Table 1, Chapter 4Summary of studies

Study, YearPopulation and ControlsInterventionOutcomes Measured and TimingFindings
Kaushal, 200821Pediatric ICU or general ward with paper charting; matched units did not receive interventionPart or full-time clinical pharmacist rounding and monitoring drug dispensing, storage, and administrationMedication errors and adverse events pre/post, identified by nurse and reviewed by 2 blinded physician reviewers; 6-8 weeks baseline, 3-month intervention periodFull-time clinical pharmacist decreased medication errors (29 to 6 per 1000 patient days); increase in medication errors in controls; part-time pharmacists did not decrease error rate.
Wang, 200722Pediatrics unit of a community teaching hospitalAddition of CPOE to existing clinical pharmacist systemMedication errors, near misses, and adverse events over a 3-month periodClinical pharmacist intercepted 78% of 111 potentially serious prescribing errors but none of 32 harmful administrative errors and few of the transcribing (6/25) or monitoring errors (3/7)
Rivkin, 201123General medical ICUInclusion of clinical pharmacist in roundingClinically important drug-drug interactions pre/post over a 10-week periodDrug interaction rates decreased significantly (65%) when compared retrospectively (historically) to a 10-week period earlier in the year
LaPointe, 200324Cardiac ICURounding and participation in patient-oriented activities (e.g., taking medication histories, discharge counseling), and provider level activities (e.g., giving in-service talks to house staff and communicating with physician and nursing staff)Medication error interventions (e.g., dose or medication changes, missing medications, allergy-drug contraindications) pre/post over 5 yearsIncidence of medication errors increased from around 15 to nearly 24 per 100 admissions, and a higher trend was seen during times of house staff transition
Stoner, 200025Outpatient psychiatric setting (235 sets of evaluations in 83 patients on anti-psychotics)Pharmacist testing/recommendations regarding patients on antipsychotics who had movement disorder complaints or who were taking drugs to counter movement disordersMovement disorder (extrapyramidal) symptomsA majority of recommendations (82% of 130 evaluations) were followed by clinicians; of these, 93% led to a resolution or reduction in extrapyramidal symptoms
Simpson, 200426Neonatal ICUPharmacist-run education program on medication orders and IV fluid review implemented at month 4 of 12 months plus other process changesMedication errors pre/post; case finding by incident reportingSignificant decrease in medication errors (from 24 to 5 per 1,000 neonatal activity days/month); error rate increased during summer staffing change
Bond, 200627584 hospitals encompassing >35,000 Medicare patient staysPharmacy staffing and presence or absence of various pharmacy servicesAdverse drug reactions (ADRs)Pharmacist involvement in 8 services (in-service education, drug information services, adverse drug reaction management, drug protocol management, cardiopulmonary resuscitation teams, medical rounds and completing admission drug histories) as well as higher staffing rates decreased ADRs; however, pharmacist participation in total parenteral nutrition teams increased ADRs
Bond, 200728885 U.S. hospitals with data on 2.8 million Medicare patients14 different clinical pharmacy services and several staffing modelsSeverity-adjusted mortality ratesIn-service education, drug information, adverse drug reaction monitoring; participation in drug protocol management, cardiopulmonary resuscitation teams and medical rounds; and completing admission drug histories were associated with reduced mortality as were two staffing variables
Brown, 200829Large rural hospital Emergency DepartmentReview of medication orders and identification of errors via retrospective review by an independent reviewer. Pharmacists also documented their interventions.Medication Errors, 1 month when pharmacist was not present to check medication orders versus 1 month when pharmacist (s) was (were) present; time periods for assessment were one year apartPre-post analysis showed significant decrease (66.6%) from error rates of approximately 16 to 5 per one hundred medications orders
Rothschild, 201030Four academic Emergency DepartmentsObservational study in which pharmacy residents conducted 226 sessions (787 hours) of observing pharmacist activities; the study included over 17,000 medications ordered or administered to nearly 6,500 patientsIdentification of medication errors at various stages of prescribing or administration by unblinded, continuous observation. Data collection was via templated forms. Captured elements included errors of interest, ranging from those intercepted before reaching the patient to caught after reaching the patient but before harm could occur to ameliorated adverse events (collectively these together were known as recovered medication errors). Case reviewers independently assessed suspected error interventions.Pharmacists identified over 500 recovered medication errors, with an overall rate of about 3 per 100 medications or about 8 per 100 patients. Approximately 90% were intercepted before reaching the patient.
Cesarz, 201231An academic medical center's 32-bed Emergency Department, serving pediatric and adult populationsProspective observational study looking at activities of four pharmacists during relevant shifts in reviewing discharge prescriptions. Data collection was over a 3 week period and used standardized forms for reporting interventions. All recommendations were provided to the ordering physician who made the determination to change a prescriptionSelf-report of interventions on discharge prescriptions. An independent reviewer determined whether the intervention was categorized as error prevention or therapeutic optimizationOf 674 discharge prescriptions reviewed, ED pharmacists intervened on about 10%; roughly half of the 68 interventions (54%) concerned error prevention.

From: Chapter 4, Clinical Pharmacist's Role in Preventing Adverse Drug Events: Brief Update Review

Cover of Making Health Care Safer II
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 211.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.