Weston Blakeslee, Ph.D.
Are Pharmacists a Remedy for Medication Errors at Transitions of Care? A New Study Says Yes.
The last thing any clinician wants is for a patient to have a negative effect from a drug interaction. Yet medication errors that cause adverse drug events (ADEs) continue to happen, especially if providers treat patients for a specific condition without knowledge of other medications those patients may be taking for unrelated conditions.
To treat anxiety, for example, a patient may be prescribed the beta-blocker propranolol by a psychiatrist. The same patient could then be prescribed another beta-blocker, metoprolol, by a cardiologist to treat high blood pressure. Taking multiple beta-blockers at the same time can cause dizziness, fatigue, and unsafe drops in blood pressure (hypotension). Unfortunately, adverse drug events like these happen when patients are prescribed medications by different providers, such as in the outpatient setting or during transitions of care, if medication lists aren’t reconciled.
When the Right People Have the Right Information, Medication Errors Are History
Clinicians at McLean Hospital are experts in psychiatric care. Their patients commonly see multiple specialists for various co-morbid conditions, such as hypertension, diabetes, and cardiovascular disease.
Unfortunately, patients are often poor stewards of their medication lists, making medication reconciliation vital at every care setting.
When patients are admitted for inpatient care, reconciling their medications often falls on hospitalists or nurses, who might not always be in tune with medications that may have formulation errors, dosage errors, or omissions. Pharmacists are experts at recognizing when an existing drug might interact with a new one. New research shows that having a pharmacist in the transition-of-care (TOC) workflow can fix many of the medication problems that plague the patient experience.
A newly published joint study, “Use of complete medication history to identify and correct transitions-of-care medication errors at psychiatric hospital admission,” was authored by clinicians and pharmacists from McLean Hospital with members of DrFirst’s Applied Clinical Research team. Among other findings, the study helps quantify the impact of TOC pharmacists on catching medication errors, which previously has been difficult to measure.
The study establishes a method for categorizing the scale and severity of medication errors corrected by pharmacy staff during medication reconciliation at admission using complete medication history data. It also establishes a rating scale that can help generate reports to quantify the impact of TOC pharmacy staff for a health system’s quality leaders.
Solid Clinical Decisions Require Accurate Medication History Data
In addition to having the right staff involved, it’s also important to have the right health IT tools to improve clinical productivity and accuracy. A complete medication history data source in the clinical workflow can quantitatively improve standards of medication reconciliation.
The study highlighted 82 examples of how medication errors were identified and corrected by pharmacy staff, with 74 of those errors (88%) having the potential to cause lasting harm after discharge had they not been corrected. Many errors were on the existing medication list, rather than errors that happened during transition from the ED to inpatient stay to discharge. If a doctor or nurse looks only at psychiatric visits, they may miss that an existing anticoagulant can interact with a medication prescribed for schizophrenia, for example.
This new study provides a strong example of how excellence in medication reconciliation practices, pharmacist expertise, and up-to-date medication history data can help hospitals and health systems avoid errors such as duplicative medications from different settings of care, and drug-drug interactions from the hospital to the home.