The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure.

Pharm World Sci. 2010 Dec;32(6):759-66

Authors: Eggink RN, Lenderink AW, Widdershoven JW, van den Bemt PM

Abstract
OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.
SETTING: A general teaching hospital in Tilburg, the Netherlands.
METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.
MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.
RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)).
CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.

PMID: 20809276 [PubMed - indexed for MEDLINE]

Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacists' intervention study.

Pharm World Sci. 2010 Oct;32(5):594-600

Authors: Khalili H, Dashti-Khavidaki S, Talasaz AH, Mahmoudi L, Eslami K, Tabeefar H

Venous thromboembolism is a major cause of mortality and morbidity in hospitalized patients. To evaluate physicians' approach to patients' thrombosis risk assessment and practice of thromboembolism prophylaxis in a teaching hospital, we designed an interventional prospective study.

PMID: 20623385 [PubMed - indexed for MEDLINE]

Related Articles

Prescribing errors during hospital inpatient care: factors influencing identification by pharmacists.

Pharm World Sci. 2009 Dec;31(6):682-8

Authors: Tully MP, Buchan IE

OBJECTIVE: To investigate the prevalence of prescribing errors identified by pharmacists in hospital inpatients and the factors influencing error identification rates by pharmacists throughout hospital admission. SETTING: 880-bed university teaching hospital in North-west England. METHODS: Data about prescribing errors identified by pharmacists (median: 9 (range 4-17) collecting data per day) when conducting routine work were prospectively recorded on 38 randomly selected days over 18 months. MAIN OUTCOME MEASURES: Proportion of new medication orders in which an error was identified; predictors of error identification rate, adjusted for workload and seniority of pharmacist, day of week, type of ward or stage of patient admission. RESULTS: 33,012 new medication orders were reviewed for 5,199 patients; 3,455 errors (in 10.5% of orders) were identified for 2,040 patients (39.2%; median 1, range 1-12). Most were problem orders (1,456, 42.1%) or potentially significant errors (1,748, 50.6%); 197 (5.7%) were potentially serious; 1.6% (n = 54) were potentially severe or fatal. Errors were 41% (CI: 28-56%) more likely to be identified at patient's admission than at other times, independent of confounders. Workload was the strongest predictor of error identification rates, with 40% (33-46%) less errors identified on the busiest days than at other times. Errors identified fell by 1.9% (1.5-2.3%) for every additional chart checked, independent of confounders. CONCLUSIONS: Pharmacists routinely identify errors but increasing workload may reduce identification rates. Where resources are limited, they may be better spent on identifying and addressing errors immediately after admission to hospital.

PMID: 19777366 [PubMed - indexed for MEDLINE]