Pharmacist Authority for Medication Errors

Overseen By Colette N Ndjom

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Methodist Health System

Disqualifiers: Misclassified CPA actions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

350 Participants Needed

Trial Summary

What is the purpose of this trial?

The study aims to document the utility of Methodist Charlton Medical Center (MCMC's)Emergency Medicine Pharmacist (EMP) Collaborative Practice Agreement (CPA )utilization for the resolution of outpatient prescription issues. Evaluation of utility will involve describing all EMP-written prescriptions pursuant to resolution of prescription issues realized after discharge.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Emergency Medicine Pharmacist Prescriptive Authority?

Research shows that pharmacists in emergency departments can significantly reduce medication errors and improve prescription quality by working closely with doctors and reviewing prescriptions. This collaboration helps ensure patients receive accurate and safe medication instructions, which can enhance overall patient care. ^{1 2 3 4 5}

Is the pharmacist authority for medication errors generally safe for humans?

The research does not provide specific safety data on pharmacist authority for medication errors, but it highlights the importance of pharmacists in reporting and managing adverse drug events, which are harmful effects related to medication use. ^{6 7 8 9 10}

How does pharmacist authority for medication errors differ from other treatments for medication errors?

This treatment is unique because it involves pharmacists actively intercepting and correcting medication errors in emergency departments, which is different from traditional treatments that may not involve direct pharmacist intervention. Pharmacists play a crucial role in identifying and preventing errors, making this approach more proactive and potentially more effective in reducing medication errors. ^{2 4 5 11 12}

Research Team

Kevin Burnham, Pharm.D.

Principal Investigator

Methodist Health System

Eligibility Criteria

This trial is for patients who have experienced prescription issues after being discharged from the Methodist Charlton Medical Center's Emergency Department. There are no specific inclusion or exclusion criteria provided, so it appears open to any patient with these concerns.

Inclusion Criteria

I had a prescription sent by an EMP and a note about it between Nov 1, 2021, and Jun 30, 2023.

Exclusion Criteria

Patients with prescriptions pursuant to simple retransmission of prescriptions

Patients documented to have left the ED against medical advice.

CPA actions misclassified as discharge prescription issue resolutions

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Evaluation

Evaluation of utility involves describing all EMP-written prescriptions pursuant to resolution of prescription issues realized after discharge

20 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, including tracking the number of patients returning with complaints or diagnoses related to EMP-generated prescriptions

6 months

Treatment Details

Interventions

• Emergency Medicine Pharmacist Prescriptive Authority

Trial Overview The study is testing the effectiveness of allowing emergency medicine pharmacists to write prescriptions to resolve outpatient prescription problems that arise post-discharge. It will document how this practice impacts patient care.

Participant Groups

Group I: Patients at MCMC who had a prescription sent by an EMP between November 1, 2021 and June 30, 2023 Experimental Treatment 1 Intervention

Evaluation of utility will involve describing all EMP-written prescriptions pursuant to resolution of prescription issues realized after discharge.

Who Is Running the Clinical Trial?

Methodist Health System

Lead Sponsor

Trials

156

Recruited

4,826,000+

Findings from Research

In a study of 2,213 pediatric emergency room prescriptions, only 5% were free of errors or omissions, highlighting a significant issue in prescription quality under pressure.

To enhance prescription accuracy, the study suggests improved training for medical students in writing clear prescriptions, better collaboration between physicians and pharmacists, and the potential use of automated systems to minimize human error.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A study of the quality of prescriptions issued in a busy pediatric emergency room. Wingert, WA., Chan, LS., Stewart, K., et al.[2018]

The introduction of two emergency medicine pharmacists in the emergency department led to a dramatic increase in medication-error reporting, with 371 reports after their addition compared to only 31 before, highlighting their crucial role in improving medication safety.

Pharmacy personnel were responsible for capturing the vast majority of medication errors (94.5%), indicating that having pharmacists on the team significantly enhances the detection and reporting of medication errors, particularly ordering errors which accounted for 79.8% of the total.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of emergency medicine pharmacists on medication-error reporting in an emergency department. Weant, KA., Humphries, RL., Hite, K., et al.[2019]

In a study of 3107 discharge prescriptions for 1648 patients, emergency medicine pharmacists made clinically significant interventions in 7.3% of cases, with 29% of those interventions rated as significant.

While pharmacist interventions were more common in patients with high-risk criteria, these interventions did not lead to a reduction in 30-day readmission rates, indicating that while beneficial, they may not directly impact patient outcomes in terms of readmissions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States. Castillo, J., Campbell, MJ., Sokn, E., et al.[2021]

In a 5-month study involving 390 patients in an emergency department, pharmacists conducted 529 interventions that significantly reduced medication errors, with an acceptance rate of 84.9%.

The study found that 21.2% of medication errors involved high-alert drugs, and the cost-benefit analysis showed a favorable ratio of 3.46 Euros gained for every Euro spent on pharmacist interventions, highlighting their economic and clinical value.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pharmaceutical interventions in the emergency department: cost-effectiveness and cost-benefit analysis. Miarons, M., Marín, S., Amenós, I., et al.[2022]

In a study involving 16,446 patients across four emergency departments, pharmacists intercepted 364 medication errors, primarily through consultative activities, highlighting their critical role in preventing medication errors.

Most errors occurred during the prescribing phase, with the most common issue being wrong doses, indicating that pharmacists' involvement in reviewing orders is essential for enhancing medication safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. Patanwala, AE., Sanders, AB., Thomas, MC., et al.[2022]

A study of 377 Texas pharmacists revealed that they generally have a strong intention to report serious adverse drug events (ADEs) to the FDA, influenced by their positive attitudes and perceived social pressure to report.

The theory of planned behavior (TPB) model effectively predicted pharmacists' reporting intentions, accounting for 34% of the variance, suggesting that enhancing their understanding of the importance of reporting and addressing social pressures could improve ADE reporting rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examination of pharmacists' intention to report serious adverse drug events (ADEs) to the FDA using the theory of planned behavior. Gavaza, P., Brown, CM., Lawson, KA., et al.[2015]

A study of 377 Texas pharmacists revealed that 67.9% had never reported adverse drug events (ADEs) to the FDA, indicating a significant gap in reporting practices.

Most pharmacists (65.7%) felt they lacked adequate knowledge about ADE reporting, highlighting the need for improved education and training on how to report ADEs effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Texas pharmacists' knowledge of reporting serious adverse drug events to the Food and Drug Administration. Gavaza, P., Brown, CM., Lawson, KA., et al.[2015]

The study aims to evaluate the impact of pharmacist-led medication reviews on reducing hospital stays for high-risk patients in the emergency department, using a multicenter quality improvement program.

Patients identified as high-risk for adverse drug events will receive comprehensive medication reviews by pharmacists, which may lead to better health outcomes and fewer days spent in the hospital within 30 days of their emergency visit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of pharmacist-led medication review in high-risk patients in the emergency department: an evaluation protocol. Hohl, CM., McGrail, K., Sobolev, B.[2020]

In a study of 468 stroke patients, severe adverse events were found to be significantly more common in those who died compared to those who were discharged, with 76.5% of events occurring in deceased patients.

Major adverse events, particularly those related to medical procedures and nursing activities, were strongly associated with death, highlighting the need for improved safety measures in stroke care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital. Daud-Gallotti, R., Dutilh Novaes, HM., Lorenzi, MC., et al.[2019]

In a study of 1,035 patients visiting the medical emergency department of a large French hospital, 19.4% were found to have experienced an adverse drug event (ADE), highlighting the significant prevalence of ADEs in outpatient settings.

The clinical pharmacy survey of adverse drug events (CPSA) effectively identified and documented ADEs, demonstrating good data quality and stability, which suggests that similar programs could be implemented in other healthcare facilities to enhance patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing a clinical pharmacy survey of adverse drug events in a French emergency department. Roulet, L., Asseray, N., Dary, M., et al.[2021]

In a study of 3,136 emergency department prescriptions, pharmacists identified errors in 3.2% of cases, with the most common errors being wrong doses and incomplete prescriptions.

Pharmacists successfully corrected 78.8% of the identified errors, highlighting their crucial role in improving prescription safety, especially for older patients and those prescribed multiple medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Detection and correction of prescription errors by an emergency department pharmacy service. Stasiak, P., Afilalo, M., Castelino, T., et al.[2019]

In a six-month study at a tertiary care hospital, pharmacists recorded 2,564 interventions to prevent prescribing errors (PEs) in 1,565 patients, highlighting their crucial role in enhancing patient safety.

The most common PEs involved wrong doses (54.3%) and unauthorized prescriptions (21.9%), with pharmacists primarily addressing these issues through dose adjustments (44.0%) and restricted medication approvals (21.9%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Description of pharmacists' reported interventions to prevent prescribing errors among in hospital inpatients: a cross sectional retrospective study. Alzahrani, AA., Alwhaibi, MM., Asiri, YA., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

A study of the quality of prescriptions issued in a busy pediatric emergency room. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Effect of emergency medicine pharmacists on medication-error reporting in an emergency department. [2019]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Pharmaceutical interventions in the emergency department: cost-effectiveness and cost-benefit analysis. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Examination of pharmacists' intention to report serious adverse drug events (ADEs) to the FDA using the theory of planned behavior. [2015]

7. United States pubmed.ncbi.nlm.nih.gov

Texas pharmacists' knowledge of reporting serious adverse drug events to the Food and Drug Administration. [2015]

8. Canada pubmed.ncbi.nlm.nih.gov

The effect of pharmacist-led medication review in high-risk patients in the emergency department: an evaluation protocol. [2020]

9. England pubmed.ncbi.nlm.nih.gov

Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital. [2019]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Implementing a clinical pharmacy survey of adverse drug events in a French emergency department. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Detection and correction of prescription errors by an emergency department pharmacy service. [2019]

12. England pubmed.ncbi.nlm.nih.gov

Description of pharmacists' reported interventions to prevent prescribing errors among in hospital inpatients: a cross sectional retrospective study. [2021]