5PSQ-036 Clinical pharmacist interventions in antimicrobial therapy stewardship: prevention of medication errors enhanced by access to the patient’s electronic health record

<h3>Background and Importance</h3> The control of pharmacotherapy aims to prevent medication errors and adverse events related to the use of drugs that are common in hospitalised patients and can cause prolonged hospitalisation, higher treatment costs and possible death. Clinical pharmacist has to ensure the correct and rational use of antimicrobial drugs by monitoring the prescription. Access to the patient’s electronic health record (EHR) allows the pharmacist to make better clinical decisions, which contributes to greater patient safety, reduction of medication errors and side effects. <h3>Aim and Objectives</h3> The aim of the study was to analyse the prevention of medication errors by interventions of clinical pharmacists in hospitalised patients on antimicrobial therapy. Pharmaceutical interventions were evaluated before and after the possibility of accessing the EHR. <h3>Material and Methods</h3> An observational-retrospective study was conducted between April 2023 and March 2024. Two clinical pharmacists performed interventions during their daily practice in a hospital pharmacy related to the processing of requests for the dispensing of reserve antimicrobial therapy. Data on the monthly number of interventions, the frequency of interventions for each antibiotic and the type of medication error (dose, dosing interval, excluded drug, dose and interval, other) were documented. <h3>Results</h3> A total of 8559 requests for antimicrobial therapy were processed in the study. Pharmacists conducted total of 73 interventions, 11 in the period April-July 2023. (without access to the EHR), 55 in the period August-December 2023. and seven in the period January-March 2024. (with access to the EHR). The most frequent interventions were on inadequate dosing interval (n=42, 57.53%), and unadjusted dosing (n=13, 17.8%). In five patients, the antibiotic was excluded from the therapy. The largest number of interventions in terms of dose and interval was for ceftiaxone (n=21, 30.0%). Of the total number of interventions, 93.15% were accepted. <h3>Conclusion and Relevance</h3> Without access to the EHR makes it very difficult for pharmacists to detect medical errors. Medication errors and prescribing problems are common without patients EHR. Access to the EHR improves results through the interventions of clinical pharmacists, contributes to the reduction of medication errors and facilitates the management of antimicrobial drugs with the aim of optimising therapy and reducing healthcare costs. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest