Recognizing and preventing unacknowledged prescribing errors associated with polypharmacy.

Area of Science:

• Clinical Pharmacy
• Health Informatics
• Patient Safety

Background:

• Prescribing errors pose significant health and economic burdens.
• Polypharmacy (≥5 drugs) increases the risk of undetected errors due to complex drug interactions and guidelines.
• Clinical decision support systems (CDSS) are vital for evaluating polypharmacy and preventing errors.

Purpose of the Study:

• To assess the frequency of unrecognized prescribing errors in polypharmacy patients.
• To evaluate the effectiveness of a specific CDSS (Drug-PIN®) in optimizing therapy and reducing medication harm.
• To determine the rate of avoidable prescribing errors in a hospital pre-admission setting.

Main Methods:

• A commercial CDSS, Drug-PIN®, was used to analyze 307 patients' medication regimens.
• The system assessed therapy-patient risk (low, moderate, high) and suggested optimizations.
• Prescribing errors were defined as cases where optimization reduced the calculated risk score.

Main Results:

• Polypharmacy was identified in 205 patients (67.1%).
• Drug-PIN® predicted moderate to high risk of medication harm in 91 patients (29.6%).
• Therapy optimization guided by Drug-PIN® successfully reduced risk in 58 of these patients (63.7%), with an overall avoidable prescribing error rate of 18.89%.

Conclusions:

• Computer-aided evaluation of medication harm is a valuable tool for preventing prescribing errors in polypharmacy.
• Hospital pre-admission services are critical for identifying and correcting potentially harmful polypharmacy regimens in fragile populations.
• Systematic use of CDSS can significantly improve patient safety by intercepting and rectifying prescribing errors.