Assessment of the Logical Prescription of Albumin Drug According to Guideline and Patient Safety for Inpatients in Intensive Care Units of Iranian Hospital: A Cross-Sectional Study
-
Naghme Dashti
,
Hesamoddin Hosseinjani
,
Saeid Eslami
,
Seyed Mohammad Tabatabaei
,
Hasan Vakili Arki
Abstract
Background: Medication errors in healthcare settings, including outpatient and hospital environments, pose a significant risk to patient safety. These errors can arise from incorrect dosages, drug interactions, contraindications, or inappropriate drug combinations.
Methods: This study aimed to assess the logical prescription of albumin according to guidelines and patient safety for inpatients in the intensive care units of Imam Reza Hospital in Mashhad through a cross-sectional study. Methods: Data were collected over a 3-month period from albumin prescriptions in intensive care units, using a checklist based on information from prescription forms, patient files, and consultations.
Results: The study found that 60.57% of albumin prescriptions were reviewed by DUE unit, with 51.53% complying with guidelines and 48.47% not. The highest prescription rate was in the Intensive Care Unit of Heart Surgery (ICUOH), at 36.83%, and the lowest in the Neonatal Intensive Care Unit (NICU), at 0.63%. The patient safety parameter, calculated based on correct/incorrect albumin prescriptions according to guidelines, showed an average safety of 67.10% across prescribing units and 62.34% based on indications. It reduced the financial burden caused by inappropriate prescriptions approximately $21,390 through DUE process.
Conclusion: The research highlights the importance of continuous guideline-base DUE on rational drug utilization, patient safety and hospitals costs.
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[32] Xiao L, Cousins G, Courtney B, Hederman L, Fahey T, Dimitrov BD. Developing an electronic health record (EHR) for methadone treatment recording and decision support. BMC Med Inform Decis Mak. 2011; 11:5.
[33] Robinson DG, Schooler NR, Correll CU, John M, Kurian BT, Marcy P, et al. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention. Am J Psychiatry. 2018; 175(2):169-79.
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[35] Goldstein MK, Hoffman BB, Coleman RW, Tu SW, Shankar RD, O'Connor M, et al. Patient safety in guideline-based decision support for hypertension management: ATHENA DSS. Proc AMIA Symp. 2001:214-8.
[36] Bowers TR, Duffy EJ. Quality of antimicrobial prescribing improved by the introduction of ePrescribing at Auckland City Hospital. Health Informatics J. 2020; 26(4):2375-2382.
[37] Charani E, Gharbi M, Moore LSP, Castro-Sanchez E, Lawson W, Gilchrist M, et al. Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship program across three teaching hospitals: an interrupted time series study. J Antimicrob Chemother. 2017; 72(6):1825-1831.
[2] Mishore K.M, Nigatu A.B, Tsegaab Y.Y, Tsion F.A. Evaluation of Drug Use Pattern in Emergency Department of Dilchora Referral Hospital, Dire Dawa, Ethiopia. Emerg Med Int. 2020.
[3] Gangwar R, Kumar A, Zargar AA, Sharma A, Kumar R. The role of drug utilization evaluation in medical sciences. Global Health Journal. 2023; 7(1):3-8.
[4] SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals SHPA Committee of Specialty Practice in Drug Use Evaluation. 2004; 34.
[5] Alshammari TM. Drug safety: The concept, inception and its importance in patients' health. Saudi Pharm J. 2016; 24(4):405-12.
[6] Alanazi MA, Tully MP, Lewis PJ. A systematic review of the prevalence and incidence of prescribing errors with high-risk medicines in hospitals. J Clin Pharm Ther. 2016; 41(3):239-45.
[7] Matthew C. Grissinger ea. Institute of Medicine, Committee on Identifying and Preventing Medication Errors, Preventing Medication Errors. National Academies Press. Journal of Managed Care Pharmacy. 2010; 62-65.
[8] Vincent Rajkumar S. The high cost of prescription drugs: causes and solutions. Blood Cancer J. 2020; 10(6):71.
[9] Hingorani R, Mahmood M, Alweis R. Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process. J Community Hosp Intern Med Perspect. 2015; 5(3):27472.
[10] Drug and Therapeutics Committee Training Course—Participants’ Guide. Rational Pharmaceutical Management Plus Center for Pharmaceutical Management Sciences for Health in Collaboration with the World Health Organization Geneva, Switzerland, 2005.
[11] Brown EM. Guidelines for antibiotic usage in hospitals. J Antimicrob Chemother. 2002; 49: 587–592.
[12] Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995; 274: 700–705.
[13] Westphal JF, Jehl F, Javelot H, Nonnenmacher C. Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf. 2011; 20(2):162-8.
[14] Tassew SG, Abraha HN, Gidey K, Gebre AK. Assessment of drug use pattern using WHO core drug use indicators in selected general hospitals: a cross-sectional study in Tigray region, Ethiopia. BMJ Open. 2021; 11(10): e045805.
[15] Vincent Rajkumar S. The high cost of prescription drugs: causes and solutions. Blood Cancer J. 2020; 10(6):71.
[16] Kimland E, Nydert P, Odlind V, Böttiger Y, Lindemalm S. Paediatric drug use with focus on off-label prescriptions at Swedish hospitals - a nationwide study. Acta Podiatry. 2012; 101(7):772-8.
[17] Yimer YS, Addis GT, Alemu MA. Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study. SAGE Open Med. 2022; 10:20503121221122422.
[18] Siele SM, Abdu N, Ghebrehiwet M, Hamed MR, Tesfamariam EH. Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators. PLoS One. 2022;17(8): e0272936.
[19] Singla AK, Kitch BT, Weissman JS, Campbell EG. Assessing patient safety culture: a review and synthesis of the measurement tools. Journal of Patient Safety. 2006; 2(3):105-15.
[20] Ann Arbor M.. The Definition of Quality and Approaches to Its Assessment. JAMA. 1988. 1:. 1743-1748.
[21] Wachter RM, G.K., Understanding Patient Safety, . Third Edition ed. May 23, 2012, United States: New York: McGraw-Hill Education, [2018]. 510 pages
[22] Borzecki AM, Rosen AK. Is there a 'best measure' of patient safety? BMJ Qual Saf. 2020; 29(3):185-188.
[23] Lamy JB, Ebrahiminia V, Seroussi B, Bouaud J, Simon C, Favre M, et al. A generic system for critiquing physicians' prescriptions: usability, satisfaction and lessons learnt. Stud Health Technol Inform. 2011; 169:125-9.
[24] Smith KL, Tran D, Westra BL. Sinusitis Treatment Guideline Adherence in the E-Visit Setting: A Performance Improvement Project. Appl Clin Inform. 2016; 7(2):299-307.
[25] Sintchenko V, Coiera E, Iredell JR, Gilbert GL. Comparative impact of guidelines, clinical data, and decision support on prescribing decisions: an interactive web experiment with simulated cases. J Am Med Inform Assoc. 2004; 11(1):71-7.
[26] Ebell M. AHRQ White Paper: Use of clinical decision rules for point-of-care decision support. Med Decis Making. 2010; 30(6):712-21.
[27] Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Jama. 2005; 293(10):1223-38.
[28] Trafton JA, Martins SB, Michel MC, Wang D, Tu SW, Clark DJ, et al. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain. Implement Sci. 2010; 5:26.
[29] Roberts GW, Farmer CJ, Cheney PC, Govis SM, Belcher TW, Walsh SA, et al. Clinical decision support implemented with academic detailing improves prescribing of key renally cleared drugs in the hospital setting. Journal of the American Medical Informatics Association: JAMIA. 2010;17(3):308-12.
[30] Westphal JF, Jehl F, Javelot H, Nonnenmacher C. Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf. 2011; 20(2):162-8.
[31] Mainous AG, 3rd, Lambourne CA, Nietert PJ. Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. J Am Med Inform Assoc. 2013; 20(2):317-24.
[32] Xiao L, Cousins G, Courtney B, Hederman L, Fahey T, Dimitrov BD. Developing an electronic health record (EHR) for methadone treatment recording and decision support. BMC Med Inform Decis Mak. 2011; 11:5.
[33] Robinson DG, Schooler NR, Correll CU, John M, Kurian BT, Marcy P, et al. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention. Am J Psychiatry. 2018; 175(2):169-79.
[34] Baysari MT, Del Gigante J, Moran M, Sandaradura I, Li L, Richardson KL, et al. Redesign of computerized decision support to improve antimicrobial prescribing. A controlled before-and-after study. Appl Clin Inform. 2017; 8(3):949-63.
[35] Goldstein MK, Hoffman BB, Coleman RW, Tu SW, Shankar RD, O'Connor M, et al. Patient safety in guideline-based decision support for hypertension management: ATHENA DSS. Proc AMIA Symp. 2001:214-8.
[36] Bowers TR, Duffy EJ. Quality of antimicrobial prescribing improved by the introduction of ePrescribing at Auckland City Hospital. Health Informatics J. 2020; 26(4):2375-2382.
[37] Charani E, Gharbi M, Moore LSP, Castro-Sanchez E, Lawson W, Gilchrist M, et al. Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship program across three teaching hospitals: an interrupted time series study. J Antimicrob Chemother. 2017; 72(6):1825-1831.
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How to Cite
1.
Dashti N, Hosseinjani H, Eslami S, Tabatabaei SM, Vakili Arki H. Assessment of the Logical Prescription of Albumin Drug According to Guideline and Patient Safety for Inpatients in Intensive Care Units of Iranian Hospital: A Cross-Sectional Study. Arch Anesth & Crit Care. 2024;.
