Effect of Synapse Medicine Decision Support on Inpatient Pharmacist Efficacy and Efficiency

Not Applicable

Not yet recruiting

• Conditions: Liver Diseases; Gastrointestinal Diseases; Lung Diseases; Infections; Kidney Diseases; Heart Diseases
• Interventions: Other: Synapse medicine platform

• Registration Number: NCT05459155
• Lead Sponsor: Brigham and Women's Hospital

Brief Summary

Adverse drug events (ADE) are common and dangerous in the hospital and following discharge to the ambulatory setting. One cause of ADEs in both settings is medication regimen inappropriateness, including polypharmacy, drug-drug interactions, and medications that are inappropriate or inappropriately dosed given patients' age, renal, and hepatic function. Hospitalization provides a good opportunity to investigate medication appropriateness given new or worsening conditions and available expertise. Inpatient pharmacists are medication experts and often round with medical teams, but they may not always have all the information available at their fingertips to make optimal recommendations regarding medication appropriateness for each patient. Clinical decision support to pharmacists at the point of care has potential to improve the speed, quantity, and quality of medication recommendations to inpatient teams; any subsequent improvements to medication regimen appropriateness have the potential to reduce ADEs in the hospital and after discharge.

Specific Aims and Objectives

Aim 1: Implement real-time decision support regarding medication regimen appropriateness among pharmacists who round with inpatient medical teams.

Aim 2: Determine the effects of this intervention on the number of medication regimen recommendations and time spent per recommendation

Aim 3: Evaluate the use and usability of the decision support tool and develop strategies to mitigate barriers and promote facilitators of implementation using mixed methods implementation science approaches.

Detailed Description

This will be a prospective pre-post mixed methods hybrid type 2 effectiveness-implementation study. The study will take place at BWH and at Vanderbilt University Medical Center (VUMC). The direct subjects will be the inpatient pharmacists (4 at each site) who round with general medicine teams. Patients will be indirect subjects as pharmacists provide medication recommendations regarding these patients to the clinicians on each team with or without the Synapse software. We estimate this number of patients to be 3 new admitted patients per day per team x 56 days x 8 teams = 1344 patients (672 at MGB sites). Patients can be any patients admitted to these general medicine service teams at BWH and VUMC. The pharmacists are trained hospital pharmacists who round with general medicine service teams and approve inpatient medication orders. There are no local site restrictions. VUMC will cede IRB approval to the MGB IRB.

Study Timeline

• Study First Submitted: 2022-07-07
• Study First Submitted QC: 2022-07-12
• Study First Posted: 2022-07-14
• Status Verified: 2023-02
• Last Update Submitted: 2023-02-07
• Last Update Posted: 2023-02-08
• Study Start: 2023-03
• Primary Completion: 2023-09
• Study Completion: 2023-12

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 672

Inclusion Criteria

• any patient that the inpatient pharmacists care for on the inpatient medical team they round with

Exclusion Criteria

• N/A

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Pharmacist team post-intervention	Synapse medicine platform	The direct subjects will be the inpatient pharmacists who round with general medicine teams and approve inpatient medication orders. They will be given full access to the Synapse Medicine medication decision support platform.

Primary Outcome Measures

Name	Time	Method
Change in the number of medication recommendations made per patient	pre- and post-intervention periods: 4 weeks each per pharmacist	Change from pre- to post-intervention in the number of recommendations regarding medication changes made by pharmacists per patient

Secondary Outcome Measures

Name	Time	Method
Change in the time spent per recommendation per patient	pre- and post-intervention periods: 4 weeks each per pharmacist	Change from pre- to post-intervention in time spent per patient evaluating regimen appropriateness divided by the number of recommendations for that patient