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RAINU KAUSHAL, M.D., M.P.H., is Associate Professor, Departments of Public Health and Pediatrics, Weill Cornell Medical College, New York, NY. DAVID W. BATES, M.D., M.SC., is Chief, Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. ERIKA L. ABRAMSON, M.D., is Instructor, Department of Pediatrics, Weill Cornell Medical College. JANE R. SOUKUP, M.SC., is Senior Programmer/Analyst, Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School. DONALD A. GOLDMANN, M.D., is Senior Vice President, Institute for Healthcare Improvement, Cambridge, MA.

Address correspondence to Dr. Kaushal at Weill Cornell Medical College, 411 East 69th Street, New York, NY 10021 (rak2007{at}med.cornell.edu).

Purpose. Rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) were measured before and after introduction of unit-based clinical pharmacists. Methods. Error rates on the study units and similar patient care units in the same hospital that served as controls were determined during six- to eight-week baseline periods and three-month periods after the introduction of unit-based clinical pharmacists (full-time in the intensive care unit [ICU] and mornings only on the general units). Nurses trained by the investigators reviewed medication orders, medication administration records, and patient charts daily to detect errors, near misses, and adverse drug events (ADEs) and determine whether near misses were intercepted. Two physicians independently reviewed and rated all data collected by the nurses. Serious medication errors were defined as preventable ADEs and nonintercepted near misses. Results. The baseline rates of serious medication errors per 1000 patient days were 29 for the ICU, 8 for the general medical unit, and 7 for the general surgical unit. With unit-based clinical pharmacists, the ICU rate dropped to 6 per 1000 patient days. In the general care units, there was no reduction from baseline in the rates of serious medication errors. Conclusion. A full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units. Index terms: Clinical pharmacists; Clinical pharmacy; Errors, medication; Hospitals; Interventions; Pediatrics; Pharmaceutical services

 

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