Arzneimitteltherapiesicherheit in einer Universitätsklinik für Psychiatrie und Psychotherapie: Evaluation des Nutzens digitaler Anwendungen und pharmazeutischer Intervention im stationären Medikationsprozess
Loading...
Files
Date
Authors
Publisher
Supervisors
Abstract
Background: In the context of legal requirements and governmental funding for digital
modernization of the healthcare system, it is of significant importance to evaluate the benefits
of digital application in medication process. This applies in particular to their impact on drug
therapy safety. A comprehensive review of the extant literature shows that both
computerized physician order entry (CPOE) and clinical decision support systems (CDSS) can
have a favorable influence on the medication process. Furthermore, studies also have proven
the benefit of clinical pharmacists towards the mediacation process. However, the extent to
which this influence has been examined in psychiatric hospitals remains limited. Moreover,
the issue of whether a clinical pharmacist is a necessary resource on the ward when digital
applications are available in a clinic is a further question that must be addressed.
Methods: The study was conducted on the clinic´s geriatric psychiatric ward. The primary
endpoint was defined as the number of medication errors occurring at the laboratory results
and medication prescription interface (laboratory diagnostics). The reasons for medication
errors were taken from the ADKA-DokuPIK database. Additional endpoints were defined as
medication errors resulting from unjustified deviations from medication standards and the
medical acceptance of pharmaceutical interventions. The study consisted of 5 phases, which
differed in terms of the degree of digitalization and the professions involved in the
medications process. P0 served as a control phase because no digital applications were
available for prescribing medication and no pharmaceutical service was established on the
ward. In phases P1 - P3 digital transmission of laboratory parameters (P1), a CPOE-system
including a CDSS (P2) and a clinical pharmacist (P3) were implemented. P4 served as the
follow-up phase. In P0 - P2 and P4 the participating clinical pharmacist collected retrospective
data and recorded medication errors using a survey matrix previously agreed upon with the
chief physician and senior physician. In P3, the clinical pharmacist participated in weekly ward rounds
with the senior physician. The interventions were recorded and differentiated
between pharmaceutical and medical interventions.
Results: The study examined 4451 medication lines across in the different study phases.
Regarding the primary endpoint (laboratory diagnostics), 389 lines were incorrect across all
phases and 19 medication lines were incorrect regarding the additional endpoint (medication
standard). Statistically significant differences in the frequency of documented medication
errors were found over the course of the 5 study phases. In P0, errors were found in 6,27% of
the cases. In P1 the proportion of medication errors rose to 8,11%, peaked in P2 at 11,39%
and fell to 5,99% in P3. In P4, again a comparatively high value of 11,3% medication errors
were detected. The amount of medication errors differed statistically significantly in each
study phase compared to the previous one, with exception of the comparison between P1 and
P0 (P1/P0: p=0,1495, P2/P1: p= 0,0215, P3/P2 u. P4/P3: p= 0,0001). Throughout all phases,
the most frequently documented reason for a medication error was „indication given but no
medication ordered“ (ranging from 51,32% to 73,68%). A total of 179 interventions were
recorded in P3. Of these, 49,72% were made by the clinical pharmacist. The pharmacist
intervened most frequently due to „indication given, but no medication ordered“. In 88,76%
of the pharmaceutical interventions, agreement was reached with the physicians.
Discussion: Implementation of digital applications alone did not lead to a reduction in the
investigated medication errors. On the other hand the integration of a clinical pharmacists in
weekly ward round achieved a significant reduction in these medication errors. Despite the
availability of digital tools, the results of this study indicate that the involvement of a clinical
pharmacist is a clinically relevant benefit. The results also indicate that the quality of the
implementation process of digital applications is crucial to whether they are perceived by
users as a safety-enhancing structure.
Conclusion: An inpatient pharmaceutical medication management is an effective procedure
for increasing drug therapy safety in a psychiatric clinic. Due to their expertise in
pharmacology and knowledge of the hospital´s internal processes, clinical pharmacists can
compensate the limitations of a CDSS.
Review
Metadata
Contributors
Supervisor:
Dates
Issued: 2026-02-27
Faculty
FB16:Pharmazie
Language
de
Keywords
ArzneimitteltherapiesicherheitAMTSPsychiatrieMedikationsprozessKlinischer Pharmazeut
show more
Kirmeß, Ana Irene: Arzneimitteltherapiesicherheit in einer Universitätsklinik für Psychiatrie und Psychotherapie: Evaluation des Nutzens digitaler Anwendungen und pharmazeutischer Intervention im stationären Medikationsprozess. : 2026-02-27.
License
This item has been published with the following license: In Copyright