Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention

Abstract

BackgroundWe previously reported reduction in the rate of hospitalisations with medication harm among older adults with our ‘Pharm2Pharm’ intervention, a pharmacist-led care transition and care coordination model focused on best practices in medication management. The objectives of the current study are to determine the extent to which medication harm among older inpatients is ‘community acquired’ versus ‘hospital acquired’ and to assess the effectiveness of the Pharm2Pharm model with each type.MethodsAfter a 3-year baseline, six non-federal general acute care hospitals with 50 or more beds in Hawaii implemented Pharm2Pharm sequentially. The other five such hospitals served as the comparison group. We measured frequencies and quarterly rates of admissions among those aged 65 and older with ‘community-acquired’ (International Classification of Diseases-coded as present on admission) and ‘hospital-acquired’ (coded as not present on admission) medication harm per 1000 admissions from 2010 to 2014.ResultsThere were 189 078 total admissions from 2010 through 2014, 7% of which had one or more medication harm codes. There were 16 225 medication harm codes, 70% of which were community-acquired, among these 13 795 admissions. The varied times when the intervention was implemented across hospitals were associated with a significant reduction in the rate of admissions with community-acquired medication harm compared with non-intervention hospitals (p=0.001), and specifically harm by anticoagulants (p<0.0001) and by medications in therapeutic use (p<0.001). The hospital-acquired medication harm rate did not change. The rate of admissions with community-acquired medication harm was reduced by 4.28 admissions per 1000 admissions per quarter in the Pharm2Pharm hospitals relative to the comparison hospitals.ConclusionThe Pharm2Pharm model is an effective way to address the growing problem of community-acquired medication harm among high-risk, chronically ill patients. This model demonstrates the importance of deploying specially trained pharmacists in the hospital and in the community to systematically identify and resolve drug therapy problems.

Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications

“…Finally, our study was limited to the immediate 45-day post-hospital discharge period, while ongoing efforts by community pharmacists working with patients up to a year postdischarge may be beneficial in reducing medication harm. 34,35…”

Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip

“…The intervention generated an estimated savings of $6.6 million per year in avoided hospitalisations compared with $1.8 million in annualised costs to deliver the intervention. With the study reported in this issue of BMJ Quality and Safety , the authors extend these results by delving more deeply into the findings, evaluating in what settings adverse drug events were reduced and which medications accounted for the greatest reduction 13. Overall, 70% of medication harms were present on admission (ie, presumably developed in the community), with the remaining 30% being hospital-acquired (ie, identified during the hospital stay but not recorded as present at the time of admission).…”

“…Into this breach step Pellegrin et al with the Pharm2Pharm intervention, outcomes of which are reported in this issue of BMJ Quality and Safety 13. In the Pharm2Pharm programme, hospital-based pharmacists identified inpatients at high risk of medication misadventures, using criteria such as use of multiple medications, presence of high-risk medications such as warfarin or glucose-lowering drugs and history of previous acute care use resulting from medication-related problems 14.…”

Clinician attitude towards safety in medication management: a participatory action research study in an emergency department

“…Medication management reflects a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care, 1 which has been evidenced as a strategy to address patient safety challenges related to medication errors. 2 This approach is essentially multidisciplinary and typically involves a range of healthcare clinicians including pharmacists, nurses and physicians. 3 Medication safety is the process and the product of medication management and relies heavily on a strong safety culture.…”