Postdischarge med errors common in heart patients despite pharmacist intervention

Postdischarge medication errors were common in patients with acute coronary syndromes (ACS) or acute decompensated heart failure even with a pharmacist-led intervention, a new study has found.

Researchers performed a randomized, controlled trial at two tertiary care academic hospitals to determine whether a tailored, pharmacist-led intervention would affect clinically important medication errors after hospital discharge among patients with ACS or acute decompensated heart failure. The intervention consisted of pharmacist-assisted medication reconciliation, inpatient counseling by a pharmacist, low-literacy adherence aids, and individualized postdischarge follow-up by telephone.

The number of clinically important medication errors per patient in the first 30 days after discharge, including preventable or ameliorable adverse drug events (ADEs) and potential ADEs caused by discrepancies or lack of adherence, was the study's primary outcome. Preventable or ameliorable ADEs, potential ADEs caused by discrepancies or lack of adherence, and preventable or ameliorable ADEs considered to be serious, life-threatening or fatal were the secondary outcomes. The study appeared in the July 3 Annals of Internal Medicine.

Four hundred thirty patients were assigned to the intervention group, and 432 were assigned to usual care, defined as medication reconciliation and discharge counseling by the treating physicians and nurses. Seven patients in the intervention group and four in the usual care group died in the hospital or withdrew their consent, meaning 851 patients were included in the intention-to-treat analysis. The patients' mean age was 60 years, and 41.4% were women. Health literacy was inadequate in approximately 10% and marginal in 8.7%; in addition, 11.5% had some cognitive impairment. Sixty-one percent had only ACS, 31% had only acute heart failure, and 7% had both.

Overall, 432 patients (50.8%) had at least one clinically important medication error, 22.9% of which were considered serious and 1.8% of which were considered life-threatening. Two hundred fifty-eight patients (30.3%) had ADEs and 253 (29.7%) had potential ADEs. The per-patient numbers of clinically important medication errors and ADEs were not significantly affected by the intervention (unadjusted incidence rate ratios, 0.92 [95% CI, 0.77 to 1.10] and 1.09 [95% CI, 0.86 to 1.39], respectively). Potential ADEs tended to be less common in the intervention group (unadjusted incidence rate ratio, 0.80 [95% CI, 0.61 to 1.04]).

The authors acknowledged that their study involved patients from only two hospitals and that the results therefore may not be generalizable, among other limitations. However, they concluded that clinically important medication errors are common within 30 days after hospitalization for a cardiac condition, and that the pharmacist-led intervention they tested did not improve overall medication safety. “Reducing ADEs and potential ADEs in the postdischarge period is becoming more critical as hospitals have increasing financial penalties tied to rehospitalization rates,” they wrote. “Further work is needed to develop and test interventions in this setting, including strategies for higher-risk populations, as well as additional methods, such as postdischarge medication reconciliation …or closer postdischarge surveillance.”