The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure

Rixt Nynke Eggink; Albert W Lenderink; Jos W M G Widdershoven; Patricia M L A van den Bemt

doi:10.1007/s11096-010-9433-6

The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure

Rixt Nynke Eggink
, Albert W Lenderink
, Jos W M G Widdershoven
, Patricia M L A van den Bemt

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.

SETTING: A general teaching hospital in Tilburg, the Netherlands.

METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.

MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.

RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)).

CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.

Original language	English
Pages (from-to)	759-66
Number of pages	8
Journal	Pharmacy World & Science
Volume	32
Issue number	6
DOIs	https://doi.org/10.1007/s11096-010-9433-6
Publication status	Published - Dec 2010
Externally published	Yes

Keywords

Aged
Aged, 80 and over
Female
Heart Failure/drug therapy
Humans
Male
Medication Errors/prevention & control
Middle Aged
Netherlands/epidemiology
Patient Discharge/standards
Pharmacists/standards
Pharmacy Service, Hospital/methods
Professional Role
Risk Factors

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10.1007/s11096-010-9433-6

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@article{73dca062ed804dbd85e8b2afb2463f43,

title = "The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure",

abstract = "OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.SETTING: A general teaching hospital in Tilburg, the Netherlands.METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39\% in the intervention group (RR 0.57 (95\% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6\% and in the intervention group it was 6.1\% (RR 0.42 (95\% CI 0.27-0.66)).CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.",

keywords = "Aged, Aged, 80 and over, Female, Heart Failure/drug therapy, Humans, Male, Medication Errors/prevention \& control, Middle Aged, Netherlands/epidemiology, Patient Discharge/standards, Pharmacists/standards, Pharmacy Service, Hospital/methods, Professional Role, Risk Factors",

author = "Eggink, \{Rixt Nynke\} and Lenderink, \{Albert W\} and Widdershoven, \{Jos W M G\} and \{van den Bemt\}, \{Patricia M L A\}",

year = "2010",

month = dec,

doi = "10.1007/s11096-010-9433-6",

language = "English",

volume = "32",

pages = "759--66",

journal = "Pharmacy World \& Science",

issn = "0928-1231",

publisher = "Kluwer Academic Publishers",

number = "6",

}

TY - JOUR

T1 - The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure

AU - Eggink, Rixt Nynke

AU - Lenderink, Albert W

AU - Widdershoven, Jos W M G

AU - van den Bemt, Patricia M L A

PY - 2010/12

Y1 - 2010/12

N2 - OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.SETTING: A general teaching hospital in Tilburg, the Netherlands.METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)).CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.

AB - OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.SETTING: A general teaching hospital in Tilburg, the Netherlands.METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)).CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Heart Failure/drug therapy

KW - Humans

KW - Male

KW - Medication Errors/prevention & control

KW - Middle Aged

KW - Netherlands/epidemiology

KW - Patient Discharge/standards

KW - Pharmacists/standards

KW - Pharmacy Service, Hospital/methods

KW - Professional Role

KW - Risk Factors

U2 - 10.1007/s11096-010-9433-6

DO - 10.1007/s11096-010-9433-6

M3 - Article

C2 - 20809276

SN - 0928-1231

VL - 32

SP - 759

EP - 766

JO - Pharmacy World & Science

JF - Pharmacy World & Science

IS - 6

ER -

The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure

Abstract

Keywords

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