Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

Abstract

The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs) in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR) recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males) reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males) in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%), incorrect doses (16.2%), unnecessary medications (8.1%), contra-indications (7.1%), incorrect drug duration (2%), and untreated conditions (1%). The physicians implemented 37 (37.4%) pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1) to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11) than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72) when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of MPEs in hospitals. Physician specialty and pharmacist gender and patient gender significantly influenced physician agreement with the pharmacist comments. Only one-third of the pharmacist recommendations were implemented. Phone drug applications would be helpful for daily hospital pharmacy practice. More pharmacist-physician collaboration is needed to address MPEs. Pharmacist-led MRR can identify and address MPEs to improve patient safety. Type: Original Research

Keywords

• Physician acceptance, pharmacist recommendations, prescribing errors, Iraq, hospitals