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Table 3 Examples of ICU hospital pharmacist's recommendations and clinical consequences of prescribing errors scored during study.

From: On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

Recommendation

Description and clinical consequence

Change drug order according to laboratory test/organ function

Ganciclovir intravenous dosage 5 mg/kg/48 hours too high. Recommended dosage according to renal function was 1.3 mg/kg/48 hours

 

Consequence: renal failure and thus temporary harm to the patient that required prolonged hospitalization (Category F)

Change route of administration

Azathioprine in oral form was causing abdominal pain. This adverse reaction was not recognized in a timely manner. After switching to intravenous form the abdominal pain disappeared. Consequence: temporary harm to the patient that required intervention (Category E, moderate harm to a patient)

Change dosage

Phenytoin intravenous treatment was initiated with only a maintenance dose and without a loading dose.

 

Consequence: an intervention was required to preclude harm to a patient (Category D).

Change drug because of drug-disease interaction

Patient with known liver function insufficiency was started on voriconazole (antifungal medication that is mostly metabolized by the liver).

 

Consequence: an intervention was required to preclude harm to a patient (Category D)

Start drug

Unintended discontinuation of low-dose aspirin (patient's home medication) for 1 day

 

Consequence: no harm to a patient (Category C)

Change dosage

Esketamine (anesthetic) 35 mg/hour (should have been 35 μg/hour) was ordered. This medication order was intercepted in the hospital pharmacy

 

Consequence: no harm to a patient (Category B)

Start drug

The pharmacist proposed continuation of a statin during ICU admission. No consensus was reached with ICU physicians because of lack of evidence and the possible negative effects of the pleiotropic effect of statins. No error

  1. ICU, intensive care unit.