Table of Contents
ROCKVILLE, Md. — Pharmacists discover and correct medication errors missed by other clinicians at hospital admission, according to a study by McLean Hospital, a leader in psychiatric care and affiliate of Harvard Medical School. The study, published this week in PLOS ONE (Public Library of Science, ONE), reveals that accurate medication history in combination with the expertise of pharmacists can help reduce medication errors during transitions of care.
Research shows that up to 70% of patients have errors on their medication list when admitted to a hospital, and up to 59% of these errors can cause harm. Medication reconciliation is a patient safety measure performed at transitions of care, such as hospital admission and discharge, to collect and confirm patients’ medication history to help avoid errors and adverse drug events (ADEs). Yet, the process is often time-consuming and prone to mistakes. The study’s authors maintain that a medication history solution that includes prescription records from a wide range of sources can give clinicians a more comprehensive medication history and better inform prescribing decisions.
“Having up-to-date, complete, accurate medication history data is a powerful tool to help reconcile a patient’s medication regimen,” said authors Victoria Vargas, Pharm.D., BCPS, Assistant Director of Pharmacy and Carol Aboud, Pharm.D., Chief Pharmacy Officer at McLean Hospital. They note that patients often have inaccurate accounts of their medication history and current medication list, resulting in clinicians calling pharmacies and caregivers or relying on patients to bring a bag of their medications to get a better sense of their medication regimen.
For the study, prescribers had access to MedHx by DrFirst for patients’ complete medication history to inform prescribing decisions. When the patient transitioned from the ED to inpatient care, pharmacy staff used MedHx to identify discrepancies between the prior-to-admission medications and inpatient medication orders. The study’s authors noted that using a medication history tool is particularly important with complex patients because increased complexity in a medication regimen typically leads to lower adherence, less accurate recollection of medications, and poorer overall health.
Using a novel method to categorize errors and predict the severity of ADEs, the researchers found 82 medication errors among 72 patients in the six months between August 1, 2019, and February 28, 2020.
The most frequent medication errors were categorized as:
Dose (33%)
Omission (26%)
Frequency (19%)
Formulation (12%)
Researchers also found that a significant majority of these errors (88%) may have harmed patients if they had not been corrected by pharmacists, underscoring the importance of pharmacists intervening in the medication reconciliation process. The study authors noted pharmacists can detect subtle medication discrepancies that other clinicians may overlook. “Pharmacists are more in tune to the miniscule differences between medication formulations and dosages, so the fact that 10/82 of these errors were formulation errors and 27/82 were dose-related errors indicates that having pharmacists review the medication history was impactful,” the authors reported.
Because omissions represent the second largest category of medication history errors (26%) which the study pharmacists corrected with information from MedHx, the authors conclude this underscores the importance of the medication history resource for TOC (transition of care) pharmacists. They state that otherwise closing gaps in patient medication lists “remains cumbersome and challenging due to long hours spent calling pharmacies, incomplete pharmacy claims data, and laborious interviews with patients and caregivers.”
Although McLean Hospital is a psychiatric treatment facility, the study found that most medication errors were not related to psychiatric medications, highlighting the importance of robust medication reconciliation in all care settings, including primary care, specialty, inpatient, and emergency visits. Researchers found errors in medications used to treat psychiatric conditions (21%), lung disorders (7%), high blood pressure (7%), as well as a range of other medications (65%).
The 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, along with members of DrFirst’s Applied Clinical Research team.
