A study that showed how to reduce medication errors common in hospital discharge summaries has been recognised as the best research article published in the Medical Journal of Australia during 2017.
The trial at Melbourne’s Alfred Hospital compared standard medication discharge summaries with those completed by pharmacists in more than 800 general medical patients.
The patient cohort covered a wide variety of illnesses, with about 7% of patients having a history of blood cancers and 20% having a history of metastatic cancer.
The main outcome measures were rates of medication errors, including omitted drugs, incorrect doses or dose frequency, incorrect or unnecessary drugs, or an incorrect route of administration, as identified by an independent assessor.
The study found the error rate in standard discharge summaries was 61.5% compared to just 15% in those prepared by a pharmacist.
“The absolute risk reduction was 46.5% (95% confidence interval [CI], 40.7-52.3%), yielding an NNT of 2.2 (95% CI, 1.9-2.5) to prevent one discharge summary containing at least one medication error,” the study said.
“The absolute risk reduction for a discharge summary containing a high or extreme risk error was 9.6% (95% CI, 6.4-12.8%), with an NNT of 10.4 (95% CI, 7.8-15.5).”
In the standard medical discharge summary group, 12.5% of summaries had two medication errors, 9.3% had three errors and 4.9% had four errors. The corresponding rates of errors in the intervention group were 3.2%, 0.2 % and 0.2%.
The most commonly identified errors were omitted drugs and incorrect dosing frequencies.
“The results of our study indicate that pharmacist input into the discharge plan should be more widely adopted. However, to be maximally effective, this requires integrating clinical pharmacists into the team structure of all medical units, and this is not currently standard in all Australian hospitals.”
“This model has the ability to reduce iatrogenic morbidity, as pharmacists can focus on medication reconciliation throughout a patient’s hospital stay with greater attention and accuracy than other medical staff members.”
“The process of pharmacists completing the medication plan in the electronic medical discharge summary has now been implemented as routine care across the majority of clinical units in the Alfred Hospital,” they said.