Zheng Linda, Pon Tiffany, Bajorek Sarah, Le Kathie, Hluhanich Rebecca, Ren Yunyi, Wilson Machelle
University of California, Davis Health, Department of Pharmacy Services, Sacramento, California, USA.
University of California, San Francisco School of Pharmacy, San Francisco, California, USA.
J Am Coll Clin Pharm. 2024 Aug;7(8):787-794. doi: 10.1002/jac5.1980. Epub 2024 Jun 4.
Medication errors during hospital discharge can lead to adverse outcomes, medication-related readmissions, and increased health care costs. Pharmacist-led medication reconciliation at discharge is a potential solution to mitigate poor outcomes and optimize medication safety.
This study aimed to quantify medication errors identified at discharge and characterize the severity of patient harm prevented following pharmacist-led discharge medication reconciliation. Cost avoidance analysis was conducted to determine its associated financial impact.
Patients discharged from an adult internal medicine service during October 2022, were included in this one-month pilot prospective quality improvement study. Number of errors at discharge were documented, categorized by type, and adjudicated for severity of potential harm. Error severity was classified based on a modified National Coordinating Council for Medication Error Reporting and Prevention Medication Error Index. Cost avoidance was calculated based on whether each error would have resulted in additional medical encounters and length of stay.
Thirty-one patients were included in the analysis. Forty errors were identified by pharmacist-led medication reconciliation at discharge, with a mean of 1.3±1.9 errors per patient and 68% of patients having at least one error. The most common errors were duplication of therapy (25%) and medication access barriers at discharge (25%). The severity of errors included low (22.5%), serious (75%), and life-threatening harm (2.5%). Thirty-five percent of errors could have led to emergency visits or hospital readmissions. The estimated total cost for errors was $25,600. Pharmacist labor cost for reconciliation was $816. Cost avoidance was $24,784 from the 14 errors at discharge that could have resulted in additional emergency or inpatient visits.
Pharmacist-led medication reconciliation at discharge may prevent harm from reaching patients, decrease cost from unnecessary health encounters, and stop the error from continuing across transitions of care.
出院时的用药错误可能导致不良后果、与用药相关的再入院以及医疗保健成本增加。由药剂师主导的出院用药核对是减轻不良后果并优化用药安全的一种潜在解决方案。
本研究旨在量化出院时发现的用药错误，并描述在药剂师主导的出院用药核对后预防的患者伤害的严重程度。进行了成本避免分析以确定其相关的财务影响。
纳入2022年10月从成人内科服务科室出院的患者，进行为期一个月的前瞻性质量改进试点研究。记录出院时的错误数量，按类型分类，并判定潜在伤害的严重程度。根据改进的国家用药错误报告和预防协调委员会用药错误指数对错误严重程度进行分类。根据每个错误是否会导致额外的医疗就诊和住院时间来计算成本避免情况。
31名患者纳入分析。通过药剂师主导的出院用药核对发现了40个错误，平均每位患者1.3±1.9个错误，68%的患者至少有一个错误。最常见的错误是治疗重复（25%）和出院时的用药获取障碍（25%）。错误的严重程度包括低（22.5%）、严重（75%）和危及生命的伤害（2.5%）。35%的错误可能导致急诊就诊或再入院。错误的估计总成本为25,600美元。药剂师进行核对的人工成本为816美元。出院时14个可能导致额外急诊或住院就诊的错误所避免的成本为24,784美元。
由药剂师主导的出院用药核对可能防止患者受到伤害，降低不必要医疗就诊的成本，并阻止错误在医疗护理转换过程中持续存在。
