Effect of a Pharmacist Intervention on Clinically Important Medication Errors after Hospital Discharge: A Randomized Controlled Trial

• Authors: Sunil Kripalani, Vanderbilt University; Christianne L. Roumie, Vanderbilt University; Anuj K Dalal, Brigham and Women’s Hospital; Courtney Cawthon, Vanderbilt University; Alexandra Businger, Brigham and Women’s Hospital; Sveltlana Eden, Vanderbilt University; Ayumi Shintani, Vanderbilt University; Kelly Cunningham Sponsler, Vanderbilt University; L. Jeff Harris, Vanderbilt University; Cecelia Theobald, Vanderbilt University; Robert L. Huang, Vanderbilt University; Danielle Scheurer, Medical University of South Carolina; Susan Hunt, University of Washington Hospitalist Service; Terry A Jacobson, Emory University; Kimberly J Rask, Emory University; Viola Vaccarino, Emory University; Tejal K Gandhi, Brigham and Women’s Hospital; David W Bates, Brigham and Women’s Hospital; Mark V. Williams, Northwestern University Feinberg School of Medicine; Jeffrey Schnipper, Brigham and Women’s Hospital, Division of General Medicine and Primary Care
• Journal Title: Annals of Internal Medicine
• Volume: Volume 157, Number 1
• Publisher: American College of Physicians | 2012-07-03, Pages 1-U35
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.7326/0003-4819-157-1-201207030-00003
• Subjects: Health Sciences, Public Health; Biology, Biostatistics; Health Sciences, Pharmacy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; ADVERSE DRUG EVENTS; PATIENTS AFTER-DISCHARGE; HEALTH LITERACY; CARE; RECONCILIATION; PREVALENCE; INPATIENT; TOOL

Abstract

Background: Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs). Objective: 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. (ClinicalTrials.gov registration number: NCT00632021) 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 ADEs, as well as potential ADEs. Results: Among 851 participants, 432 (50.8%) had 1 or more clinically important medication errors; 22.9% of such errors were judged to be serious and 1.8% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential ADEs in 253 patients (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (unadjusted incidence rate ratio, 0.92 [95% CI, 0.77 to 1.10]) or ADEs (unadjusted incidence rate ratio, 1.09 [CI, 0.86 to 1.39] ). Patients in the intervention group tended to have fewer potential ADEs (unadjusted incidence rate ratio, 0.80 [CI, 0.61 to 1.04]). Limitation: The characteristics of the study hospitals and participants may limit generalizability. Conclusion: Clinically important medication errors were present among one half of patients after hospital discharge and were not significantly reduced by a health-literacy-sensitive, pharmacistdelivered intervention. Primary Funding Source: National Heart, Lung, and Blood Institute.