Adverse Drug Events, Medication Administered in Error
Conditions
Keywords
adverse drug events, outpatient
Brief summary
Adverse drug events (ADEs) after hospital discharge are common. The purpose of this research study is see if we can design an electronic tool given to your primary care provider (PCP) that will reduce adverse drug events, hospital readmissions, and emergency department visits after you are discharged from the hospital.
Detailed description
The objective of this research is to reduce the incidence of post-discharge medication discrepancies, preventable and ameliorable ADEs, hospital readmissions, and ED visits through the use of HIT. The proposed tool will prompt primary care physicians to perform medication reconciliation at the first post-discharge outpatient visit, clearly display and organize preadmission and discharge medication regimens, and facilitate the creation of the new post-discharge medication list with just a few keystrokes. Using methodologies from prior studies at BWH, we will evaluate the intervention in a two-site RCT. The study will be conducted at Brigham and Women's Hospital and Massachusetts General Hospital, taking advantage of our rich experience with designing and testing new informatics applications, including one for inpatient medication reconciliation.
Interventions
OTHEROutpatient Medication Reconciliation
The post-discharge medication reconciliation module has the following features: 1. Presents the (preadmission) ambulatory medication list and the hospital discharge medication list side-by-side, sorted by class, with all identical medications lined up next to each other and all differences in the two regimens highlighted. 2. Allows users to update the ambulatory medication list with a few keystrokes (i.e., to accept individual changes made during the hospitalization). 3. Allows reconciliation to be performed in full (e.g., for PCPs who are responsible for the entire medication list) or in part (e.g., for specialists).
Sponsors
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients admitted to BWH or MGH who plan to follow up with a PCP in one of 12 primary care practices affiliated with BWH or MGH. * Patients will need to meet the following criteria: * 1\) be 55 years or older, * 2\) be admitted to the participating delivery system's hospital during the study period for a non-psychiatric condition, * 3\) have no plans to enter hospice, * 4\) be discharged back to the community, * 5\) be prescribed 5 or more medications at discharge, including at least one of the following: * antibiotics, * insulin, * antihypertensives, * anti-rejection, * antiarrhythmics, * inhalers, * antiepileptics, * antianginals, * pain medications, * oral hypoglycemics, * steroids, * anticoagulants. * These drugs were selected because they require close monitoring, increase risk for drug-drug interactions, have a narrow therapeutic window, or are known to increase risk for ADEs in the older adult population
Exclusion criteria
Unable to provide informed consent and has no proxy who administers patient's medications and can provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| presence of at least one serious medication error per patient | 30 days post-discharge |
Secondary
| Measure | Time frame |
|---|---|
| ED visits and non-scheduled hospital readmissions and ED visits | within 30 days of discharge |
| Accuracy of medication list in ambulatory electronic medical record | 30 days post discharge |
Countries
United States
Outcome results
None listed