Clinical Effects of a Pharmacist Intervention in Acute Wards - A Randomized Controlled Trial

Autor: Mette Rasmussen, Trine Rune Høgh Nielsen, Stig Andersen, Per Hartvig Honoré
Rok vydání: 2017
Předmět:
Male
Medication Systems
Hospital
medicine.medical_specialty
Pediatrics
Time Factors
Drug-Related Side Effects and Adverse Reactions
Medication history
Medication Therapy Management
Denmark
030204 cardiovascular system & hematology
Pharmacists
Toxicology
law.invention
Electronic Prescribing
03 medical and health sciences
Medication Reconciliation
Patient Admission
0302 clinical medicine
Randomized controlled trial
Risk Factors
law
Intervention (counseling)
Medication therapy management
medicine
Humans
Medication Errors
Drug Interactions
Prospective Studies
030212 general & internal medicine
Medical prescription
Prospective cohort study
Aged
Retrospective Studies
Aged
80 and over
Pharmacology
Inpatients
business.industry
Retrospective cohort study
General Medicine
Odds ratio
Length of Stay
Middle Aged
Treatment Outcome
Emergency medicine
Polypharmacy
Female
Patient Safety
Pharmacy Service
Hospital
business
Zdroj: Basic & Clinical Pharmacology & Toxicology. 121:325-333
ISSN: 1742-7835
Popis: The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16 months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p = 0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p = 0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p = 0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm.
Databáze: OpenAIRE
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