Prevented Prescribing Errors in an ICU of a Brazilian Teaching Hospital Specializing in Women’s Health

To the Editor: It is known that women require special attention during the pregnancy-puerperium cycle, and gynecological and oncological treatments, when they can develop complications, requiring admission to an intensive care unit (ICU). Drugs used in treatments in the ICU may have risks and should be continuously investigated and monitored for patient safety and better outcomes. Because of the large number of medications prescribed in the ICU, prescribing errors are frequent, severe, and expected, and pharmaceutical interventions can contribute to patient care. With that in mind, we conducted a study to demonstrate the influence of pharmaceutical interventions in preventing prescribing errors at a women’s health ICU. This was an interventional, prospective, and longitudinal study, during 13 months, at a 6-bed ICU of a referral teaching hospital specializing in women’s health care at the State University of Campinas. Patients are acutely ill women affected by clinical complications (obstetric, gynecological, and oncological) requiring intensive life support. A trained clinical pharmacist reviewed patients’ medical records, monitored patients’ exams, and analyzed electronic prescriptions. Prescribing errors and drugs most frequently involved were quantified and classified. In order to prevent errors from affecting patients, the pharmacist proposed pharmaceutical interventions, which were subsequently quantified and classified. The study included 222 patients, who were hospitalized for more than 24 hours in this ICU; most were obstetric (n = 108) and oncological (n = 95) patients. The clinical pharmacist detected 101 prescribing errors in 1259 prescriptions. The prevalent types of errors comprised too high a dosage (22; 21.8%), drugs that were unsafe because of potential for drug interactions (DIs; 20; 19.8%), and drugs that were unsafe for use during lactation (15; 14.9%). Errors involving too low a dosage were associated with drugs used to treat the blood and hematopoietic organs; errors involving drugs unsafe to use during lactation, because of safety issues related to the potential for DIs, were associated with drugs used to treat the nervous system, digestive tract, and metabolic disorders and these were statistically significant associations (P < .05). Eighty-seven (86.1%) errors were prevented. The clinical pharmacist performed 127 interventions, yielding an average of 0.6 ± 0.9 interventions per patient and 0.5 ± 0.7 interventions per day. The higher number of pharmaceutical interventions in relation to prescribing errors is explained by the presence of 2 types of interventions—“intravenous route to oral route” and “information drugs”—that are not directly related to prescribing errors but are suggestions that contribute to treatment and noninvasive methods for administration of the drug, aiming for patient safety. Most interventions were related to dosages (30; 23.6%) and DIs (20; 15.7%). Regarding acceptance, 113 (89.0%) were accepted, 5 (3.9%) were partially accepted, and 9 (7.1%) were not accepted. This study suggested that during admission at a women’s health ICU, prescribing errors can occur for obstetric, gynecologic, and oncologic patients. Thus, a good acceptance rate of pharmaceutical interventions by the medical team shows the contribution to prevention of prescribing errors associated with dosages of drugs and DIs, enhancing women’s health safety.