The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study

BMC Health Services Research, Aug 2015

Background Potential adverse drug events (PADEs) are defined as being potentially harmful unintentional medication discrepancies. Discrepancies regarding medication history (MH) often occur when a patient is being admitted to a hospital’s emergency department (ED); they are clinically important and represent a significant source of data regarding adverse drug events occurring during emergency admission to hospital. This study sought to measure the impact of pharmacist-acquired MH during admission to an ED; it focused on whether a patient’s current home medication regimen being available for a doctor when consulting a patient in an ED would have reduced potential adverse drug events. Method A multicentre, double-blind, randomised, controlled parallel-group study was carried out at 3 large teaching hospitals in Bogota, Colombia. Two hundred and seventy patients who had been admitted to an ED were enrolled; each had a standardised, comprehensive MH interview, focusing on a patient’s current home medication regimen prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The main outcome dealt with comparing the intervention and control groups regarding the percentage of patients having at least 1 potential adverse drug event. Results There were 811 PADE (3.35 per patient), 528 (65 %) on the standard care arm and 283 (35 %) on an intervention arm. Most PADEs were judged to have had the potential to cause moderate discomfort (42.6 %), 33.4 % were deemed unlikely to have caused harm and 23.9 % were judged to have had the potential to cause clinical deterioration. Conclusion Many patients suffer potentially adverse drugs events during the transition of care from home to a hospital. Patient safety-focused medication reconciliation during admission to an ED involving a pharmacist and drawing up a history of complete medication could contribute towards reducing the risk of PADES occurring and improve follow-up of patients’ medication-based therapy. Trial registration 28/10/2012, ISRCTN63455839.

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The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study

Becerra-Camargo et al. BMC Health Services Research The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study Jesus Becerra-Camargo 1 Fernando Martínez-Martínez 0 Emilio García-Jiménez 0 0 Pharmacy Department, Universidad de Granada, Granada University's Pharmaceutical Care Research Institute , Paseo Cartuja, S/N, 18071 Granada , Spain 1 Universidad Nacional de Colombia , Ciudad Universitaria Edificio 450 Oficina 204, Bogota 111321Cundinamarca , Colombia Background: Potential adverse drug events (PADEs) are defined as being potentially harmful unintentional medication discrepancies. Discrepancies regarding medication history (MH) often occur when a patient is being admitted to a hospital's emergency department (ED); they are clinically important and represent a significant source of data regarding adverse drug events occurring during emergency admission to hospital. This study sought to measure the impact of pharmacist-acquired MH during admission to an ED; it focused on whether a patient's current home medication regimen being available for a doctor when consulting a patient in an ED would have reduced potential adverse drug events. Method: A multicentre, double-blind, randomised, controlled parallel-group study was carried out at 3 large teaching hospitals in Bogota, Colombia. Two hundred and seventy patients who had been admitted to an ED were enrolled; each had a standardised, comprehensive MH interview, focusing on a patient's current home medication regimen prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The main outcome dealt with comparing the intervention and control groups regarding the percentage of patients having at least 1 potential adverse drug event. Results: There were 811 PADE (3.35 per patient), 528 (65 %) on the standard care arm and 283 (35 %) on an intervention arm. Most PADEs were judged to have had the potential to cause moderate discomfort (42.6 %), 33.4 % were deemed unlikely to have caused harm and 23.9 % were judged to have had the potential to cause clinical deterioration. Conclusion: Many patients suffer potentially adverse drugs events during the transition of care from home to a hospital. Patient safety-focused medication reconciliation during admission to an ED involving a pharmacist and drawing up a history of complete medication could contribute towards reducing the risk of PADES occurring and improve follow-up of patients' medication-based therapy. - Background Potential adverse drug events (PADE) are defined as being potentially harmful, unintentional medication discrepancies [1]. It has been estimated that such events account for 17 million emergency department (ED) visits and 8.7 million hospital admissions annually in the United States [2, 3]. They are clinically important and represent a significant source of PADE occurring during emergency admission to hospital. Adverse drug-related events have recently been evaluated in ED care settings; it has been estimated that 12 %–14.2 % of hospital admissions are drug-related [4]. At least 1 medication is omitted in more than 57 % of patients admitted to an ED [5, 6]. Involving a pharmacist-obtained MH has been associated with a 43 % to 84 % relative risk reduction [7–10]. Unfortunately, the effect on PADEs on a pharmacistacquired medication history in an ED has not reflected in most studies as these have been retrospective or have analysed administrative data. Retrospective studies may underestimate the incidence of drug-related visits because information may be missing or has been inaccurately documented because patients seen in the ED for an adverse drug-related event are typically not admitted [11]. Studies performed to date have used different concepts regarding PADE, thereby limiting comparative evaluation and generalizability [12]. Despite the burden of drug-related morbidity and mortality, prospective research assessing the potential clinical importance of such discrepancies and/or the impact on PADEs of an MH acquired by a pharmacist in an ED has been limited. An attempt was made to overcome some research limitations in this area by using a prospective design aimed at determining whether PADE could become reduced by a pharmacist-acquired MH in an ED which focused on a patient’s current home medication regimen and which was available for a doctor when consulting a patient in an ED. Methods Study design, setting and participants A multicentre, double-blind, randomised, controlled parallel-group trial study was carried out from October 26th to November 30th 2012 at 3 large teaching hospitals in Bogota, Colombia; Fundacion Cardio Infantil, San Carlos teaching hospital and Samaritana teaching hospital. Each participant gave their written informed consent and the study protocol was (...truncated)


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Jesus Becerra-Camargo, Fernando Martínez-Martínez, Emilio García-Jiménez. The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study, BMC Health Services Research, 2015, pp. 337, 15, DOI: 10.1186/s12913-015-0990-1