Trial Outcomes & Findings for Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy (NCT NCT02026453)

Results Overview

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.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

306 participants

Primary outcome timeframe

Attempted to obtain the day after admission

Results posted on

2018-02-22

Participant Flow

Eligible participants were medically complex patients admitted to Cedars-Sinai Medical Center, a large university-affiliated hospital, through the emergency department. Enrollment screening occurred Mondays through Thursdays from approximately 11 AM to 8 PM beginning 1/7/2014 through 2/14/2014.

Participant milestones

Participant milestones
Measure	Usual Care Physicians and nurses obtain admission medication history.	Pharmacist Obtains Home Med hx Pharmacist obtains admission medication history, although usual care practices may also continue. Pharmacist obtains admission medication history	Pharm Tech Obtains Home Med hx Pharmacy technician obtains admission medication history, although usual care practices may also continue. Pharmacy technician obtains admission medication history
Overall Study STARTED	101	103	102
Overall Study COMPLETED	95	94	89
Overall Study NOT COMPLETED	6	9	13

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Pharmacists and Pharmacy Technicians to Improve Admission Medication History Accuracy

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Usual Care n=101 Participants Physicians and nurses obtain admission medication history.	Pharmacist Obtains Home Med hx n=103 Participants Pharmacist obtains admission medication history, although usual care practices may also continue.	Pharm Tech Obtains Home Med hx n=102 Participants Pharmacy technician obtains admission medication history, although usual care practices may also continue.	Total n=306 Participants Total of all reporting groups
Age, Continuous	71 years STANDARD_DEVIATION 18 • n=5 Participants	72 years STANDARD_DEVIATION 16 • n=7 Participants	71 years STANDARD_DEVIATION 16 • n=5 Participants	72 years STANDARD_DEVIATION 12 • n=4 Participants
Sex: Female, Male Female	48 Participants n=5 Participants	54 Participants n=7 Participants	55 Participants n=5 Participants	157 Participants n=4 Participants
Sex: Female, Male Male	53 Participants n=5 Participants	49 Participants n=7 Participants	47 Participants n=5 Participants	149 Participants n=4 Participants

PRIMARY outcome

Timeframe: Attempted to obtain the day after admission

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.

Outcome measures

Outcome measures
Measure	Usual Care n=95 Participants Physicians and nurses obtain admission medication history.	Pharmacist Obtains Home Med hx n=94 Participants Pharmacist obtains admission medication history, although usual care practices may also continue. Pharmacist obtains admission medication history	Pharm Tech Obtains Home Med hx n=89 Participants Pharmacy technician obtains admission medication history, although usual care practices may also continue. Pharmacy technician obtains admission medication history
Mean Severity-weighted Admission Medication History (AMH) Error Score	23 Mean Severity-weighted AMH Error Score Interval 19.7 to 26.2	4.1 Mean Severity-weighted AMH Error Score Interval 2.7 to 5.5	4.1 Mean Severity-weighted AMH Error Score Interval 2.6 to 5.6

SECONDARY outcome

Timeframe: Attempted to obtain the day after admission

The severity-weighted admission medication order (AMO) error score are weighted error counts. Significant, serious, and life-threatening errors count for 1, 4, and 9 points each, respectively. Higher scores indicate either more errors or errors of greater severity. The range includes integers starting with 0 (indicating zero errors) up to infinity. For each AMH error identified, two physicians independently reviewed the relevant medications ordered at hospital admission in the context of the clinical chart. They classified each AMH error as either resulting in no AMO error, or an AMO error of significant, serious, or life-threatening severity. A third physician adjudicated disagreements. In cases where the admitting physician's knowledge of an AMH error was unclear and the orders clinically reasonable, we determined the AMH error did not lead to any AMO error. Because reviewers needed chart access to determine error severity, there was no practicable way to mask study arm.

Outcome measures

Outcome measures
Measure	Usual Care n=95 Participants Physicians and nurses obtain admission medication history.	Pharmacist Obtains Home Med hx n=94 Participants Pharmacist obtains admission medication history, although usual care practices may also continue. Pharmacist obtains admission medication history	Pharm Tech Obtains Home Med hx n=89 Participants Pharmacy technician obtains admission medication history, although usual care practices may also continue. Pharmacy technician obtains admission medication history
Mean Severity-Weighted Admission Medication Order (AMO) Error Score	6.9 Mean Severity-Weighted AMO Error Score Interval 5.5 to 8.4	1.5 Mean Severity-Weighted AMO Error Score Interval 0.089 to 2.1	1.2 Mean Severity-Weighted AMO Error Score Interval 0.067 to 1.7

Adverse Events

Usual Care

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Pharmacist Obtains Home Med hx

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Pharm Tech Obtains Home Med hx

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Joshua M. Pevnick

Cedars-Sinai Medical Center

Phone: 310-423-6976

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place