Prescribing Errors in Iraqi Intensive and Cardiac Care Units: A Qualitative Investigations of Pharmacists' Perceptions, Determining Factors, Outcomes and Management Strategies.

Background: Prescribing errors are common in critical care units (CRCU) in developing countries. Little is known about the causes of these errors and the pharmacists' role in preventing and managing them in Iraqi hospitals. Objective: To get an in-depth understanding of the perspectives and practice of Iraqi pharmacists regarding prescribing errors in CRCU. Methods: A descriptive-qualitative study was conducted through face-to-face interviews with a consensus sample of pharmacists who have been working at the CRCU of Al-Husain Hospital in Al-Muthanna city/Iraq for at least 3 months. The interviews were conducted in Arabic using a validated semi-structured guide. The data were analyzed using thematic-analysis. Results: Sixteen pharmacists participated in the study, and three themes emerged. The first theme explored pharmacists' perceptions and experiences of prescribing errors in CRCU, with most pharmacists viewing these errors as common and potentially harmful to patients. The second theme focused on the types and determinants of prescribing errors, with drug-drug interactions, dosing errors, and irrational prescribing identified as the main types; pharmacists perceived that such errors are often physician-related, stemming from negligence and limited competence, and institution-related, due to patient workload and medication shortages. The third theme addressed the detection, prevention, and management of prescribing errors, with all pharmacists reporting the use of websites and general mobile applications for error detection and resolution. Most pharmacists indicated informing the responsible physician about the errors and leaving the correction decision to the physician's discretion. Additionally, most participants recommended enhancing physicians' skills through targeted training and developing specialized applications to support physicians in managing CRCU patients. Conclusion: Participating pharmacists considered prescribing errors, mainly dosing and drug-interactions, to be common in CRCU. They attributed these errors to physician negligence, limited competence, and workload. Pharmacists are using general applications for error detection. To reduce these errors, implementing targeted training and developing specialized applications are recommended.