Impact of a Pharmacist-Facilitated Hospital Discharge Program

Walker, Paul C.; Bernstein, Steven J.; Jones, Jasmine; Piersma, John; Kim, Hae Won; Regal, Randolph E.; Kuhn, Latoya; Flanders, Scott A.

doi:10.1001/archinternmed.2009.398

Cited by 207 publications

(265 citation statements)

References 21 publications

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“…To avoid medication errors at discharge and potential harm thereafter, care transitions interventions have given special attention to medication reconciliation 30,31 , particularly for older adults and those with caregivers. 32,33 To be most effective these efforts must begin at hospital admission, when medication histories are taken.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

et al. 2012

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BACKGROUND:Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge. OBJECTIVE: To identify patient-and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list. DESIGN, PARTICIPANTS: We conducted a crosssectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacistassisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study. MAIN MEASURES:Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors. KEY RESULTS: On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR=1.46; 95% CI, 1.00-2.12) and number of pre-admission medications (IRR=1.17; 95% CI, 1.10-1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR=0.54; 95% CI, 0.30-0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR=1.31; 95% CI, 1.19-1.45) and number of medications changed prior to discharge (IRR=1.06; 95% CI, 1.01-1.11). CONCLUSIONS: Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.

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Section: Discussionmentioning

confidence: 99%

“…20 Scores range from 0-36 and were categorized as adequate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), marginal (17)(18)(19)(20)(21)(22), or inadequate health literacy (0-16). We treated health literacy as a dichotomous variable in our analyses (inadequate/ marginal vs. adequate).…”

Section: Patient-related Measuresmentioning

confidence: 99%

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

et al. 2012

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“…[1][2][3][4][5] Discharge-related medication discrepancies increase health care resource utilization, including rehospitalization and emergency department (ED) visits. 2,3,6 Medication discrepancies cause discharge-related adverse drug events, which occur in 12% to 17% of patients, and the incidence increases when 8 or more medications are prescribed. 1,3,4,[7][8][9] The risk of having an adverse drug event is greatest during the first 7 to 10 days after discharge, which is a particular concern for primary care providers (PCPs) who may not be able to offer patients appointments within this time frame.…”

Section: Introductionmentioning

confidence: 99%

Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions

Hawes

Maxwell

White

et al. 2013

J Prim Care Community Health

156

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Purpose: Medication errors related to hospital discharge result in rehospitalization and emergency department (ED) visits, yet no systematic approach has been implemented nationally to decrease these medication errors. Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits. Methods: This prospective, randomized, open-label, pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies. Results: Of the 61 subjects included in the study, 33 (54%) had medication discrepancies identified at discharge. Fifty percent of medication discrepancies were resolved in subjects randomized to the pharmacist intervention arm compared with 9.5% in the usual care arm (P = .015). Patients randomized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm (0% vs 40.5%, P < .001). Conclusion: A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study.

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“…[4][5][6] The literature also shows that when pharmacists are involved in care transitions and take measures to decrease the prevalence of drug therapy problems, the quality of the discharge process is improved and rehospitalization rates and preventable adverse drug events are lowered. [4][5][6][7] This provides compelling evidence to support the need to identify and eliminate gaps in the care transitions process, especially drug therapy problems, in order to improve care transitions.…”

Section: Introductionmentioning

confidence: 99%

Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

Root¹,

Phelps²,

Brummel³

et al. 2012

Innov Pharm

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Impact of a Pharmacist-Facilitated Hospital Discharge Program

Abstract: While our intervention improved the quality of patient discharge by identifying and reconciling medication discrepancies at discharge, there was no effect on postdischarge health care resource utilization.

Cited by 207 publications

References 21 publications

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions

Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

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