Intervention study for the reduction of medication errors in elderly trauma patients

Abstract

Objective To analyse the impact of a set of measures designed by a working group to reduce medication errors (MEs) during the care transition of elderly trauma patients. The secondary objectives were to classify MEs and determine their location. Methods A 43‐month pre‐post prospective intervention study in a university hospital. A working group was set up in the Trauma Service. A pharmacist analysed the pharmacotherapeutic processes of all patients admitted to the Trauma Service in different healthcare locations from Monday to Friday. To detect MEs, the pharmacist reviewed this process at the following points: reconciliation, prescription, validation, dispensing, and administration records. Errors were classified according to the Ruiz Jarabo classification. Subsequently, the working group designed a set of measures that were implemented with the incorporation into the Acute Care Team and the intervention of a pharmacist. Data on MEs were again collected in a post‐implementation phase. Results There was a statistically significant reduction in MEs between phases. A total of 132 (31.3%) patients experienced MEs during the pre‐implementation phase and 75 (16.2%) during the post‐implementation phase. Among the measures implemented, the incorporation of the pharmacist to the team, as well as training sessions and design of medication protocols. During the pre‐implementation and post‐implementation phases, the ME rates were respectively as follows: reconciliation 31.6% (172) vs 14.8% (91); prescription 7.7% (79) vs 1.9% (23); dispensing 1% (10) vs 0.3% (3); administration record 0.4% (4) vs 0.0% (0); and validation 0.3% (3) vs 0.1% (1). There were significant reductions in reconciliation, prescription, and dispensing errors. The majority of the MEs occurred in the Trauma Service. Conclusions The implementation of specific measures by a Multidisciplinary Safety Group reduced MEs in the care transition of elderly trauma patients, particularly those MEs that occurred during reconciliation. The greatest reduction in MEs occurred in the Trauma Service.

Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis

“…These studies included 13 242 participants in total, with sample sizes varying considerably between 34 and 3594 participants 17 18. Ten studies were controlled pre–post interventional studies,19–28 nine were cohort studies,29–37 three were RCTs,38–40 three were controlled concurrent studies,18 41 42 three were pre–post interventional studies without controls,17 43 44 two were controlled sequential studies45 46 and one was a multicentre cross-sectional study 47. Seven of the studies exclusively limited the participants to older adults, aged 65 years and above 18 23 28 40 41 45 46…”

“…Types of interventions were clustered around eight activities (table 2 and online supplemental table 4). Pharmacists were predominantly involved in comprehensive medication reviews and order verification,19 20 22 23 28–33 37–42 44 45 identification of drug-related problems,19 32 40 41 43 46 47 structured patient and/or caregiver interviews,19 20 28 33 37–41 43–47 or medication prescribing/co-prescribing 18 20 21 23 29 35 36 46…”

“…Eighteen studies reported the interventions’ impact on medication errors17–20 22 25 28 29 33 35 38 40 41 43–47 and one study on adverse drug events (online supplemental table 4). 39 The errors in the intervention groups17 19 20 22 25 28 29 33 35 38 40 41 43–47 and control groups17 20 25 28 35 38 40 41 43–47 were prospectively identified in the majority of the studies. The errors were retrospectively identified from the medical records in one study for the intervention group18 and in five studies for the control groups 2 18 19 22 29 33.…”

“…Twelve studies reported statistically significant reductions in the number of errors per patient, compared with usual care (online supplemental table 5). 19 20 22 25 28 29 35 38 40 44–46 Pooling results from these studies indicated that pharmacist interventions were associated with an average error rate decrease of 0.33 per patient (95% CI −0.42 to −0.23, p<0.001) with relatively moderate heterogeneity (I 2 =51%, Q =22.5, p<0.001) (figure 2). A sensitivity analysis from 11 studies of good methodological quality yielded a similar result (mean difference: 0.31, 95% CI −0.41 to −0.21, p<0.001) 19 20 22 25 28 29 35 38 44–46.…”

“…19 20 22 25 28 29 35 38 40 44–46 Pooling results from these studies indicated that pharmacist interventions were associated with an average error rate decrease of 0.33 per patient (95% CI −0.42 to −0.23, p<0.001) with relatively moderate heterogeneity (I 2 =51%, Q =22.5, p<0.001) (figure 2). A sensitivity analysis from 11 studies of good methodological quality yielded a similar result (mean difference: 0.31, 95% CI −0.41 to −0.21, p<0.001) 19 20 22 25 28 29 35 38 44–46. There was moderate heterogeneity (I 2 =49.2%, Q =19.7, p = 0.033) (online supplemental figure 2).…”