Antiparkinsonian Medication Reconciliation as a Strategy to Improve Safety by Preventing Medication Errors

ABSTRACT

Background

About 70% of neurologists report that PD patients do not get their medication properly when hospitalized, and 33% are prescribed contraindicated drugs.

Objectives

To execute medication reconciliation (MedRec) focused on antiparkinsonian drugs to identify, characterize and, eventually, prevent medication errors, thus promoting therapeutic quality and safety in daily practice.

Methods

An interventional, single‐center, 1 year, prospective study. All the patients who were hospitalized and had, at least, one active prescription containing an antiparkinsonian drug at hospital admission were included. MedRec was performed by following a three‐phased check: inpatient electronic prescription validation after assessing the outpatient medication schedule, review of the latest clinical report emitted by the Neurology Department/General Practitioner, and pharmacist‐driven interview of the patient and/or caregiver to confirm the information regarding medication gathered.

Results

A total of 171 admission episodes from 132 patients were registered (February 1, 2021, and January 31, 2022). Of 224 prescription lines involving antiparkinsonian drugs, 179 contained, at least, one medication error (59.8%). Commission errors (91.62%) were more frequent than omitted drugs (8.38%). The most common medication errors were related to timing (41.90%), frequency (21.23%), and dosing (19.55%). The implementation of this program prevented the erroneous administration of 2716 antiparkinsonian doses, 60% of the total number of doses prescribed. Interestingly, a significant relationship between the number of medication errors and having levodopa prescribed was evidenced (P < 0.05). A contraindicated drug was prescribed in almost one‐third of the episodes (29.82%).

Conclusions

Clinical pharmacists' implementation of an antiparkinsonians reconciliation program sharply reduced medication errors and prescription of contraindicated drugs.

According to the 2016 Global Burden of Disease report, 6.1 million individuals had Parkinson's disease (PD) worldwide, compared with 2.5 million in 1990. ¹ Besides, some authors infer that this number could go up to nearly 9 million by 2030. ² These data are coherent with previous epidemiological studies highlighting that, among neurological disorders, Parkinson's disease is the fastest‐growing in prevalence, disability, and deaths. ³ Nevertheless, this increase cannot be solely explained by the growth of the elderly population since age‐standardized prevalence rates have also increased proportionally over the same period. ¹

To date, pharmacotherapy is the primary treatment for PD. As the disease progresses, medication adherence becomes increasingly critical for functional independence. ⁴ Moreover, the administration of PD medication also needs to be carried out at a particular time to avoid missing doses or inaccurate dosage schemes that may result in motor and non‐motor consequences. ⁵ Therefore, medications should be administered on time, according to a patient's unique schedule, to avoid periods of sub‐optimal treatment ⁶ that will, ultimately, lead to an immediate augmentation of symptoms. ⁷

In this sense, developing strategies focused on promoting accurate PD medication administration is crucial, even more throughout hospitalization, a critical period for PD patients when viewed from the perspective of pharmacological treatment, ⁷ especially considering that PD patients are admitted to hospitals more frequently and longer than the general population. ⁸ , ⁹ One‐third of all patients with PD visit an emergency department or hospital each year, ¹⁰ yet about 70% of neurologists report that PD patients do not get their medication properly when hospitalized. ¹¹ For these patients, it is safest to administer antiparkinsonian drugs according to the scheduled times the patients take the medication at home, ¹¹ yet this requires an individualized treatment regimen that is not always available due to the healthcare pressure and limited human resources. As a result, it is frequent that many patients suffer from omitted, delayed, or even wrong treatment regimens during their hospital stay which can lead PD patients to experience worsening tremors, increased rigidity, loss of balance, confusion, or agitation. ¹² Besides, 1 in 3 patients with PD is prescribed contraindicated drugs during hospitalization, and serious complications, mostly neuropsychiatric, occur in more than half of these patients. ¹² , ¹³

In this context, and though many PD patients seem to deteriorate during hospitalization, most hospitals do not have proper guidelines or interventions to prevent the worsening of PD symptoms and complications due to PD medication errors during hospital stays. ⁸ Nonetheless, PD patients would not be the only ones who could benefit from this initiative, also those who suffer from other movement disorders (parkinsonism, akinetic–rigid syndromes, etc.) and need to be treated with antiparkinsonian drugs. In this scenario timing, dosage and every other aspect of antiparkinsonian treatment are also essential to guarantee an optimal clinical response.

Healthcare systems could also take advantage of this type of intervention considering medication errors are the leading cause of avoidable harm across healthcare organizations. ¹⁴ For this reason, the protocol developed and executed to prevent these errors needs to be concise and may not leave any patient's clinical record unreviewed during the admission process. In this sense, electronic clinical records implemented in most hospitals may be useful. Once the patient is admitted to the hospital, the system would automatically upload all the current medication prescribed to the patient, yet this process has meaningful limitations since up to 70% may no longer be used by the patient as medication lists become out‐of‐date, and 15.5% of current medications are not listed in the electronic medical record ¹⁵ or may contain errors. For example, correct posology may not be correctly uploaded since PD patients may have changed dose timing due to neurologist advice but, somehow, is not properly reflected on the record. This could happen because of prescription software limitations regarding detailed/individualized posology options. Another common circumstance is the lack of cross‐verification due to reliance on the electronic record and shortage of human resources or even the lack of training in PD pharmacology that prevents physicians to prescribe the treatment correctly during medical wards and nurses to identify potential errors in these complex treatment schemes. Hence, alternate data collection strategies may be necessarily added to help accurately quantify and characterize medication errors and improve medication safety and health outcomes. ¹⁶

Thus, Clinical Pharmacy, a health science discipline in which pharmacists provide care to patients that optimizes medication therapy and promotes health, wellness, and disease prevention ¹⁷ could play a useful role. Previous evidence has shown that drug histories taken at admission by a clinical pharmacist in medical rounds reduce medication errors by 51% and adverse drug reactions by performing medication reconciliation (MedRec) programs, ¹⁸ , ¹⁹ which has been shown to have a positive impact on reducing the length of hospital stay and mortality rate. ¹⁹ MedRec is a formal, and collaborative process of obtaining and verifying a complete and accurate list of a patient's current medicines to ensure that precise and comprehensive medication information is transmitted consistently across care transitions, ²⁰ which seems to be more effective when performed by clinical pharmacists at either hospital admission or discharge. ²¹

Thus, it seems feasible that, developing a programmed intervention led by clinical pharmacists to reconcile medication in PD patients during hospital admission could prevent medication errors during patients’ transitions of care, and error‐induced morbidities or potentially avoid unnecessary costs to the healthcare facility. ²² To do so, this study aims to initiate a clinical pharmacist‐led MedRec protocol for antiparkinsonian medication and evaluate the results derived from this program 1 year after its implementation.

Methods

Study Design

This research project was conducted in Hospital Universitario Dr. Balmis, a tertiary specialty hospital in Alicante, Spain. This was a single center, 1 year (February 1, 2021–January 31, 2022), prospective, interventional study analyzing the impact of developing an antiparkinsonian MedRec program led by clinical pharmacists to identify and correct potential medication errors related to PD pharmacotherapy at the time of admission to the hospital.

The study was approved by the institutional Ethics Committee (Comité Ético de la Investigación con Medicamentos del Departamento de Salud de Alicante–Hospital General, study reference: PI2022‐072) according to the STROBE checklist. Informed consent was waived from the present study since the research presented no more than minimal risk of harm to subjects and involved no procedures for which written consent is normally required outside of the research context. Moreover, this decision did not adversely affect the rights and welfare of the patients.

Study Participants

Inclusion Criteria

All the patients who were hospitalized during the defined period and had, at least, one active prescription for an antiparkinsonian drug at hospital admission.

Exclusion Criteria

Patients requiring hospital stay with active prescription of antiparkinsonian treatment who were not able to be interviewed (nor their caregiver).

MedRec Program Design and Data Screening

A program of MedRec and pharmaceutical care was designed and implemented in daily clinical practice, including clinical pharmacist 24 h ward rounds during the 365 days the study lasted (it is important to mention that 24 h/7 days pharmacist ward rounds were a reality prior to the design of the present study). A team of qualified pharmacists, trained in MedRec, extracted the data of each patient from their electronic prescription at the time of hospital admission. All the commercial presentations and pharmaceutical forms for benserazide, carbidopa, entacapone, levodopa, opicapone, pramipexole, rasagiline, rotigotine, and selegiline were reconciled following this procedure (Table S1).

The reconciliation process is based on validating and verifying the inpatient e‐prescription using a well‐structured and replicable procedure: (1) each patient's electronic medical record was accessed to assess any discrepancies between outpatient antiparkinsonian medication and the one prescribed during admission to the hospital; (2) the consultations and medical record obtained during a medical interview from the Neurology Department and General/Family practitioners were checked to be aware of the patient's current treatment and clinical situation; (3) the patient and/or caregiver were interviewed by a clinical pharmacist performing the intervention to reconcile the medication accurately.

The data obtained throughout the reconciliation process were age, sex, the reason for admission, medical unit admitted to, date of hospital admission, treatment indication, number of antiparkinsonian drugs prescribed, antiparkinsonian drugs prescribed, dose, frequency, and liberation form, date of antiparkinsonian treatment reconciliation and date of hospital discharge. Discrepancies found were determined as medication errors and properly classified into two major categories: omission and commission. Omission errors were defined as the absence of antiparkinsonian prescription when needed, whereas commission errors were defined as any discrepancy in drug, dose, frequency, timing, or liberation form between the electronic prescription and the patient's ambulatory treatment [drug: (eg, levodopa plus carbidopa instead of levodopa plus benserazide); dose error: (eg, 200 mg instead of 100 mg); frequency error: (eg, every 6 h instead of every 8 h); timing error: the drug is prescribed in a different schedule from the one referred by Neurology and followed by the patient (eg, 8‐16‐24 h instead of breakfast, lunch, dinner); liberation form: (eg, immediate release instead of extended‐release)].

Additionally, the complete prescribed inpatient treatment was also validated to identify and prevent the prescription of contraindicated drugs. To evaluate contraindication or drug–drug interaction, different databases were consulted: Lexicomp® drug interactions tool, the American Parkinson Disease Association consensus document, and recent reviews involving this topic (Bitner et al ²³ and Agnieszka et al ²⁴ ).

To conclude every intervention, physicians and nursing staff were directly informed by the pharmacist via telephone. Moreover, to avoid potential oversights, changes that needed to be performed regarding antiparkinsonian medication were also reflected in detail on the electronic prescription software. A graphic scheme of the final protocol is depicted in Fig. 1.

FIGURE 1.

Antiparkinsonian medication reconciliation (MedRec) procedure leaded by clinical pharmacists of Hospital General Dr. Balmis de Alicante.

It is important to understand that there is no stock of antiparkinsonian drugs in the inpatient units or emergency room. Therefore, the nursing staff could not give an antiparkinsonian drug if the clinical pharmacist had not signed the dispensation since pharmacy technicians cannot prepare or deliver medication without having the medical prescription signed by a clinical pharmacist. This measure prevented administering incorrect therapeutic schemes.

Study Endpoints

The primary endpoint of the present study was to design and implement in daily practice a MedRec protocol led by clinical pharmacists to identify, characterize and, eventually, prevent PD medication errors. To evaluate the impact of this intervention both the number of erroneous doses avoided during the hospital stay and the number of correct doses of antiparkinsonian medication administered without requiring intervention were quantified.

The secondary endpoint was to assess the number of contraindicated drugs prescribed in patients with active PD disease treatment. To do so, contraindicated drugs were identified, and suspended and the pharmacists immediately contacted the physician in charge of the patient to recommend alternatives that were appropriate considering the patient's condition.

Data Screening and Statistical Analysis Software

Medication prescribed during hospital stay was consulted using the e‐prescription tool Athos™ Prisma (Athos™ Pharma, APD). The medical record was accessed to verify outpatient prescriptions and the last clinical interview with the neurologist or general/family practitioner through Orion Clinic® and SIA Abucasis®. To analyze data recollected, a descriptive test of the means was conducted to evaluate the normality of the sample. Descriptive data were expressed as absolute and relative frequencies. Continuous variables were expressed as mean or median according to the normality test, whereas their dispersion was expressed as interquartile range. To evaluate differences within one group, one sample t test was performed. The relationship between medication errors and the number of antiparkinsonian drugs/type of antiparkinsonian treatment prescribed was assessed by performing a Chi‐Square Test of Independence. Data analyzes were performed with SigmaPlot v11.0 (Systat Software Inc., Chicago, IL, USA) software.

Results

Patient Selection and Demographics

A total of 171 admission episodes from 132 patients were registered between February 1, 2021, and January 31, 2022. No patient with an active prescription of antiparkinsonian treatment at hospital admission was determined to be ineligible. During the study period, more men than women (55.0 vs. 45.0%) with active antiparkinsonian treatment were hospitalized. The most common scenario involved patients with one antiparkinsonian drug prescribed, mainly levodopa associated with carbidopa or benserazide, and the main cause of admission was an infectious disease, followed by trauma and cardiac affection, respectively. Patient demographics are described in detail in Table 1.

TABLE 1.

Summary of patient demographics.

Parameter	Patients (n = 132)
Sex
Male	73 (55.3%)
Female	59 (44.7%)
Age	80.5 (73.3–85.4)*
Mean number of antiparkinsonian drugs prescribed per patient	1.7 (1–4)**
1 drug prescribed	98 (74.3%)
2 drugs prescribed	29 (21.9%)
3 drugs prescribed	4 (3.0%)
4 drugs prescribed	1 (0.8%)
Antiparkinsonian drug prescribed
Levodopa/carbidopa	118 (89.4%)
Levodopa/benserazide	27 (20.5%)
Rasagiline	11 (8.3%)
Pramipexole	7 (5.3%)
Ropinirol	3 (2.3%)
Selegiline	2 (1.5%)
Rotigotine	2 (1.5%)
Levodopa/carbidopa/entacapone	1 (0.8%)
Opicapone	1 (0.8%)
Length of hospital stay (days)	8.8 (7.4)***
Reason for admission
Infectious disease	53 (40.2%)
Trauma	21 (15.9%)
Cardiac affection	19 (14.4%)
Neurological disorder	11 (8.3%)
Other:	28 (21.2%)
○ Digestive disorder	15 (53.6%)
○ Vascular affection	8 (28.6%)
○ Non‐infectious respiratory affection	5 (17.8%)

Note: Parameter: variable analyzed. Patients: individuals admitted to the hospital with an active prescription of antiparkinsonian drugs. Sex, detailed antiparkinsonian drugs prescribed per patient and reason for admission are represented as absolute and relative frequencies.

^*Age is represented as median (interquartile range).

^**Mean number of antiparkinsonian drugs prescribed per patient is represented as mean (range).

^***Length of hospital stay is represented as mean (standard deviation).

MedRec Intervention Analysis

Throughout the study period, 134 prescriptions with errors were evaluated. From 224 prescription lines involving antiparkinsonian drugs, a total number of 179 (79.9%) medication errors were registered. Commission errors (91.62%) were more frequent than omitted drugs (8.38%). The most common medication errors involved drug timing (41.90%), frequency (21.23%), and dose (19.55%), respectively. Interestingly, the implementation of the MedRec program prevented the erroneous administration of 2716 antiparkinsonian doses, approximately 60% of the total number of doses administered during this period (Table 2).

TABLE 2.

Summary of antiparkinsonian medication errors.

Total number of prescriptions involving at least one antiparkinsonian drug	224	P < 0.05*
Number of correct prescriptions	90 (40.2%)
Number of erroneous prescriptions	134 (59.8%)
Total number of prescription errors (considering one prescription could have one or more errors, e.g., dose and liberation)	179	P < 0.05*
Commission errors	164 (91.6%)
○ Timing	75 (41.8%)
○ Frequency	38 (21.2%)
○ Dose	35 (19.6%)
○ Liberation form	13 (7.3%)
○ Active ingredient	3 (1.7%)
○ Omission errors	15 (8.4%)
Total administered doses during hospital stay	4515	P < 0.05*
Correctly administered with no need of intervention	1799 (39.8%)
Doses that would be erroneously administered without intervention	2716 (60.2%)

Note: Total number of prescriptions involving at least one antiparkinsonian drug: lines of antiparkinsonian treatment analyzed. Total number of prescription errors: quantification of errors identified after treatment reconciliation. Total administered doses during hospital stay: quantification of the number of antiparkinsonian drug administrations (ie: one patient prescribed levodopa/carbidopa 25/100 mg every 12 h and the correct prescription happened to be 25/100 mg at breakfast‐lunch‐dinner would count as 3 errors each day of stay). All the parameters are represented as absolute and relative frequencies.

^* P < 0.05 is considered statistically significant.

To assess the relationship between medication errors and the number of antiparkinsonian drugs prescribed, a Chi‐Square Test of Independence was performed. There was no significant relationship between the two variables, Χ ²(1, 171) = [0.387], P = [0.534] (Table 3). Additionally, a new Chi‐Square Test of Independence was performed to evaluate any potential link between medication errors and the type of antiparkinsonian treatment prescribed. As shown in Table 3, a statistically significant relationship between the number of medication errors and having levodopa prescribed was evidenced X ²(1, 211) = [6.045], P = [<0.05].

TABLE 3.

Chi‐Square test of independence analyzes.

Characteristic	Description	Medication error		P value
		Yes	No
Number of antiparkinsonian drugs prescribed	1 drug	78 (76.5%)	49 (71.0%)	0.534
	2 drugs or more	24 (23.5%)	20 (29.0%)
Type of antiparkinsonian drug prescribed	Levodopa	112 (90.3%)	67 (77.0%)	<0.05*
	Others	12 (9.7%)	20 (23.0%)

Note: Medication error: discrepancies between inpatient and outpatient treatment after Neurology/general practitioner medical record review and pharmaceutical interview. Association between medication errors and number/type of antiparkinsonian drug prescribed.

^* P < 0.05 is considered statistically significant.

During almost one‐third of the episodes (29.82%), a contraindicated drug was prescribed. After temporary suspension and pharmaceutical intervention, 96.08% of the contraindicated drugs were discontinued or switched to a therapeutic alternative that was not contraindicated (Table 4).

TABLE 4.

Registration of contraindicated drugs prescribed and clinical decision after pharmaceutical intervention: immediate contact with prescribers and therapeutic alternatives recommendation.

Episodes	171
Without contraindicated drug	120 (70.2%)
With contraindicated drug:	51 (29.8%)
○ Metoclopramide	35 (60.3%)
○ Haloperidol	14 (24.1%)
○ Trazodone	1 (1.7%)
○ Fentanyl	1 (1.7%)
Temporarily suspended drugs	51
Therapy discontinuation	45 (88.2%)
Therapy substitution	4 (7.8%)
Therapy maintenance	2 (3.9%)

Note: Episodes: number of hospital admissions evaluated. Temporarily suspended drug: interrupted treatments by clinical pharmacists as a safety measure that were discontinued/substituted/maintained by physicians after discussing the best therapy approach for each patient. All the parameters are represented as absolute and relative frequencies.

Discussion

The outcomes of the present study show how a pharmacist‐driven MedRec program for antiparkinsonian drugs results in a substantial identification and prevention of antiparkinsonian medication errors. These findings fall in line with recently published studies and help to answer some of the questions raised by other authors in this field.

This statement is supported by the following findings: (i) ≈ 60% of the prescriptions containing antiparkinsonian medication happened to have, at least, one medication error directly related to PD treatment; (ii) after identifying the error during hospital admission, a preventive correction was suggested to the physician by a clinical pharmacist, thus avoiding more than 2700 erroneous administrations throughout the year the study took place (≈60% of the total number of PD medication administrations); (iii) therapeutic schemes containing levodopa in any of its available presentations were related to a higher medication error frequency; (iv) in nearly 30% of the episodes a prescription containing a contraindicated drug was identified, of these, ≈96% were suspended or therapeutically interchanged after a pharmaceutical recommendation.

To date, PD clinical management still relies on pharmacotherapeutic treatment, therefore misprescription and delay or omission in the administration of these medications upon admission to the hospital can result in increased morbidity and mortality. ²⁵ , ²⁶ Additionally, patients suffering from PD are hospitalized more frequently, have longer admissions, and suffer more complications during hospitalization than age‐matched control groups. ²⁷ , ²⁸ For this reason, it seems cautious that therapeutic schemes containing antiparkinsonian drugs are checked to ensure correct treatment. However, high rates of inaccuracy when prescribing antiparkinsonian drugs in hospitalized patients have been previously reported (up to a 50% of the episodes). ²⁹ These results are coherent with the ones obtained in the present study, though discrepancies found here are higher (almost 60% of the episodes). This could be explained, at least in part, by the bigger sample size evaluated in this study and its prospective design, which could enhance inpatient follow‐up and reduce patients’ loss when compared to retrospective studies. It is also important to understand that a lack of human resources and increased healthcare services demand due to the pandemic situation could help to explain this noticeable number of errors.

Regarding the mean number of antiparkinsonian drugs prescribed and the reason for hospital admission, the results shown here are very similar to those reported by other authors. ²⁹ , ³⁰ In this work, no significant relationship between medication errors and the number of antiparkinsonian drugs prescribed was found after data analyzes. This result does not concur with observations reported by other authors recently. ²⁹ This could be a consequence of the more conservative statistical analysis performed in the present study since the episodes were directly divided into two groups (less and more than two antiparkinsonian drugs prescribed) rather than comparing means. Mean comparison could be interesting if the sample followed normality and the number of episodes with two or more antiparkinsonian drugs prescribed was bigger, yet it only represents 26% of the sample studied in the present work.

Although the mean number of antiparkinsonian drugs prescribed did not seem to play an evident role in the number of medication errors, the type of antiparkinsonian prescribed did. In episodes in which levodopa was prescribed, in any of its forms (associated either with carbidopa or benserazide), a higher number of commission errors was evidenced (≈90% of medication errors detected). This could be explained by multiple factors: (i) On the one hand, levodopa is the most prescribed antiparkinsonian drug for the management of PD, ³¹ , ³² , ³³ thus the odds of finding more errors in PD patients treated with this drug are higher. (ii) On the other hand, it is the most suitable antiparkinsonian drug to individualize according to a patient's clinical needs, due to the numerous liberation (immediate or extended) and dosage forms available. (iii) Additionally, due to this wide variety of options, elderly patients with polypharmacy could refer to a wrong dose when interviewed by the physician in the emergency room, especially those with cognitive impairment. Therefore, treatments containing the same drug may differ widely among patients, leading, ultimately, to an increase in the number of errors in the emergency room or acute hospitalization services. This observation is supported by the fact that the most common medication errors found in the present work are related to timing, frequency, or dose, but very rarely with the drug type.

Medication errors involving contraindicated drugs were frequent (≈30% of the episodes) yet not the common scenario. This could result from: (i) Highly skilled physicians attending medical wards for unplanned admissions via emergency room are aware of contraindicated drugs in PD patients. (ii) e‐prescription software employed for medical prescriptions has several warning messages regarding safety when co‐prescribing a contraindicated drug with antiparkinsonian treatments. Nevertheless, time‐dependent medical actions, patient complexity, limited staff, and the high ratio of comorbidities often require immediate actions to stabilize patients that end up involving pre‐defined prescription protocols or multiple prescribers that may precipitate a contraindicated drug prescription. However, once identified and suspended, the immediate communication between the clinical pharmacist prescribers and nursing staff prevented the administration of contraindicated drugs and allowed a rapid switch to therapeutic alternatives fit for PD patients.

Altogether, it seems reasonable to suggest that developing MedRec protocols in which clinical pharmacists play an active role could improve healthcare assistance quality and patients’ safety by preventing medication errors. This statement supports previous work in the field of medication safety when applying MedRec protocols ³⁴ and helps to answer previous research questions raised by authors in this field by showing how developing a MedRec protocol and involving clinical pharmacists in the therapeutic evaluation greatly diminishes medication errors. ²⁹ , ³⁵ , ³⁶ Moreover, it also enhances the knowledge available regarding PD pharmacotherapy management in hospitalized patients since, to the authors’ knowledge, this is the first 1 year prospective study analyzing and preventing antiparkinsonian medication errors.

To conclude, it is essential to be coordinated with the clinical team and the nursing staff, especially considering that MedRec should be performed within the first 24 h according to different good clinical practice guidelines. ³⁷ The authors understand not every hospital has clinical pharmacists available 24 h a day. Nonetheless, this work should be taken as a statement to comprehend the value of having a clinical pharmacist available on medical wards and night shifts.

Limitations

Although the study sample was representative of Dr. Balmis University Hospital, the findings here reported may not be as relevant as expected for monographic centers of different medical specialties that may have a low incidence of PD patient admission or other healthcare institutions due to the variability in hospital practice. Nevertheless, it is important to understand that tertiary hospitals with similar MedRec programs could identify and prevent a substantial number of medication errors. It could be believed that the effect of medication discrepancy on patient outcomes was not measured, yet this is coherent with the purpose of the study since medication errors were prevented at admission. Furthermore, it could also be believed that the authors did not measure any cost‐effective analysis, but again, medication errors were prevented, this was neither plausible nor practicable.

Patients who have not prescribed antiparkinsonian drugs despite having active antiparkinsonian treatment as outpatients could have not been included in the present study. This hypothetical situation, though rare, prevents the authors of the present work to claim that no patient was lost during the study period.

Authors also understand that 24 h round wards by clinical pharmacists every day of the year are not a reality in many hospitals. This service was already stablished in Hospital Universitario Dr. Balmis de Alicante prior to this project, which has facilitated the prospective 24 h/7 days design of this MedRec intervention. Moreover, countries or institutions that lack electronic prescription software may not be able to hire clinical pharmacists to perform 24 h shifts due to lack of resources.

Finally, it would have been of great interest to have a control group. Nevertheless, since the focus of the program is medication error prevention it did not seem ethical to have a control group, though the authors are aware this would have augmented the reach/impact of the study.

Conclusions

The implementation of a MedRec program could benefit any patient with a PD diagnosis admitted to a hospital since it helps to reduce drug discrepancies and, therefore, medication errors, which have a meaningful negative impact on the clinical management of PD patients. This is of great importance, especially considering that more than half of the antiparkinsonian prescriptions evaluated in this study contained, at least, one error.

Incorporating clinical pharmacists into the multidisciplinary team during medical wards and taking PD clinical records at admission can prevent not only medication errors but also avoid prescription of contraindicated drugs in PD patients that may end up provoking neuropsychiatric adverse effects on these patients.

These measures followed no other objective but to improve drug safety and the standard of care by solidifying patient‐centered interventions. For this reason, this antiparkinsonian drug reconciliation program has been now established as part of the daily clinical practice routine of the authors’ hospital.

Author Roles

(1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing of the first draft, B. Review and Critique.

V‐M.A.: 1A, 1B, 1C, 2A, 2B, 2C, 3A

R‐L.A.: 1B, 1C, 2B, 2C, 3ª

L‐N.J.: 1B, 1C, 3B.

C‐G.E.: 2C, 3B.

S. G.: 1A, 1B, 2C, 3B.

Disclosures

Ethical Compliance Statement: Ethics approval was required for this study. To this purpose, the Ethics Committee of Hospital General Universitario Dr. Balmis de Alicante r(Comité Ético de la Investigación con Medicamentos del Departamento de Salud de Alicante‐Hospital General, study reference: PI2022‐072) according to the STROBE checklist. Authors confirm that they have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Informed consent was waived from the present study since the research presented no more than minimal risk of harm to subjects and involved no procedures for which written consent is normally required outside of the research context. Moreover, this decision did not adversely affect the rights and welfare of the patients.

Funding Sources and Conflicts of Interest: No public or private funding were used for the development of the present study. None of the authors has conflicts of interest directly relevant to this study.

Financial Disclosures for the Previous 12 months: The authors declare that there are no additional disclosures to report.

Supporting information

TABLE S1. Dosage and pharmaceutical forms of antiparkinsonian drugs reconciled in this study.