Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy
We will test two interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions will target elderly and chronically ill patients prone to erroneous medication histories and resultant medication errors. For targeted patients, we will test the effect of using pharmacists and pharmacy technicians to obtain an initial medication history. This will be studied using a randomized controlled trial of usual care (which involves nurses and physicians) vs usual care + pharmacists vs usual care + pharmacy technicians to obtain an admission medication history.
Our overarching hypothesis is that by leveraging pharmacists and pharmacy technicians we can minimize admission medication history errors and related downstream events.
Adverse Drug Events
Other: Pharmacist obtains admission medication history
Other: Pharmacy technician obtains admission medication history
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy|
- Medication History Errors, or Medication Order Errors [ Time Frame: within 48 hours of hospital admission ] [ Designated as safety issue: Yes ]The project was originally funded to measure the effect of these interventions on medication history errors. We are currently applying for more funding which would allow us to use the more meaningful, more downstream outcome of medication order errors, and this will become the primary outcome if funding for such is received.
|Study Start Date:||January 2014|
|Estimated Study Completion Date:||May 2015|
|Primary Completion Date:||February 2014 (Final data collection date for primary outcome measure)|
No Intervention: Usual care
Physicians and nurses obtain admission medication history.
Experimental: Pharmacist obtains home med hx
Pharmacist obtains admission medication history, although usual care practices may also continue.
|Other: Pharmacist obtains admission medication history|
Experimental: Pharm tech obtains home med hx
Pharmacy technician obtains admission medication history, although usual care practices may also continue.
|Other: Pharmacy technician obtains admission medication history|
At a large university-affiliated hospital, we conducted an IRB-approved, pragmatic randomized trial with informed consent waived.
Inclusion criteria, accessed via EHR, were: >=10 chronic prescription medications, history of acute myocardial infarction or congestive heart failure, admission from skilled nursing facility, history of transplant, or active anticoagulant, insulin, or narrow therapeutic index medications; excluded if admitted to pediatric or trauma services or transplant services with pharmacists.
All arms received usual care for patients admitted from the emergency department. This included RNs obtaining AMHs, and natural variation in checking, correcting and ordering from these AMHs by admitting providers. In the two intervention arms, PSPTs and pharmacists obtained initial AMHs. They contacted family, pharmacies,and/or providers to resolve questions. As per prior studies, we obtained reference standard AMHs from all patients (usually one day after admission), and initial AMH errors were independently rated by >=2 pharmacists as significant, serious, or life-threatening. These three error severities were assigned 1, 4, and 9 points, respectively. We calculated weighted error scores for each patient, and mean scores/pt for each arm. We had 80% power to identify arms with higher/lower scores of >=11.2/patient.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02026453
|Principal Investigator:||Joshua M Pevnick, MD, MSHS||Cedars-Sinai Health System|