January 22, 2017
Having pharmacists complete medication management plans in the electronic medical discharge summary may reduce the number of medical errors in discharge summaries for general medical unit patients, according to a study published in the Medical Journal of Australia.
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Patients admitted to GMUs generally have complex histories, including multiple comorbidities and polypharmacy, both of which put them at a greater risk for drug-related problems associated with increased morbidity and mortality.
At Alfred Hospital in Melbourne, Australia, researchers noticed that medication errors in their own electronic discharge summaries were common. To address the problem, they created a model that allowed pharmacists to complete a form listing the patients’ medications, including any commenced during admission, withdrawn or changed, as well as any know adverse drug reactions.
In a study led by Erica Y Tong, Alfred Health, researchers evaluated patient discharge summaries written between March 16, 2015 and July 27, 2015, including only those who were discharged during pharmacist working hours. Those who were transferred to another hospital or died during inpatient admission were excluded.
A total of 832 patients were included in the final analysis and randomized to an intervention arm (n = 401) where they received medication management plans completed by a pharmacist; and a control arm (n = 431), where they received standard medical discharge summaries.
Overall, medication errors were identified in 61.5% of patients (n = 265) in the control compared with just 15% of patients (n = 60) in the intervention arm. The absolute risk reduction was 46.5% (95% CI, 40.7–52.3%); the number needed to treat (NNT) to avoid one error was 2.2 (95% CI, 1.9–2.5). Additionally, completing the plans for patients also reduced the likelihood of high or extreme risk errors to 9.6% 95% CI, 6.4–12.8%), with a NNT of 10.4 (95% CI, 7.8–15.5).
Thus, authors of the study concluded that pharmacists completing medication management plans in the electronic medical discharge summary significantly reduced the number of medication errors (including errors of high and extreme risk) in discharge summaries for general medical unit patients.
“The results of our study indicate that pharmacist input into the discharge plan should be more widely adopted,” the authors wrote. “However, to be maximally effective, this requires integrating clinical pharmacists into the team structure of all medical units, and this is not currently standard in all Australian hospitals.”—Sean McGuire.
Tong EY, Roman CP, Mitra B, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust. 2017;206(1):36-39.