Effect of a Pharmacist Intervention on Clinically Important Medication Errors After Hospital Discharge

Abstract

Background Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events as well as medication discrepancies or non-adherence with high potential for future harm (potential adverse drug events). Objective The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study sought to determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge. Design Randomized controlled trial with concealed allocation and blinded outcome assessors. Setting Two tertiary care academic hospitals. Patients Adults hospitalized with acute coronary syndromes or acute decompensated heart failure. Intervention Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. Measurements The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable adverse drug events, as well as potential adverse drug events. Results Among 851 participants, 432 (50.8%) experienced 1 or more clinically important medication errors; 23% of such errors were judged to be serious, and 2% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential adverse drug events in 253 (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (IRR=0.92; 95% CI, 0.77 to 1.10) or adverse drug events (IRR=1.09; CI, 0.86 to 1.39). Intervention patients tended to have fewer potential adverse drug events (IRR=0.80; CI, 0.61 to 1.04). Limitations The characteristics of the study hospitals and participants may limit generalizability. Conclusions Clinically important medication errors were present among half of patients after hospital discharge and were not significantly reduced by a health-literacy sensitive, pharmacist-delivered intervention.

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study

“…[23][24][25] However, while the nurse-reviewers were not blinded to urban/ rural status, they used a structured interview guide and patient summary process. 15,16 Furthermore, physician-adjudicators were blinded to residence status, rigorously trained, and with co-adjudication by two physicians (and a third if necessary). Lastly, recall bias was addressed by corroborating all patient reports to the health record.…”

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“…Lastly, we utilized a standard approach to classify the type of AE. [2][3][4][5] We utilized the Naranjo algorithm, which is a validated scoring system for determining attribution of symptoms to medications, 18 previously modified by these investigators, 15,16 as a guide for determining adverse drug events (ADEs). If there was disagreement between the two reviewers regarding causality (AE or not), preventability, or ameliorability, they discussed the case and attempted to come to consensus.…”

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