Drug-related problems identified in post-discharge medication reviews for patients taking warfarin

Abstract

Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified; however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.

The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale

“…Incomplete or inaccurate medication reconciliation is widespread 45,142 and has been associated with adverse events, including drug interactions, 154 dangerous starting or cessation of medications for chronic conditions, 14,59,139 and avoidable hospital readmission. 68 Hospitalization puts patients at high risk for medication errors after discharge at least in part because medication records are often incomplete.…”

Should Hospital Pharmacists Provide Postdischarge Follow-Up Care to High-Risk Patients?

“…Although there has been significant variability in the pharmacist-driven interventions considered in the literature, there is a common trend that includes patient follow-up. 8,9 The REACT study, a Canadian randomized trial, investigated the benefits of a support program that included postdischarge follow-up by hospital-based pharmacists for patients with heart failure. The results of this study showed significant reductions in both emergency department visits for cardiovascular issues and hospitalization days.…”

Advocating for Patients and the Pharmacist's Role in Primary Care

“…For example, from a patient's perspective as a key stakeholder, HMRs improved their knowledge, skills and confidence in using medicines. [5][6][7] Patients also reported a high satisfaction rate with the service. [5][6][7] From a GP's perspective, these doctors alone have complete control over the HMR and RMMR program activities: pharmacists can only initiate an HMR or RMMR in response to a GP's referral.…”

“…[5][6][7] Patients also reported a high satisfaction rate with the service. [5][6][7] From a GP's perspective, these doctors alone have complete control over the HMR and RMMR program activities: pharmacists can only initiate an HMR or RMMR in response to a GP's referral. Given that these referrals have been made, 10 it would appear obvious that there is support from this sector.…”

“…There is substantial evidence that pharmacists improve medication use, enhance the safety and quality use of medicines and reduce unnecessary costs. [5][6][7] Since their inception, HMRs have required a GP referral to medication supply. 20 Advantages for the general practice pharmacist include an increased scope of practice, greater team care involvement, credibility and professional satisfaction.…”