Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy

NCT02026453 | Completed Results

• 3 other identifiers: KL2TR000122-00032874K23AG049181-01KL2TR000122
• Study Type: interventional
• Target: 306
• Locations: 0 countries
• Sites: N/A

Brief Summary

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.

Conditions

Adverse Drug Events

Keywords

Adverse drug events

Outcome Measures

Primary Outcomes (1)

• Mean Severity-weighted Admission Medication History (AMH) Error Score

  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.

  Attempted to obtain the day after admission

Secondary Outcomes (1)

• Mean Severity-Weighted Admission Medication Order (AMO) Error Score

  Attempted to obtain the day after admission

Study Arms (3)

Usual care

NO INTERVENTION

Physicians and nurses obtain admission medication history.

Pharmacist obtains home med hx

EXPERIMENTAL

Pharmacist obtains admission medication history, although usual care practices may also continue.

Other: Pharmacist obtains admission medication history

Pharm tech obtains home med hx

EXPERIMENTAL

Pharmacy technician obtains admission medication history, although usual care practices may also continue.

Other: Pharmacy technician obtains admission medication history

Interventions

Pharmacist obtains admission medication history OTHER

Pharmacist obtains home med hx

Pharmacy technician obtains admission medication history OTHER

Pharm tech obtains home med hx

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Accessed via EHR, were: \>=10 chronic prescription medications
• History of acute myocardial infarction or congestive heart failure
• Admission from skilled nursing facility
• History of transplant, or active anticoagulant, insulin, or narrow therapeutic index medications.

You may not qualify if:

• Admitted to pediatric, trauma or transplant services with pharmacists

Sponsors & Collaborators

• Cedars-Sinai Medical Center: lead
• National Institutes of Health (NIH): collaborator
• National Institute on Aging (NIA): collaborator

Related Publications (3)

• Pevnick JM, Palmer KA, Shane R, Wu CN, Bell DS, Diaz F, Cook-Wiens G, Jackevicius CA. Potential benefit of electronic pharmacy claims data to prevent medication history errors and resultant inpatient order errors. J Am Med Inform Assoc. 2016 Sep;23(5):942-50. doi: 10.1093/jamia/ocv171. Epub 2016 Jan 17.

  PMID: 26911817 RESULT

• Nguyen CB, Shane R, Bell DS, Cook-Wiens G, Pevnick JM. A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories. J Hosp Med. 2017 Mar;12(3):180-183. doi: 10.12788/jhm.2702.

  PMID: 28272596 RESULT

• Pevnick JM, Nguyen C, Jackevicius CA, Palmer KA, Shane R, Cook-Wiens G, Rogatko A, Bear M, Rosen O, Seki D, Doyle B, Desai A, Bell DS. Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial. BMJ Qual Saf. 2018 Jul;27(7):512-520. doi: 10.1136/bmjqs-2017-006761. Epub 2017 Oct 6.

  PMID: 28986515 RESULT

MeSH Terms

Conditions

Drug-Related Side Effects and Adverse Reactions

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders

Limitations and Caveats

* Powered on intermediate endpoints * Only used one site * Could not practicably mask arm allocation

Results Point of Contact

• Title: Dr. Joshua M. Pevnick
• Organization: Cedars-Sinai Medical Center

Joshua.Pevnick@cshs.org

310-423-6976

Study Officials

• Joshua M Pevnick, MD, MSHS

  Cedars-Sinai Health System

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: December 31, 2013
• First Posted: January 3, 2014
• Study Start: January 1, 2014
• Primary Completion: February 1, 2014
• Study Completion: October 1, 2016
• Last Updated: February 22, 2018
• Results First Posted: October 6, 2017

Record last verified: 2018-01

Data Sharing

• IPD Sharing: Will not share