Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 306
- 主要终点
- Mean Severity-weighted Admission Medication History (AMH) Error Score
研究概览
简要总结
We tested two interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions target elderly and chronically ill patients prone to erroneous medication histories and resultant medication errors. For targeted patients, we tested the effect of using pharmacists and pharmacy technicians to obtain an initial medication history. This was studied using a randomized controlled trial of usual care (which involves nurses and physicians) vs usual care + pharmacists vs usual care + pharmacy technicians to obtain an admission medication history.
The overarching hypothesis was that by leveraging pharmacists and pharmacy technicians we can minimize admission medication history errors and related downstream events.
详细描述
Importance: 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.
Design: Three-arm randomized clinical trial. Setting: Large hospital with community and trainee physicians. Population: 306 enrolled patients with complex medical histories. Interventions: 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. This included common process variation occurring in: accuracy of pre-existing medication histories; nurses' ability to obtain AMHs at hospital admission; and admitting physicians' efforts to verify and order from prior AMHs.
Main Outcomes and Measures: 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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- 未提供
研究组 & 干预措施
Usual care
Physicians and nurses obtain admission medication history.
Pharmacist obtains home med hx
Pharmacist obtains admission medication history, although usual care practices may also continue.
干预措施: Pharmacist obtains admission medication history (Other)
Pharm tech obtains home med hx
Pharmacy technician obtains admission medication history, although usual care practices may also continue.
干预措施: Pharmacy technician obtains admission medication history (Other)
结局指标
主要结局
Mean Severity-weighted Admission Medication History (AMH) Error Score
时间窗: Attempted to obtain the day after admission
The primary outcome was severity-weighted mean admission medication history (AMH) error score which are weighted error counts. Significant, serious, and life-threatening errors count for 1, 4, and 9 points each, respectively. As such, higher scores indicate either more errors or errors of greater severity. The range includes integers starting with 0 (indicating zero errors) up to infinity. 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.
次要结局
- Mean Severity-Weighted Admission Medication Order (AMO) Error Score(Attempted to obtain the day after admission)
研究者
Josh Pevnick
Assistant Professor
Cedars-Sinai Medical Center