Friday, 16 July 2010: 8:50 AM
Learning Objective 1: Discuss an enhanced medication reconciliation protocol implemented by a nurse-pharmacist team to reduce preventable ADE s.
Learning Objective 2: Understand the methodology used to complete a cost-benefit analysis of the protocol
Purpose: In many academic medical centers, various members of the interdisciplinary team obtain medication histories from patients and document their findings on separate tools. This research study tested a nurse-pharmacist intervention to prevent adverse drug events (ADE) through an enhanced medication reconciliation protocol. A cost-benefit analysis was conducted to determine the cost of the intervention. Methods: The nurse-pharmacist team conducted medication reconciliation on admission and discharge at a 1,000 bed academic tertiary care hospital. Study team verified/improved “active” medication list used by the care team. The interview took an average of 10 minutes; accessing additional sources of information took an additional 29 minutes to complete the protocol. The pharmacist was a consultant to the nurses. Potential discrepancies between the home list and admission/discharge orders were discussed with the prescriber and counted as “unintended discrepancies” if the patient’s orders were changed . Results: A total of 563 medicine patients entered the study: 87 percent were emergency admissions, 69.5 percent were under 65 years old, and 65 percent were African-American. The average number of medications taken was 7.76 Mean ± 4.9 SD.Of the 563 patients, 226 (40%) experienced unintended discrepancies on admission or discharge. Of those, 162 patients had discrepancies rated as having the potential to cause harm determined by a team of physicians and pharmacists (intra-class correlation 0.58). Logistic regression was used to predict the occurrence of discrepancies, the number of medications was significantly associated with discrepancy.The average intervention cost per patient was $32 with a projected cost of $9300 per ADE prevented. The intervention would breakeven if one ADE were prevented in 290 patients.Conclusion: A nurse-led protocol to detect and correct unintended discrepancies improved patient safety and the appropriateness of care. Interdisciplinary team interventions to prevent ADEs can reduce health care costs.
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