This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (405)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Critical Care/ Intensive Care Medicine  • Adult Critical Care  • Drug Therapy  • Medication Error  • Alert me on articles by topic  Social Bookmarking   What's this?

Lucian L. Leape, MD; David J. Cullen, MD; Margaret Dempsey Clapp, MS, RPh; Elisabeth Burdick, MS; Harold J. Demonaco, MS, RPh; Jeanette Ives Erickson, MSN, RN; David W. Bates, MD, MSc

JAMA. 1999;282:267-270.

Context  Pharmacist review of medication orders in the intensive care unit (ICU) has been shown to prevent errors, and pharmacist consultation has reduced drug costs. However, whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied.

Objective  To measure the effect of pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events (ADEs) caused by ordering errors.

Design  Before-after comparison between phase 1 (baseline) and phase 2 (after intervention implemented) and phase 2 comparison with a control unit that did not receive the intervention.

Setting  A medical ICU (study unit) and a coronary care unit (control unit) in a large urban teaching hospital.

Patients  Seventy-five patients randomly selected from each of 3 groups: all admissions to the study unit from February 1, 1993, through July 31, 1993 (baseline) and all admissions to the study unit (postintervention) and control unit from October 1, 1994, through July 7, 1995. In addition, 50 patients were selected at random from the control unit during the baseline period.

Intervention  A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning, and was available on call throughout the day.

Main Outcome Measures  Preventable ADEs due to ordering (prescribing) errors and the number, type, and acceptance of interventions made by the pharmacist. Preventable ADEs were identified by review of medical records of the randomly selected patients during both preintervention and postintervention phases. Pharmacists recorded all recommendations, which were then analyzed by type and acceptance.

Results  The rate of preventable ordering ADEs decreased by 66% from 10.4 per 1000 patient-days (95% confidence interval [CI], 7-14) before the intervention to 3.5 (95% CI, 1-5; P<.001) after the intervention. In the control unit, the rate was essentially unchanged during the same time periods: 10.9 (95% CI, 6-16) and 12.4 (95% CI, 8-17) per 1000 patient-days. The pharmacist made 366 recommendations related to drug ordering, of which 362 (99%) were accepted by physicians.

Conclusions  The presence of a pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially lower rate of ADEs caused by prescribing errors. Nearly all the changes were readily accepted by physicians.

Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Dr Leape and Ms Burdick); Departments of Anesthesia (Dr Cullen), Pharmacy (Ms Clapp and Mr Demonaco), and Nursing (Ms Erickson), Massachusetts General Hospital; and Division of General Internal Medicine, Brigham and Women's Hospital (Dr Bates), Boston, Mass.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Preventing Medication Errors in the Intensive Care Unit
Jack J. Chen, Glenn Y. Yokoyama, Joseph I. Boullata, Patrick J. McDonnell, Christopher Rubino, J. Laurence Ransom, Peter Gal, Christopher Shaffer, Lucian L. Leape, Elisabeth Burdick, David J. Cullen, Margaret Dempsey Clapp, Harold J. Demonaco, Jeanette Ives Erickson, and David W. Bates
JAMA. 2000;283(10):1287-1289.
EXTRACT | FULL TEXT  

RELATED ARTICLES

July 21, 1999
JAMA. 1999;282(3):295-296.
EXTRACT | FULL TEXT  

Take your medications as prescribed
JAMA. 1999;282(3):298.
PDF  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Role of pharmacists in the medical home
Bates
Am J Health Syst Pharm 2009;66:1116-1118.
FULL TEXT  

Antimicrobial Prescription Errors in Hospitalized Children: Role of Antimicrobial Stewardship Program in Detection and Intervention
Di Pentima et al.
CLIN PEDIATR 2009;48:505-512.
ABSTRACT  

Medication errors in critical care: risk factors, prevention and disclosure
Camire et al.
CMAJ 2009;180:936-943.
FULL TEXT  

Effect of a Pharmacist on Adverse Drug Events and Medication Errors in Outpatients With Cardiovascular Disease
Murray et al.
Arch Intern Med 2009;169:757-763.
ABSTRACT | FULL TEXT  

Survey of physicians regarding clinical pharmacy services in academic emergency departments
Szczesiul et al.
Am J Health Syst Pharm 2009;66:576-579.
ABSTRACT | FULL TEXT  

Effect of Alerts for Drug Dosage Adjustment in Inpatients with Renal Insufficiency
Sellier et al.
J. Am. Med. Inform. Assoc. 2009;16:203-210.
ABSTRACT | FULL TEXT  

Effects of a Pharmacist-to-Dose Computerized Request on Promptness of Antimicrobial Therapy
Vincent et al.
J. Am. Med. Inform. Assoc. 2009;16:47-53.
ABSTRACT | FULL TEXT  

A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety
Rodriguez-Paz et al.
Anesth. Analg. 2009;108:202-210.
ABSTRACT | FULL TEXT  

ASHP Statement on Pharmacy Services to the Emergency Department
Am J Health Syst Pharm 2008;65:2380-2383.
FULL TEXT  

Pediatric Aspects of Inpatient Health Information Technology Systems
Kim et al.
Pediatrics 2008;122:e1287-e1296.
ABSTRACT | FULL TEXT  

Implementation of clinical pharmacy services in a dialysis unit
Erickson et al.
Am J Health Syst Pharm 2008;65:2011-2013.
FULL TEXT  

Economic Impact of a Pharmacy Resident in an Assisted Living Facility-Based Medication Therapy Management Program
Maack et al.
The Annals of Pharmacotherapy 2008;42:1613-1620.
ABSTRACT | FULL TEXT  

An educational and audit tool to reduce prescribing error in intensive care
Thomas et al.
Qual Saf Health Care 2008;17:360-363.
ABSTRACT | FULL TEXT  

The Iowa Continuity of Care study: Background and methods
Carter et al.
Am J Health Syst Pharm 2008;65:1631-1642.
ABSTRACT | FULL TEXT  

Medication errors reported by US family physicians and their office staff
Kuo et al.
Qual Saf Health Care 2008;17:286-290.
ABSTRACT | FULL TEXT  

Implementation of pharmacy services in a telemedicine intensive care unit
Meidl et al.
Am J Health Syst Pharm 2008;65:1464-1469.
ABSTRACT | FULL TEXT  

Unit-based clinical pharmacists' prevention of serious medication errors in pediatric inpatients
Kaushal et al.
Am J Health Syst Pharm 2008;65:1254-1260.
ABSTRACT | FULL TEXT  

Identifying and Quantifying Medication Errors: Evaluation of Rapidly Discontinued Medication Orders Submitted to a Computerized Physician Order Entry System
Koppel et al.
J. Am. Med. Inform. Assoc. 2008;15:461-465.
ABSTRACT | FULL TEXT  

Assessment of Clinical Pharmacists' Interventions in French Hospitals: Results of a Multicenter Study
Bedouch et al.
The Annals of Pharmacotherapy 2008;42:1095-1103.
ABSTRACT | FULL TEXT  

Realizing the pharmacoeconomic benefit of clinical pharmacy
Kaboli
Am J Health Syst Pharm 2008;65:1123-1123.
FULL TEXT  

The incidence and nature of in-hospital adverse events: a systematic review
de Vries et al.
Qual Saf Health Care 2008;17:216-223.
ABSTRACT | FULL TEXT  

Pharmacist Monitoring of QTc Interval-Prolonging Medications in Critically Ill Medical Patients: A Pilot Study
Ng et al.
The Annals of Pharmacotherapy 2008;42:475-482.
ABSTRACT | FULL TEXT  

Hospitalist-pharmacist collaboration: Only natural
Daniels
Am J Health Syst Pharm 2008;65:207-207.
FULL TEXT  

Patient-Focused Sedation and Analgesia in the ICU
Sessler and Varney
Chest 2008;133:552-565.
ABSTRACT | FULL TEXT  

Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist
Kopp et al.
Am J Health Syst Pharm 2007;64:2483-2487.
ABSTRACT | FULL TEXT  

Effect of pharmaceutical care services on outcomes for home care patients with heart failure
Triller and Hamilton
Am J Health Syst Pharm 2007;64:2244-2249.
ABSTRACT | FULL TEXT  

Accreditation Council for Graduate Medical Education Competencies: Practice-Based Learning and Systems-Based Practice
Moskowitz and Nash
American Journal of Medical Quality 2007;22:351-382.
 

Medical and nursing staff highly value clinical pharmacists in the emergency department
Fairbanks et al.
Emerg. Med. J. 2007;24:716-718.
ABSTRACT | FULL TEXT  

Impact of pharmacy validation in a computerized physician order entry context
Estellat et al.
Int J Qual Health Care 2007;19:317-325.
ABSTRACT | FULL TEXT  

Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury
Treggiari et al.
Am. J. Respir. Crit. Care Med. 2007;176:685-690.
ABSTRACT | FULL TEXT  

Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients
Bond and Raehl
Am J Health Syst Pharm 2007;64:1935-1942.
ABSTRACT | FULL TEXT  

Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework
Vermeulen et al.
Am J Health Syst Pharm 2007;64:1699-1710.
ABSTRACT | FULL TEXT  

Use of personal digital assistants for documentation of pharmacists' interventions: A literature review
Fox et al.
Am J Health Syst Pharm 2007;64:1516-1525.
ABSTRACT | FULL TEXT  

Differences in pharmacy terminology and practice between the United Kingdom and the United States
Brock and Franklin
Am J Health Syst Pharm 2007;64:1541-1546.
FULL TEXT  

Effects of a pharmacist-led pediatrics medication safety team on medication-error reporting
Costello et al.
Am J Health Syst Pharm 2007;64:1422-1426.
ABSTRACT | FULL TEXT  

Randomized Trial to Improve Prescribing Safety During Pregnancy
Raebel et al.
J. Am. Med. Inform. Assoc. 2007;14:440-450.
ABSTRACT | FULL TEXT  

ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems: Ensuring the Best Use of Medicines in Hospitals and Health Systems
Am J Health Syst Pharm 2007;64:1320-1330.
FULL TEXT  

Impact of a Pharmacy Resident on Hospital Length of Stay and Drug-Related Costs
Terceros et al.
The Annals of Pharmacotherapy 2007;41:742-748.
ABSTRACT | FULL TEXT  

Pharmacists versus nonpharmacists in adverse drug event detection: A meta-analysis and systematic review
Phansalkar et al.
Am J Health Syst Pharm 2007;64:842-849.
ABSTRACT | FULL TEXT  

Developing a model to determine the effects of adverse drug events in hospital inpatients
Nilsen and Fotis
Am J Health Syst Pharm 2007;64:521-525.
ABSTRACT | FULL TEXT  

Provision of pain management by a pharmacist with prescribing authority
Dole et al.
Am J Health Syst Pharm 2007;64:85-89.
ABSTRACT | FULL TEXT  

Reimbursement for clinical services provided by pharmacists: What are we doing wrong?
Dole and Murawski
Am J Health Syst Pharm 2007;64:104-106.
FULL TEXT  

The State of US Emergency Care: A Call to Action for Hospital Pharmacists
Idrees and Clements
The Annals of Pharmacotherapy 2006;40:2251-2253.
ABSTRACT | FULL TEXT  

Implementation of online radiology quality assurance reporting system for performance improvement: initial evaluation.
Kruskal et al.
Radiology 2006;241:518-527.
ABSTRACT | FULL TEXT  

Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit.
Kane-Gill et al.
Am J Health Syst Pharm 2006;63:1876-1881.
ABSTRACT | FULL TEXT  

Risk Reduction for Adverse Drug Events Through Sequential Implementation of Patient Safety Initiatives in a Children's Hospital
Leonard et al.
Pediatrics 2006;118:e1124-e1129.
ABSTRACT | FULL TEXT  

Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy.
Poon et al.
ANN INTERN MED 2006;145:426-434.
ABSTRACT | FULL TEXT  

Which Pharmacists Contribute to High-Level Pharmacotherapy Audit Meetings with General Practitioners?
Florentinus et al.
The Annals of Pharmacotherapy 2006;40:1640-1645.
ABSTRACT | FULL TEXT  

Tracking progress in patient safety: an elusive target.
Pronovost et al.
JAMA 2006;296:696-699.
FULL TEXT  

Compelling features of a safe medication-use system.
Kelly and Rucker
Am J Health Syst Pharm 2006;63:1461-1468.
FULL TEXT  

Adverse Drug Reactions Among Children Over a 10-Year Period
Le et al.
Pediatrics 2006;118:555-562.
ABSTRACT | FULL TEXT  

Medication Therapy Management Programs: Forming a New Cornerstone for Quality and Safety in Medicare
Smith and Clancy
American Journal of Medical Quality 2006;21:276-279.
 

Adverse Drug Event Reporting in Intensive Care Units: A Survey of Current Practices
Kane-Gill and Devlin
The Annals of Pharmacotherapy 2006;40:1267-1273.
ABSTRACT | FULL TEXT  

Proposed model for assuring quality of Medicare's medication therapy management
Chen and Thompson
Am J Health Syst Pharm 2006;63:1167-1171.
FULL TEXT  

Opportunities for performance improvement in relation to medication administration during pediatric stabilization.
Morgan et al.
Qual Saf Health Care 2006;15:179-183.
ABSTRACT | FULL TEXT  

Clinical pharmacists and inpatient medical care: a systematic review.
Kaboli et al.
Arch Intern Med 2006;166:955-964.
ABSTRACT | FULL TEXT  

A Systematic Review of the Literature on Multidisciplinary Rounds to Design Information Technology
Gurses and Xiao
J. Am. Med. Inform. Assoc. 2006;13:267-276.
ABSTRACT | FULL TEXT  

Quality of Medication Records and Use of Pharmacy Resources in Community Residential Care Facilities
Gray et al.
The Annals of Pharmacotherapy 2006;40:894-899.
ABSTRACT | FULL TEXT  

Critical Care Pharmacy Services in United States Hospitals
MacLaren et al.
The Annals of Pharmacotherapy 2006;40:612-618.
ABSTRACT | FULL TEXT  

Hospital pharmacy services in Puerto Rico
Perez et al.
Am J Health Syst Pharm 2006;63:460-465.
FULL TEXT  

Are newer, more expensive pharmacotherapy options associated with superior symptom control compared to less costly agents used in a collaborative practice setting?
Weschules et al.
AM J HOSP PALLIAT CARE 2006;23:135-149.
ABSTRACT  

Predictors of rehospitalization after acute coronary syndromes
Jennings et al.
Am J Health Syst Pharm 2006;63:367-372.
FULL TEXT  

Effect on health outcomes of a community-based medication therapy management program for seniors with limited incomes
Smith et al.
Am J Health Syst Pharm 2006;63:372-379.
FULL TEXT  

A research agenda for patient safety
Perneger
Int J Qual Health Care 2006;18:1-3.
FULL TEXT  

Pharmacy Clarification of Prescriptions Ordered in Primary Care: A Report from the Applied Strategies for Improving Patient Safety (ASIPS) Collaborative
Hansen et al.
J Am Board Fam Med 2006;19:24-30.
ABSTRACT | FULL TEXT  

Antimicrobial Stewardship Programs in Health Care Systems
MacDougall and Polk
Clin. Microbiol. Rev. 2005;18:638-656.
ABSTRACT | FULL TEXT  

Risk of adverse drug events by patient destination after hospital discharge
Triller et al.
Am J Health Syst Pharm 2005;62:1883-1889.
ABSTRACT | FULL TEXT  

Postoperative pain management: A practical review, part 1
Strassels et al.
Am J Health Syst Pharm 2005;62:1904-1916.
ABSTRACT | FULL TEXT  

Clinical pharmacists: Essential members of the pediatric critical care team
Chicella and Dice
Am J Health Syst Pharm 2005;62:1763-1763.
FULL TEXT  

Documentation of pharmacist interventions in the emergency department
Ling et al.
Am J Health Syst Pharm 2005;62:1793-1797.
FULL TEXT  

Impact of the Clinical Pharmacist on Readmission in Patients with Acute Coronary Syndrome
O'Dell and Kucukarslan
The Annals of Pharmacotherapy 2005;39:1423-1427.
ABSTRACT | FULL TEXT  

Use of specific indicators to detect warfarin-related adverse events
Hartis et al.
Am J Health Syst Pharm 2005;62:1683-1688.
ABSTRACT | FULL TEXT  

Hospitalwide adverse drug events before and after limiting weekly work hours of medical residents to 80
Mycyk et al.
Am J Health Syst Pharm 2005;62:1592-1595.
ABSTRACT | FULL TEXT  

Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy
Bond and Raehl
Am J Health Syst Pharm 2005;62:1596-1605.
ABSTRACT | FULL TEXT  

Crosswalk for the 2015 Initiative
Am J Health Syst Pharm 2005;62:1392-1393.
FULL TEXT  

How to avoid paediatric medication errors: a user's guide to the literature
Walsh et al.
Arch. Dis. Child. 2005;90:698-702.
ABSTRACT | FULL TEXT  

Epidemiology, Comparative Methods of Detection, and Preventability of Adverse Drug Events
Al-Tajir and Kelly
The Annals of Pharmacotherapy 2005;39:1169-1174.
ABSTRACT | FULL TEXT  

Pharmaceutical validation as a process of improving the quality of antineoplastic treatment
Fabia et al.
J Oncol Pharm Pract 2005;11:45-50.
ABSTRACT  

Improving the ICU: Part 2
Garland
Chest 2005;127:2165-2179.
ABSTRACT | FULL TEXT  

Five Years After To Err Is Human: What Have We Learned?
Leape and Berwick
JAMA 2005;293:2384-2390.
ABSTRACT | FULL TEXT  

Impact of an interdisciplinary team on drug therapy outcomes in a geriatric clinic
Lam and Ruby
Am J Health Syst Pharm 2005;62:626-629.
FULL TEXT  

Unresolved issues in pharmacy
Zellmer
Am J Health Syst Pharm 2005;62:259-265.
FULL TEXT  

Survey of hospital pharmacy practice in Flemish-speaking Belgium
Willems et al.
Am J Health Syst Pharm 2005;62:321-324.
FULL TEXT  

Implications for practice: challenges for healthcare leaders in fostering patient safety
Weingart and Page
Qual Saf Health Care 2004;13:ii52-ii56.
ABSTRACT | FULL TEXT  

Pharmacist-Run Travel Medicine Clinic
Brennan
The Annals of Pharmacotherapy 2004;38:2168-2169.
FULL TEXT  

Strategies for Detecting Adverse Drug Events among Older Persons in the Ambulatory Setting
Field et al.
J. Am. Med. Inform. Assoc. 2004;11:492-498.
ABSTRACT | FULL TEXT  

Medication errors in the neonatal intensive care unit: special patients, unique issues
Gray and Goldmann
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89:F472-F473.
FULL TEXT  

Reducing medication errors in the neonatal intensive care unit
Simpson et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89:F480-F482.
ABSTRACT | FULL TEXT  

Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
Landrigan et al.
NEJM 2004;351:1838-1848.
ABSTRACT | FULL TEXT  

Quality and Safety Revolution in Health Care
Thrall
Radiology 2004;233:3-6.
FULL TEXT  

Evaluation of a Method to Reduce Over-the-Counter Medication Dosing Error
Frush et al.
Arch Pediatr Adolesc Med 2004;158:620-624.
ABSTRACT | FULL TEXT  

Influential Characteristics of Physician/Pharmacist Collaborative Relationships
Zillich et al.
The Annals of Pharmacotherapy 2004;38:764-770.
ABSTRACT | FULL TEXT  

Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease
Choi et al.
CMAJ 2004;170:1409-1413.
ABSTRACT | FULL TEXT  

The Epidemiology of Prescribing Errors: The Potential Impact of Computerized Prescriber Order Entry
Bobb et al.
Arch Intern Med 2004;164:785-792.
ABSTRACT | FULL TEXT  

Can Health Care Teams Improve Primary Care Practice?
Grumbach and Bodenheimer
JAMA 2004;291:1246-1251.
ABSTRACT | FULL TEXT  

Reply to Bhosle and Sansgiry
Ash and Carpenter
J. Am. Med. Inform. Assoc. 2004;11:127-128.
FULL TEXT  

Do pharmacists' presence on rounding teams reduce preventable adverse drug events in hospital general medical units?
Etchells
CMAJ 2004;170:333-333.
FULL TEXT  

Management of Diabetes and Hyperglycemia in Hospitals
Clement et al.
Diabetes Care 2004;27:553-591.
FULL TEXT  

Drug Errors: What Role do Nurses and Pharmacists have in Minimizing the Risk?
Guy et al.
J Child Health Care 2003;7:277-290.
ABSTRACT