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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines the effectiveness of pharmacists in resolving prescription problems after patients leave the hospital. It focuses on pharmacists at Methodist Charlton Medical Center who have the authority to directly prescribe medications to address these issues (Emergency Medicine Pharmacist Prescriptive Authority). The study will evaluate prescriptions written by pharmacists to determine their effectiveness in resolving outpatient medication problems. Eligible participants are patients who received a prescription from a hospital pharmacist at MCMC between November 2021 and June 2023, accompanied by a note explaining the necessity. As an unphased trial, this study provides patients the opportunity to contribute to enhancing pharmacy practices and patient care.

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 prior data suggests that the Emergency Medicine Pharmacist Prescriptive Authority is safe?

Research has shown that involving an Emergency Medicine Pharmacist (EMP) in prescribing can resolve medication issues after patients leave the hospital. One study found that EMPs fixed 295 prescription problems by issuing 340 prescriptions. This demonstrates the crucial role pharmacists can play in ensuring patients receive the correct medication upon discharge.

The safety of this approach appears promising. Involving pharmacists can reduce errors that often occur when prescribing or dispensing medications in the emergency department. Nearly 14% of prescriptions written in emergency departments have been found to contain errors. An EMP reviewing prescriptions can lower the risk of these errors.

Although specific reports on the safety of prescriptions made by EMPs are lacking, their involvement has been linked to fewer potentially inappropriate medications (PIMs), meaning fewer medications that could be wrong or unnecessary. This suggests that allowing pharmacists to prescribe could enhance medication safety for patients leaving the hospital. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial for Emergency Medicine Pharmacist (EMP) Prescriptive Authority because it aims to empower pharmacists to directly address medication errors, which are often identified after patients are discharged. Unlike the traditional model where physicians are solely responsible for prescribing, this approach allows specially trained pharmacists to step in and correct prescription issues immediately. This could streamline the process, reduce medication errors, and improve patient outcomes by ensuring that medication adjustments are made quickly and accurately. If successful, this method could lead to a more collaborative healthcare environment and enhance patient safety.

What evidence suggests that the Emergency Medicine Pharmacist Prescriptive Authority is effective for resolving outpatient prescription issues?

Research has shown that Emergency Medicine Pharmacists (EMPs) play a crucial role in resolving prescription problems after patients leave the hospital. This trial will include patients at MCMC who received a prescription from an EMP between November 1, 2021, and June 30, 2023. One study found that EMPs resolved 295 prescription issues by issuing 340 new prescriptions, accounting for 11.6% of all prescriptions they managed during that period. Medication errors often occur when prescriptions are initially written, particularly in emergency rooms. Involving EMPs in the prescribing process can potentially reduce these errors significantly. This approach aims to enhance medication safety and ensure patients receive the correct prescriptions before discharge. ^{2 3 4 5 6}

Who Is on the Research Team?

Kevin Burnham, Pharm.D.

Principal Investigator

Methodist Health System

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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 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 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 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]

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]

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 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 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]

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]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S2688115225002292

Emergency Medicine Pharmacist Prescriptive Authority for ... EMPs resolved 295 discharge prescription issues by sending a total of 340 prescriptions, representing 11.6% of the 2919 prescriptions issued by EMPs during the ...

2. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK519065/

Medication Dispensing Errors and Prevention - NCBI - NIH The incidence of medication errors is 30% higher in patients who are prescribed five or more drugs and 38% higher in those 75 years or older.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11587461/

Nexus of Quality Use of Medicines, Pharmacists' Activities ... The prevalence of medication errors in the ED is about 23% [40]. Up to 50% and 35% of medication errors in the ED occur during the prescribing ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2831215

Emergency Department Programs to Support Medication ... Clinical pharmacist review was not associated with decreased hospital admission or length of stay, but 2 studies showed a 32% reduction in PIMs ...

5. patientsafetyj.com patientsafetyj.com/api/v1/articles/73462-medication-safety-in-the-emergency-department-a-study-of-serious-medication-errors-reported-by-101-hospitals-from-2011-to-2020.pdf

Medication Safety in the Emergency Department: Our analysis revealed that serious medication errors in the ED occurred most often during the ordering/prescribing and adminis- tration stages ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5349807/

Emergency department discharge prescription errors in an ... This study shows that nearly 14% of discharge prescriptions written in the ED contain medication errors.