Journal of Research in Pharmacy Practice

Abstract  We aimed to detect and report the frequency of occurrence of drug-related problems (DRPs) in a Middle Eastern University Children's Hospital (Isfahan, Iran) and classify them in terms of their nature and cause to clarify the responsibility of clinical pharmacists for the safe utilization of medications in hospitalized children. Methods: In this cross-sectional study which was carried out in Imam Hossein Children's University Hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran) from September 2017 to May 2018, DRPs during the hospitalization of pediatric patients in three medical wards, the pediatric intensive care unit, and two neonatal intensive care units were detected and identified concurrently with the treatment process using Pharmaceutical Care Network of Europe data gathering form for DRPs v. 8.01. All cases were verified and validated in a professional focus group before documentation. Findings: We detected 427 DRPs in 201 out of 250 randomly included hospitalized children in which 86% of them were directly reported by the hospital's clinical pharmacist. The highest frequency of DRPs (47.3%) was observed in the age range of 1 month–2 years. Safety of treatment was the most frequently reported as the nature of the problem (43.5%), followed by effectiveness issues (36.8%). The most frequent cause of DRPs was dose selection issues (34.2%), followed by drug-type selection (25.5%), and unavailability of appropriate dosage forms (13.6%). Ninety-eight interventions were proposed by the clinical pharmacist, in which 59.2% of them were accepted. Conclusion: This study confirms the necessity for the active role of clinical pharmacists before, during, and after drug therapy in hospitalized pediatric patients for the safety and proper utilization of drugs in this vulnerable population.

Abstract This study was conducted to explore and to describe the causes of medication errors in Intensive Care Units (ICUs) from the perspective of physicians, nurses, and clinical pharmacists. Methods: The study was conducted using a descriptive qualitative method in 2016. We included 16 ICUs of seven educational hospitals affiliated to Isfahan University of Medical Sciences. Participants included 19 members of the healthcare team (physician, nurse, and clinical pharmacist) with at least 1 year of work experience in the ICUs. Participants were selected using purposeful sampling method. Data were collected through semi-structured individual interviews and were used for qualitative content analysis. Findings: The four main categories and ten subcategories were extracted from interviews. The four categories were as follows: “low attention of healthcare professionals to medication safety,” “lack of professional communication and collaboration,” “environmental determinants,” and “management determinants.” Conclusion: Incorrect prescribing of physicians, unsafe drug administration of nurses, the lack of pharmaceutical knowledge of the healthcare team, and the weak professional collaboration lead to medication errors. To improve patient safety in the ICUs, healthcare center managers need to promote interprofessional collaboration and participation of clinical pharmacists in the ICUs. Furthermore, interprofessional programs to prevent and reduce medication errors should be developed and implemented.

Abstract Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. Methods: A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Findings: Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. Conclusion: In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue.

Abstract Objective: Emergency departments (EDs) are characterized by simultaneous care of 
multiple patients with various medical conditions. Due to a large number of patients with 
complex diseases, speed and complexity of medication use, working in under‑staffing and 
crowded environment, medication errors are commonly perpetrated by emergency care 
providers. This study was designed to evaluate the incidence of medication errors among 
patients attending to an ED in a teaching hospital in Iran.
Methods: In this cross‑sectional study, a total of 500 patients attending to ED were randomly 
assessed for incidence and types of medication errors. Some factors related to medication 
errors such as working shift, weekdays and schedule of the educational program of trainee 
were also evaluated.
Findings: Nearly, 22% of patients experienced at least one medication error. The rate of 
medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The 
frequency of medication errors was higher in men, middle age patients, first weekdays, night‑time 
work schedules and the first semester of educational year of new junior emergency medicine 
residents. More than 60% of errors were prescription errors by physicians and the remaining 
were transcription or administration errors by nurses. More than 35% of the prescribing 
errors happened during the selection of drug dose and frequency. The most common 
medication errors by nurses during the administration were omission error (16.2%) followed 
by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and 
thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%).
Conclusion: In this study, at least one‑fifth of the patients attending to ED experienced 
medication errors resulting from multiple factors. More common prescription errors 
happened during ordering drug dose and frequency. More common administration errors 
included dug omission or unauthorized drug.