Pharmacists Reduce Anti-Epileptic Drug Prescription Errors

Clinical pharmacists can reduce anti-epileptic drug (AED) prescription errors that commonly result from incomplete or poor documentation, according to a literature review published in Seizure, The European Journal of Epilepsy.

Researchers from the Alder Hey Children’s NHS Foundation Trust in the United Kingdom conducted a 12-month retrospective review of all pediatric outpatient prescriptions of anti-epileptic drugs (AEDs) at a large children’s hospital. In the study, the authors acknowledged that pediatric AEDs are particularly difficult to prescribe, given the wide variety of available choices and potential interactions among AEDs and other medications.

The investigators monitored all new prescriptions for AEDs issued from the hospital’s general pediatric and pediatric neurology departments in 2012. Data was collected regarding patient demographics, diagnosis/indication for the AED, clarity of dosage instructions, prescriber details, and whether a pharmacist intervention was required prior to dispensing the medication.

Over the course of the year, a total of 262 new AED prescriptions were written, with 19 patients receiving more than 1 AED prescription. Of those prescriptions, an astounding 72.1% were deemed incomplete with at least 1 piece of missing information, the study authors noted.

Furthermore, 164 (62.6%) of the prescriptions did not document any diagnosis or reason for prescribing the AED. Of the remaining 98 prescriptions, 50 documented only the word “epilepsy,” while 48 described a non-epileptic diagnosis, such as “migraine,” “behavioral problems,” and “chronic pain.”

AED prescribers recorded their designation and immediate contact details in just 41.6% of all AED prescriptions. Of those detailed prescriptions, 65.1% were written by a senior doctor, 17.4% were prescribed by a specialist trainee or junior doctor, and another 17.4% were illegible or not recorded.

Among all epilepsy diagnoses, the most commonly prescribed AED was sodium valproate, followed by a tie between carbamezapine and levetiracetam. For prescriptions with a designated non-epileptic diagnosis, the most commonly prescribed medication was gabapentin.

Pharmacists contacted physicians concerning 44 prescriptions (16.8%), 15 (34%) of which were due to errors in dosage or frequency of administration. Such dosing errors were identified by pharmacists for carbamazepine, gabapentin, lamotrigine, and topiramate, among other AEDs. According to the researchers, all AED prescriptions with dosing errors were amended prior to being dispensed.

“Although there were high numbers of incomplete or inadequate prescriptions in the current study, no patients had their medication incorrectly dispensed, (which) reflects the pharmacists’ review of each prescription prior to the drug being dispensed,” the study authors concluded. “Clearly, it is the clinician’s responsibility to prescribe the most appropriate AED, but it might be reasonable to have the choice of drug confirmed by a clinical pharmacist.”