PubMed · 13170838
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H F SMYTH, C P CARPENTER, C S WEIL, U C POZZANI. 1954. Range-finding toxicity data: list V.. https://pubmed.ncbi.nlm.nih.gov/13170838/
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BACKGROUND: The Institute of Medicine's report To Err Is Human: Building a Safer Health System recommends pharmacist participation in patient rounds as an immediate approach to reducing medical errors. In the same report and in prior publications, cardiovascular drugs have been commonly associated with severe adverse drug events. METHODS: We systematically reviewed the experience of a clinical pharmacist on the cardiology wards between September 1, 1995, and February 18, 2000. We classified medication errors according to the type of error, medications involved, personnel involved, stages of drug administration involved, and time of year most frequently associated with errors. RESULTS: Among 14983 pharmacist interventions, 4768 were related to medication errors, or 24 medication errors per 100 admissions. The most common errors involved the wrong drug (36.0%) or wrong dose (35.3%), and cardiovascular medications were involved in 41.2% of the errors. Prescribers were associated with most of the errors, and the transition from outpatient to inpatient was the most common point in the system for the occurrence of these medication errors. Higher numbers of errors were also identified during the transition period of house staff, and the total number of errors increased during the study period. CONCLUSIONS: Through the clinical pharmacist's identification and correction of medication errors, 2 areas of improvement that may reduce medication errors were identified. The first is ensuring accurate knowledge of a patient's outpatient medication regimen. The second involves improving the education and support of new interns during their initial months of training. This work exemplifies the approach recommended by the Institute of Medicine to reduce medical errors through systematic analyses rather than ascribing fault to individuals.
A referral-based, pharmacist-conducted medication management program designed to identify, categorize, and resolve drug-related problems (DRPs) in a home health care (HHC) population was studied. A clinical pharmacy service model was developed to identify patients at high risk for adverse health events resulting from DRPs. Policies and procedures were developed for this service model, including explicit referral criteria, patient-consent documentation, and physician orders. All identified DRPs were categorized, and pharmacist activities relating to the discovery and resolution of DRPs were tabulated. From July 1, 2001, through March 29, 2002, 80 patients were referred for and received clinical pharmacy services, and pharmacists identified 271 DRPs. Every patient referred had a DRP, and 32% of DRPs were identified by a visit to the patient's home. Nearly 65% of pharmacist recommendations were implemented. Using a referral-based practice model in an HHC setting, pharmacists were able to identify and resolve DRPs for every patient referred.
Numerous drugs have been suspected to be associated with the occurrence of epileptic seizures. Our information retrieval, however, shows that drug-induced seizures are relatively rare. The risk of seizure seems to be increased, also in patients who are not predisposed to seizure, when taking clozapine, enflurane, theophylline, foscarnet, ganciclovir, and ritonavir. The risk of seizure is greatest in patients predisposed to seizure by use of conventional antipsychotics, olanzapine, risperidone, bupropion, tricyclic antidepressants/selective serotonin reuptake inhibitors, cyclosporin, interferon, corticosteroids, propofol, imipenem, chloroquine, and mefloquine. In case of suspicion of drug-induced seizures, reporting should be made to the Danish Medicines Agency. If the drug has been on the market less than two years, reporting is mandatory.