The Clinical Pharmacology Consult Team is a concept which has been developed in the Amsterdam UMC.
Within this multidisciplinary team knowledge and expertise of doctors and pharmacist are combined. The aim is to improve rational (safe and effective) prescribing of medication.
Watch the video below for more information.
The Clinical Pharmacology Consult Team contributes to:
• Giving recommendations about personalized medicines optimisation for admitted patients;
• Executing medication reviews for admitted patients (with polypharmacy);
• Educating doctors and medical students about medication reviews;
• The development of a hospital-wide induction program on rational prescribing for (starting) prescribers;
• The farmacopedia website, which gives directions to the appriopriate guidelines.
The Clinical Pharmacology Consult Team has grown to being a well-known team within the Amsterdam UMC by working together intensively with different clinical departments and several clinical teams (such as the A-team) within the Amsterdam UMC. In addition, they offer postacademic courses (such as the clinical pharmacology training programme) and work together with new initiatives (as the Junior ADE-managers project). The Clinical Pharmacology Consult Team strives for more clinical relevance and innovation on medication – and patient safety.
In conclusion, the Clinical Pharmacology Consult Team is a multidisciplinary team, who offer conclusive guidelines, applications and guidance in rational prescribing.
Contact the Pharmacology Consult Team for a medication review request via:
35748 (intern) / 0650087722 (extern) – location VUmc
29593 (intern) / 0207329593 (extern) – location AMC
The Pharmacotherapy Consult Team
Professor Michiel van Agtmael MD PhD
Head of the section Pharmacotherapy and internist
Why reducing prescribing errors?
Prescribing errors, resulting from inappropriately prescribed medication, can cause iatrogenic patient harm, prolonged hospitalization and hospital readmission1-3. These events are associated with an increased risk of morbidity and mortality and increased healthcare costs. Recent estimations show that 5–7% of all hospital admissions in economically developed countries are medication related. Approximately 66% of these admissions are due to inappropriate prescribed medication. Associated worldwide costs are estimated at 42 billion USD each year1, 4 and are therefore a worldwide topic of awareness5.
In the Netherlands, the HARM study showed that 2.4% of all hospital admissions and 5.6% of all acute admissions in Dutch hospitals were related to medication errors6. Almost half (46%) of these admissions were potentially preventable. One or more prescribing errors were detected in most (71%) of the preventable admissions.
In response, over the past decades, several strategies aiming to reduce in-hospital PEs and related patient harm have been developed. These strategies include programmes with a focus on specific medications and their harmful adverse drug reactions (ADEs) (e.g. nonsteroidal anti‐inflammatory drugs and antiplatelet drugs causing gastrointestinal tract bleeding6, 7, medication reconciliation8 and the implementation of computerized physician order entry (CPOE) systems, often in combination with clinical decision support systems (CDSS)). Nonetheless, ADEs still occur and numbers are not declining9, 10. A recent report, commissioned by the Dutch government10, revealed a rise of 26% in (the absolute number of) medication‐related hospital admissions between 2008 and 2013. This is in line with international publications9, underscoring the need for more effective strategies.
How to reduce prescribing errors in the in-hospital setting?
In-hospital prescribers are challenged in prescribing due to the increasing complexity of hospital-admitted patients (e.g. multimorbidity, polypharmacy, multiple prescribers involved, older age); the demanding work environment; hard to find or conflicting protocols; a heavy workload, appropriately. To prevent and reduce medication-related harm, new strategies are urgently needed. In this new strategy, we hypothesize that a multidisciplinary team (‘Pharmacotherapy team’) including a clinician and a hospital pharmacist, working together with local stakeholders, e.g. (junior) prescribers, nurses, medical managers, can make a valuable contribution to reduce prescribing errors.
Since September 2015, this Pharmacotherapy team is operational in Amsterdam University Medical Centers – location VUmc, and nowadays it is operational in both locations.
Between mid 2015 and mid 2018 we developed a multifaceted strategy using Participatory Action Research (PAR). PAR is characterized by the involvement of relevant stakeholders in the analysis of complex problems and in leading the change process11. Stakeholders are empowered to identify the problem’s root causes as well as opportunities to improve, develop and implement a tailored plan of improvement. This process should result in sustainable improvement as stakeholders place value on an intervention they partially created, the IKEA effect12. This study was recently published and led to several hospital-wide interventions.
Based on the results of the individual wards, hospital-wide interventions are developed including:
– Consultation of the Pharmacotherapy team, involving clinical pharmacologists, clinical pharmacist and medical doctors in daily clinical practice.
– eLearning covering important prescribing topics (e.g. pain/fluid management, anticoagulation) for junior doctors;
– ‘App-ification and optimization of hospital guidelines for drug prescribing.
Eversince, the Pharmacotherapy team is inbedded in daily in-hospital practice. Future research will focuss on in-dept research of facilitators and protective barriers to in-hospital prescribing errors and how to use this information in developing a more effective multifaceted strategy to sustainably reduce prescribing errors in the in-hospital setting.
1. The Pharmacotherapy-team: A novel strategy to improve appropriate in-hospital prescribing using a participatory intervention action method
2. Medication review 2.0 (Dutch)
3. Prescribing errors in post-COVID-19 patients: prevalence, severity and risk factors in patients visiting a post-COVID-19 outpatient clinic
1. Assiri GA, Shebl NA, Mahmoud MA, Aloudah N, Grant E, Aljadhey H, et al. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ open. 2018;8(5):e019101.
2. De Vries T, Henning RH, Hogerzeil HV, Fresle D, Policy M, Organization WH. Guide to good prescribing: a practical manual. Geneva: World Health Organization; 1994.
3. Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. Prevalence, incidence and nature of prescribing errors in hospital inpatients. Drug safety. 2009;32(5):379-89.
4. Organization GWH. Medication Errors – Technical Series on Safer Primary Care2016. 32 p.
5. Organization WH. Medication errors: World Health Organization; 2016.
6. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Archives of internal medicine. 2008;168(17):1890-6.
7. Warlé-van Herwaarden MF, Kramers C, Sturkenboom MC, van den Bemt PM, De Smet PA. Targeting outpatient drug safety. Drug safety. 2012;35(3):245-59.
8. Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. Journal of critical care. 2003;18(4):201-5.
9. Veeren JC. Trends in emergency hospital admissions in England due to adverse drug reactions: 2008-2015.: Journal of Pharmaceutical Health Services Research; 2017.
10. Sturkenboom MC. EINDRAPPORT: VERVOLGONDERZOEK MEDICATIEVEILIGHEID (2017)2017.
11. Baum F, MacDougall C, Smith D. Participatory action research. Journal of epidemiology and community health. 2006;60(10):854.
12. Norton MI, Mochon D, Ariely D. The IKEA effect: When labor leads to love. Journal of consumer psychology. 2012;22(3):453-60.