Background Admission medication history (AMH) errors frequently cause medication order errors and patient harm.
Objective To quantify AMH error reduction achieved when pharmacy staff obtain AMHs before admission medication orders (AMO) are placed.
Methods This was a three-arm randomised controlled trial of 306 inpatients. In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians, obtained initial AMHs prior to admission. They obtained and reconciled medication information from multiple sources. All arms, including the control arm, received usual AMH care, which included variation in several common processes. The primary outcome was severity-weighted mean AMH error score. To detect AMH errors, all patients received reference standard AMHs, which were compared with intervention and control group AMHs. AMH errors and resultant AMO errors were independently identified and rated by ≥2 investigators as significant, serious or life threatening. Each error was assigned 1, 4 or 9 points, respectively, to calculate severity-weighted AMH and AMO error scores for each patient.
Results Patient characteristics were similar across arms (mean±SD age 72±16 years, number of medications 15±7). Analysis was limited to 278 patients (91%) with reference standard AMHs. Mean±SD AMH errors per patient in the usual care, pharmacist and technician arms were 8.0±5.6, 1.4±1.9 and 1.5±2.1, respectively (p<0.0001). Mean±SD severity-weighted AMH error scores were 23.0±16.1, 4.1±6.8 and 4.1±7.0 per patient, respectively (p<0.0001). These AMH errors led to a mean±SD of 3.2±2.9, 0.6±1.1 and 0.6±1.1 AMO errors per patient, and mean severity-weighted AMO error scores of 6.9±7.2, 1.5±2.9 and 1.2±2.5 per patient, respectively (both p<0.0001).
Conclusions Pharmacists and technicians reduced AMH errors and resultant AMO errors by over 80%. Future research should examine other sites and patient-centred outcomes.
Trial registration number NCT02026453.
- healthcare quality improvement
- health services research
- human error
- medication reconciliation
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Contributors JP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: JP, CN, CJ, KP, RS, AR, MB, DB. Acquisition, analysis or interpretation of data: JP, CN, CJ, KP, RS, GCW, AR, MB, OR, DS, BD, AD, DB. Drafting of the manuscript: JP, CN, GCW. Critical revision of the manuscript for important intellectual content: JP, CN, CJ, KP, RS, GCW, AR, OR, BD, DB. Statistical analysis: JP, CJ, GCW, AR. Administrative, technical or material support: JP, CN, KP, RS, MB, OR, DS, DB. Study supervision: JP, CN, KP, RS, DB.
Funding Joshua Pevnick was supported by the National Institute On Aging and the National Center for Advancing Translational Science of the National Institutes of Health under awards K23AG049181 and UCLA CTSI KL2TR000122. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests JP currently receives funding from the American Society for Health-System Pharmacists Research and Education Foundation to design a toolkit for pharmacists to use in postdischarge medication management.
Ethics approval Cedars-Sinai Medical Center Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.