cost ratio was calculated by taking into account the net time hospital pharmacy staff needed for the prevention of the error (this included potential time saving for nursing staff, when an error was prevented by hospital pharmacy staff instead of nursing staff), as well as taking into account the possible consequences of the prescribing error (were the error not prevented).
Results: A total of 3540 orders, of which 351 contained prescribing errors (9.9%), were analysed. During the 1-week period investigated, time-investment of the pharmacy staff had net costs of EUR285 (2000 values). During the same period estimated benefits related to this investment were EUR9867. The finding of higher benefits than costs was robust in sensitivity analysis. Conclusions: From this study it can be concluded that prevention of prescribing errors by hospital pharmacy staff results in higher benefits than the costs related to the net time investment.
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References
Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991 Feb 7; 324(6): 377–84
Van den Bemt PMLA, Egberts ACG, De Jong-van den Berg LTW, et al. Drug-related problems in hospitalized patients -a review. Drug Saf 2000 Apr; 22(4): 321–33
Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA 1995 Jul 5; 274(1): 29–34
Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997 Jan 22/29; 277(4): 307–11
Anderson JG, Jay SJ, Anderson M, et al. Evaluating the potential effectiveness of using computerized information systems to prevent adverse drug events. Proc AMIA Annu Fall Symp 1997: 228–32
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998 Oct 21; 280(15): 1311–6
Nightingale PG, Adu D, Richards NT, et al. Implementation of rules based computerized prescribing system. BMJ 2000 Mar 18; 320(7237): 750–3
Leape LL, Cullen DJ, Dempsey Clapp M, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999 Jul 21; 282(3): 267–70
Bond CA, Raehl CL, Pitterle ME, et al. Health care professional staffing, hospital characteristics, and hospital mortality rates. Pharmacotherapy 1999; 19(2): 130–8
Bond CA, Raehl CL, Franke T. Clinical pharmacy services and hospital mortality rates. Pharmacotherapy 1999; 19(5): 556–64
Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals. Pharmacotherapy 2000; 20(6): 609–21
Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals. Pharmacotherapy 1999; 19(12): 1354–62
National Coordinating Council of Medication Error Reporting [online]. Available from URL: http://www.nccmerp.org/recs (accessed February 2001)
Jefferson T, Demicheli V, Mugford M. Elementary economic evaluation in health care. London: BMJ Publishing group, 1996
Henry D, Lim LLY, Garcia Rodriguez LA, et al. Variability in risk of gastrointestinal complications with individual nonsteroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996 Jun 22; 312: 1563–6
Central Committee on Health Care Charges. Table of charges in health care institutions from January 1st 1999 [in Dutch]. Utrecht: COTG 1999
College for Health Care Insurances. Manual for cost research; methods and guideline prices for economic evaluations in health care [in Dutch]. Amstelveen: College voor Zorgverzekeringen, 2000
Central Supporting Committee for the Testing of Health Care Practices. Treatment and prevention of coronary heart disease by lowering plasma cholesterol concentrations; consensus cholesterol second revision April 1998 [in Dutch]. Utrecht: Centraal Begeleidingsorgaan voor de Intercollegiale Toetsing, 1998
Eikelboom JW, Anand SS, Malmberg K, et al. Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet 2000 Jun 3; 355: 1936–42
Lammers JWJ, Folgering HThM, Van Herwaarden CLA. Respiratory tolerance of bisoprolol and metoprolol in asthmatic patients. J Cardiovasc Pharmacol 1986; 8Suppl. 11: S69–73
Hospenthal DR, Bennett JE. Flucytosine monotherapy for Cryptococcosis. Clin Infect Dis 1998 Aug; 27: 260–4
Louie A, Liu W, Miller DA, et al. Efficacies of high-dose fluconazole plus amphotericin B and high-dose fluconazole plus 5-fluorocytosine versus amphotericin B, fluconazole, and 5-fluorocytosine monotherapies in treatment of experimental endocarditis, endophthalmitis, and pyelonephritis due to Candida albicans. Antimicrob Agents Chemother 1999 Dec; 43(12): 2831–40
Vermes A, Guchelaar HJ, Dankert J. Flucytosine: a review of its pharmacology, clinical indications, pharmacokinetics, toxicity and drug interactions. J Antimicrob Chemother 2000; 46: 171–9
Vanden Bossche H, Dromer F, Improvisi I, et al. Antifungal drug resistance in pathogenic fungi. Med Mycol 1998; 36Suppl. 1: 119–28
Thijs JP, Serruys-Schoutens E, Rocmans P, et al. Amikacin concentrations in uninfected postthoracotomy pleural fluid and in serum after intravenous and intrapleural injection. Chest 1984 Apr; 85(4): 502–5
Stafford EG, Clagett OT. Postpneumonectomy empyema -neomycin instillation and definitive closure. J Thorac Cardiovasc Surg 1972 May; 63(5): 771–5
Katz NM, McElvein RB. A method of early irrigation of the contaminated postpneumonectomy space. Ann Thorac Surg 1981 May; 31(5): 464–8
Rosenfeldt FL, McGibney D, Braimbridge MV, et al. Comparison between irrigation and conventional treatment for empyema and pneumonectomy space infection. Thorax 1981; 36: 272–7
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van den Bemt, P.M., Postma, M.J., van Roon, E.N. et al. Cost-Benefit Analysis of the Detection of Prescribing Errors by Hospital Pharmacy Staff. Drug-Safety 25, 135–143 (2002). https://doi.org/10.2165/00002018-200225020-00006
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DOI: https://doi.org/10.2165/00002018-200225020-00006