Table 1 Definitions
Term | Definition |
|---|---|
1. Adverse drug events (ADE) [18] | “An injury resulting from medial intervention related to drug” |
2. Prescribing error (PE) [23] | “An error in prescribing decision(s) and/or the (electronic) prescription writing process that could result in clinically relevant and significant harm to the patient or to a diminished effect of treatment” |
3. Unintentional drug discrepancy [24] | A change in prescribed medication, without there being a documented rationale for this change. |
3.1. Unintentional initiation of a drug | Medication was initiated i) even though there is no rationale or indication documented justifying initiation; ii) even though there is a rationale documented where a drug was discontinued and should stay discontinued but was re-initiated. |
3.2. Unintentional omission of a drug | Medication was not prescribed and there was no documented rationale justifying discontinuation. |
3.3. Unintentional switch of a drug within the same Anatomical Therapeutic Chemical (ATC) group | Medication was switched to another drug within the same ATC group, even though there was no rationale documented justifying the switch. |
3.4. Unintentional change of a drug dosage | Dosage was changed either to a higher or lower dosage even though there was no rationale documented justifying the change. |
4. Inappropriate prescription | Deviations in medication therapy as stated in hospital-, national- (e.g. The Royal Dutch Pharmacists Association database), or international evidence-based guidelines. In case there were pathophysiological and/or evidence-based reasons for deviations from these evidence-based guidelines recorded in the patient’s medical record, this was not considered inappropriate by the pharmacotherapy team. |
4.1. ‘Underuse’ | - Incomplete pharmacotherapy according to relevant guideline or protocol; - Incorrect duration (too short) of prescribed drug therapy. |
4.2. ‘Overuse’ | - Drug continued despite no indication (anymore) (desprescribing); - (Pseudo) drug duplication. |
4.3. Potentially inappropriate medications | Drug should be discontinued due to an adverse drug event (ADE), in toleration or contra-indication |
4.4. Incorrect dosing | - Under- or overdosing - Incorrect dosing frequency |
5. Medication reconciliation [25] | “The process of obtaining and maintaining a complete and accurate list of the patients’ current medication use across healthcare settings” performed by trained pharmacy technicians |