Table 2

Reasons for pharmacist intervention

Reason for recommendationFrequency
Dosage error: 1.5 to 10 times higher than normal (if medication has a normal therapeutic index)454
Dosage error: very low for medication that may not save the patient's life246
Clarification of medical order/information request117
Medication not included in the hospital drug guide90
Inappropriate or unavailable dosage form83
Sequential therapy71
Therapeutic duplication58
Inappropriate dosage interval53
Dosage error: results in potentially toxic concentrations49
Medication omitted from the medical order (untreated)41
Route of administration may lead to severe toxicity35
Dosage error: 10 times higher than normal (if medication has a normal therapeutic index)31
Refill/medical order error leads to dispensing error30
Drug without indication (indication not studied or no evidence of use, independently of drug data sheet)20
Dosage error: 1.5 to 4 times higher than normal (if medication has a narrow therapeutic index)17
Dosage error: 4 to 10 times higher than normal (if medication has a narrow therapeutic index)14
Dosage error: 10 times higher than normal (if medication has a narrow therapeutic index)12
Dosage error: very low for medication that could save the patient's life10
Adverse reaction linked to precautions or contraindications7
Interaction: clinically significant, requires monitoring6
Incomplete information on the medical order5
Route of administration may lead to mild toxicity5
Documented allergies to a drug4
Financial savings4
Illegible, ambiguous or incomprehensible abbreviations3
Failure to adhere to hospital policy3
Others: failure to adhere to hospital policy, administration information for parenteral/oral medicines, interactions that contraindicate combinations, interventions in adherence to treatment in outpatients and preventive measure to avoid adverse reaction omitted7