Effectiveness of a pharmacist-led quality improvement program to reduce medication errors during hospital discharge

Evaluation of a Pharmacist-Driven Discharge Medication Reconciliation Service Pilot at a Children's Hospital

OBJECTIVE

The purpose of this study was to evaluate the feasibility of a pharmacist-driven discharge medication reconciliation (DMR) service at our children's hospital by completing a 2-week pilot on a general pediatrics unit.

METHODS

This was a prospective study and included patients discharged during pilot hours whose DMR was completed by the pharmacist. The primary outcome was evaluation of time required for a pharmacist to complete the DMR. Secondary outcomes included classification of pharmacist interventions made and their associated cost-avoidance, medication-related problems reported within 14 days of discharge, hospital readmission due to medication problems within 30 days of discharge, and medical resident satisfaction assessed via prepilot and postpilot surveys.

RESULTS

A total of 67 patients had their DMR completed by a pharmacist during the pilot. The pharmacist spent an average of 30 minutes completing each DMR, although this was variable, as evidenced by an SD of 36.4 minutes. Pharmacists documented 89 total interventions during the study period. The most common intervention types were therapeutic optimization (32.6%) and modification of directions (29.2%). Total estimated cost-avoidance during the study pilot was $84,048.01. For the pilot population, 1 medication-related problem was identified within 14 days of discharge. There were no medication-related readmissions identified. Medical residents reported increased confidence that the DMR was completed accurately and satisfaction with the DMR process during the pilot compared with before the pilot.

CONCLUSIONS

Implementing a pharmacist discharge medication service requires consideration of -pharmacist time and salary, which may be offset by cost-avoidance.

The Critical Role of Ward-Based and Satellite Pharmacists in Improving Pharmaceutical Care in Hospital

Objective

Medical errors are the third leading cause of death in the U. S., with medication mistakes being a common issue. Medication reconciliation (MR) involves comparing patients' orders with their existing medications to prevent errors. Pharmacists are ideally suited for MR tasks. Effective MR can reduce drug-related rehospitalizations. This study aimed to investigate medication errors among hospitalized patients and to evaluate the impact of ward-based and satellite pharmacists on the quality of drug administration services.

Methods

A descriptive cross-sectional study was conducted at Nikan General Hospitals in Tehran, Iran, over 6 months. We assessed the performance of ward-based and satellite pharmacists in various wards. All patient medication activities were meticulously monitored and recorded. Adjusted drug-related problem (DRP) codes were then used to identify medication errors and the corresponding interventions.

Findings

The study included 1682 patients, each experiencing at least one DRP. The data revealed a DRP prevalence of 6.44% (95% confidence interval: 6.15%-6.75%). A total of 2173 DRPs were identified, with 650 originating from intensive care units and the remaining 1523 from other wards. Notably, DRPs attributed to nurses (labeled as S2) constituted 18.36%, and those due to drug interactions (classified as D7) accounted for 13.48%. Following intervention, the most common pharmacist recommendations were initiating a medication (14.04%), discontinuing a medication (13.12%), changing a medication (11.38%), and reducing doses (11.09%).

Conclusion

Effective MR, supported by comprehensive training of medical staff such as physicians and nurses, can significantly reduce DRPs in hospitalized patients. Clinical pharmacists play a vital role in this context.

Perspectives of hospital pharmacists on quality improvement initiatives in patient care: A pilot study from one healthcare system in Canada

Background

Quality Improvement (QI) is any systematic process that seeks to improve patient safety or clinical effectiveness in healthcare. Although hospital pharmacists positively contribute to QI initiatives, there is no information available regarding Canadian hospital pharmacists' involvement and perspectives with QI.

Objectives

The primary objective of the study was to describe the QI experiences (including attitudes, enablers and barriers) of hospital pharmacists employed by the Lower Mainland Pharmacy Services (LMPS) in British Columbia.

Methods

This research study used an exploratory cross-sectional survey. A 30-item survey was developed to measure QI experiences of hospital pharmacists including prior QI experiences, their attitudes towards pursuing QI initiatives, and their perceived enablers and barriers to participating in QI initiatives in hospital settings.

Results

Forty-one pharmacists responded (response rate of 14%). Thirty-eight participants (93%) indicated that they were familiar with the concept of QI. All participants (100%) reported that it was important for pharmacists to be involved with QI despite the general lack of formal QI training among the participants, and 40 participants (98%) agreed that QI was necessary to advance patient care. Moreover, 21 participants (51%) showed interest in leading QI initiatives, while 29 (71%) would participate in QI initiatives. Participants identified several individual and organizational barriers that hindered hospital pharmacists from pursuing QI initiatives.

Conclusion

Our findings suggest that hospital pharmacists in LMPS would like to be actively involved with QI initiatives; however, individual and organizational barriers must be addressed in order to facilitate widespread adoption of QI practices.

Hospital staff perspectives: medication reconciliation responsibility and barriers at a tertiary teaching hospital in Jordan

Objectives

To explore hospital staff perspective on the responsibility and barriers to medicine reconciliation (MedRec) at a leading internationally renowned teaching hospital in Jordan.

Methods

A cross-sectional study using a self-completed questionnaire was conducted at Jordan University Hospital (JUH). The target sample was members of the health team caring for patients across various locations and settings. A convenient sample of physicians, pharmacists and nurses was targeted. Those were approached at various days, shifts, locations to scop various views and practices across JUH.

Key findings

Two hundred questionnaires were included in the analysis, of which 41 (20.5%) completed by physicians, 23 (11.5%) by pharmacists and 136 (68.0%) by nurses. For most steps, physicians were seen as the prim responsible health providers. Nurse perceived their role to come second. Whilst pharmacists perceived limited or no role of nurses in a number of steps. The main barriers reported are heavy workload 158 (79%), followed by lack of time 152 (76%) and communication between health care providers 140 (70%). Pharmacists highlighted lack of knowledge, clarity and training as leading barriers too.

Conclusions

Physicians are perceived as the leading provider responsible for all MedRec steps. MedRec as a process involve overlapping functions with various skill-based steps. A number of steps allocated potentially to nurses or pharmacists, particularly comparing different sources of information, constructing medication lists or written summaries upon discharge. Barriers to MedRec might be overcome by interdisciplinary discussions and mapping MedRec process clearly.

Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis

INTRODUCTION

Medication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits.

OBJECTIVE

To describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates.

METHODS

A systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465.

RESULTS

Twelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65).

CONCLUSION

Pharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

Improving patient safety through a pharmacist-led medication reconciliation programme in nursing homes for the elderly in Spain

Background Medication errors frequently occur during transitions of care and may have damaging consequences, especially amongst the elderly. Some studies show that quality improvement initiatives with a focus on medication reconciliation have resulted in better health outcomes and a reduced number of readmissions. Objective The primary objective of this study was to quantify and classify medication reconciliation errors detected by a pharmacist and taking place during transitions of care between nursing homes and the health system. Secondary objectives were to assess the relation between error frequency and polypharmacy or between error frequency and the transition type and to describe the medication concerned by this error. Setting Five elderly nursing homes of the health care area in Ferrol (Spain) between January 2013 and December 2017 Method A prospective descriptive study on medication discrepancies found during pharmacist's medication reconciliation. This was performed at first admission and after every transition of care upon the patient's return to the nursing home. Interventions were categorized according to the consensus terminology. Main outcome measure Number and type of medication errors, percentage of transitions of care and percentage of patients who suffered at least one reconciliation error were measured. Results At least one medication error was found in 16% of the 2123 studied care transitions, summing up 417 reconciliation errors in 273/981 patients (28%). Wrong dosing (48%) and medication omissions (31%) were the most frequently detected errors. High-risk medication was involved in 40% of the cases. A positive association between polypharmacy (≥ 5 chronic medications) and the frequency of reconciliation errors was found. On the other hand, different transition types did not show a difference in error frequency. Conclusion Reconciliation errors were found in almost 30% of our patients. Unlike other studies, visits to outpatient specialist clinics were included as another type of healthcare transition, encompassing an important percentage of reconciliation errors. The pharmacist helped to reduce these errors in a particularly fragile population such as institutionalized patients.