Unacknowledged Prescribing Errors in Polypharmacy: How Technology Can Help

Polypharmacy, the use of five or more medications by a patient, is a common scenario in modern healthcare, especially among the elderly and those with chronic conditions.

However, this practice is fraught with potential prescribing errors that often go unrecognized.

In their 2024 study, Gentile et al. explored the effectiveness of a Clinical Decision Support System (CDSS) named Drug-PIN® in identifying and correcting these errors.

At a Glance

• Key Findings:

  • 66.8% of patients were on polypharmacy regimens.

  • 29.6% of patients were at moderate to high risk of medication harm.

  • 63.7% of these risks could be reduced through Drug-PIN® optimization.

  • Overall, 18.89% of prescribing errors were avoidable.

• Study Period: April to June 2023

• Location: Sant’Andrea Hospital of Rome, Italy

• Participants: 307 patients

The Problem with Polypharmacy

Polypharmacy increases the risk of unacknowledged prescribing errors due to complex drug-drug interactions, guidelines, and contraindications. These errors are particularly challenging to identify when multiple healthcare providers are involved in a patient's care.

According to the authors:

The Role of Drug-PIN®

Drug-PIN® is a commercial CDSS that evaluates the risk associated with a patient's medication regimen. It classifies therapies into low, moderate, or high risk and suggests optimizations by exchanging drugs within the same therapeutic class. This study aimed to assess the frequency of unrecognized prescribing errors and the effectiveness of Drug-PIN® in reducing these risks.

Key Findings

Out of 307 patients, 205 were on polypharmacy regimens. The Drug-PIN® system identified that 91 patients were at moderate to high risk of medication harm. Among these, 63.7% could have their risk significantly reduced through the system's recommendations. The study found that patients whose therapies could not be optimized typically had a higher number of medications, highlighting the complexity involved in managing extensive drug regimens.

Examples of Optimization

• Patient 1: Initially on a high-risk regimen, their therapy was optimized by replacing simvastatin with pitavastatin and esomeprazole with roxatidine, and deprescribing cholecalciferol. This reduced their risk score from 74.77 to 22.47.

• Patient 2: Initially on a moderate-risk regimen, their therapy was optimized by selecting alternative drugs, reducing their risk score from 74.77 to 17.3.

Implications for Healthcare

The findings suggest that computer-aided evaluation of medication regimens can be a valuable tool in reducing prescribing errors, especially in polypharmacy. The study was conducted in a hospital pre-admission setting, which allowed for the interception of potentially harmful regimens before they could affect patient outcomes.

Moving Forward

The study highlights the importance of integrating CDSS like Drug-PIN® into regular healthcare practices. While MedRec (Medication Reconciliation) is effective in identifying basic errors, more complex and hidden errors require advanced bioinformatics support. The systematic use of such tools could potentially save thousands of lives and millions of healthcare dollars annually.

Conclusion

Prescribing errors in polypharmacy are a significant healthcare challenge. The study demonstrates that tools like Drug-PIN® can play a crucial role in identifying and correcting these errors, thereby improving patient safety and healthcare efficiency.

The integration of CDSS with MedRec activities could represent a major step toward safer and more effective medication practices.

In summary, while the study's retrospective nature means the clinical effects of therapy optimization weren't directly observed, previous research supports the efficacy of Drug-PIN®. As healthcare continues to advance, the adoption of such technologies will be essential in minimizing medication errors and enhancing patient care.