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Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT02026453
First Posted: January 3, 2014
Last Update Posted: October 6, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborators:
National Institutes of Health (NIH)
National Institute on Aging (NIA)
Information provided by (Responsible Party):
Josh Pevnick, Cedars-Sinai Medical Center
  Purpose

We tested two interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions target elderly and chronically ill patients prone to erroneous medication histories and resultant medication errors. For targeted patients, we tested the effect of using pharmacists and pharmacy technicians to obtain an initial medication history. This was 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.

The overarching hypothesis was that by leveraging pharmacists and pharmacy technicians we can minimize admission medication history errors and related downstream events.


Condition Intervention
Adverse Drug Events Other: Pharmacist obtains admission medication history Other: Pharmacy technician obtains admission medication history

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy

Resource links provided by NLM:


Further study details as provided by Josh Pevnick, Cedars-Sinai Medical Center:

Primary Outcome Measures:
  • Mean Severity-weighted Admission Medication History (AMH) Error Score [ Time Frame: Attempted to obtain the day after admission ]
    The primary outcome was severity-weighted mean admission medication history (AMH) error score which are weighted error counts. Significant, serious, and life-threatening errors count for 1, 4, and 9 points each, respectively. As such, higher scores indicate either more errors or errors of greater severity. The range includes integers starting with 0 (indicating zero errors) up to infinity. To detect AMH errors, all patients received reference standard AMHs, which were compared with intervention and control group AMHs. AMH errors and resultant AMO errors were independently identified and rated by ≥2 investigators as significant, serious or life-threatening.


Secondary Outcome Measures:
  • Mean Severity-Weighted Admission Medication Order (AMO) Error Score [ Time Frame: Attempted to obtain the day after admission ]
    The severity-weighted admission medication order (AMO) error score are weighted error counts. Significant, serious, and life-threatening errors count for 1, 4, and 9 points each, respectively. Higher scores indicate either more errors or errors of greater severity. The range includes integers starting with 0 (indicating zero errors) up to infinity. For each AMH error identified, two physicians independently reviewed the relevant medications ordered at hospital admission in the context of the clinical chart. They classified each AMH error as either resulting in no AMO error, or an AMO error of significant, serious, or life-threatening severity. A third physician adjudicated disagreements. In cases where the admitting physician's knowledge of an AMH error was unclear and the orders clinically reasonable, we determined the AMH error did not lead to any AMO error. Because reviewers needed chart access to determine error severity, there was no practicable way to mask study arm.


Enrollment: 306
Study Start Date: January 2014
Study Completion Date: October 2016
Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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

Detailed Description:

Importance: Admission medication history (AMH) errors frequently cause medication order errors and patient harm.

Objective: To quantify AMH error reduction achieved when pharmacy staff obtain AMHs before admission medication orders (AMO) are placed.

Design: Three-arm randomized clinical trial. Setting: Large hospital with community and trainee physicians. Population: 306 enrolled patients with complex medical histories. Interventions: In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians obtained initial AMHs prior to admission. They obtained and reconciled medication information from multiple sources. All arms, including the control arm, received usual AMH care. This included common process variation occurring in: accuracy of pre-existing medication histories; nurses' ability to obtain AMHs at hospital admission; and admitting physicians' efforts to verify and order from prior AMHs.

Main Outcomes and Measures: The primary outcome was severity-weighted mean AMH error score. To detect AMH errors, all patients received reference standard AMHs, which were compared with intervention and control group AMHs. AMH errors and resultant AMO errors were independently identified and rated by ≥2 investigators as significant, serious or life-threatening. Each error was assigned 1, 4 or 9 points, respectively, to calculate severity-weighted AMH and AMO error scores for each patient.

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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.

Exclusion criteria:(supersedes inclusion criteria)

  • Admitted to pediatric, trauma or transplant services with pharmacists
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02026453


Sponsors and Collaborators
Cedars-Sinai Medical Center
National Institutes of Health (NIH)
National Institute on Aging (NIA)
Investigators
Principal Investigator: Joshua M Pevnick, MD, MSHS Cedars-Sinai Health System
  More Information

Publications:
Responsible Party: Josh Pevnick, Assistant Professor, Cedars-Sinai Medical Center
ClinicalTrials.gov Identifier: NCT02026453     History of Changes
Other Study ID Numbers: KL2TR000122-00032874
K23AG049181-01 ( U.S. NIH Grant/Contract )
KL2TR000122 ( U.S. NIH Grant/Contract )
First Submitted: December 31, 2013
First Posted: January 3, 2014
Results First Submitted: April 25, 2017
Results First Posted: October 6, 2017
Last Update Posted: October 6, 2017
Last Verified: October 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Josh Pevnick, Cedars-Sinai Medical Center:
Adverse drug events

Additional relevant MeSH terms:
Drug-Related Side Effects and Adverse Reactions
Chemically-Induced Disorders