This systematic review of 54 studies found that over half of adult and pediatric patients experienced a medication error post-discharge, and that these errors regularly involved common drug classes such as antibiotics, antidiabetics, analgesics, and cardiovascular drugs. The authors suggest that future research examine the burden of post-discharge medication errors, particularly in pediatric populations.

Hospital discharge remains a particularly vulnerable time for adverse drug events, despite the use of medication reconciliation and other strategies to prevent medication errors at discharge. Previously, pharmacist involvement has also been shown to be beneficial in reducing medication errors, and even led to decreased readmissions in at least one study. However, in this randomized, controlled trial, approximately 50% of adult patients who received a robust pharmacist-driven intervention still experienced a clinically important medication error within one month following discharge for an episode of acute coronary syndrome or acute decompensated heart failure. The four-component intervention included pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. A case of a preventable readmission due to a medication error is discussed in this AHRQ WebM&M commentary.

Prevention of medication errors in emergency departments is a growing focus of safety efforts, due in part to a National Patient Safety Goal targeting medication errors. Clinical pharmacists effectively prevent medication errors in the inpatient setting, but their role in the emergency department is less studied. This systematic review of 17 published studies characterizes roles played by emergency pharmacists, including medication reconciliation, error prevention, and a variety of other duties. Another study (not included in this review) found a significant reduction in medication errors after assigning pharmacists to review medication orders in the emergency department. 

This systematic review evaluated 36 studies that encompassed pharmacy participation in patient rounds and medication reconciliation efforts as well as drug-specific pharmacist services. The authors detail the individual and collective findings, which include reductions in adverse drug events or errors in more than half the trials with improvements in medication adherence, knowledge, and appropriateness in a similar proportion. None of the studies demonstrated a worse overall outcome, and only one suggested increased health care utilization. The authors outline the needs for future investigation around roles for clinical pharmacists, clinical areas and patients most likely to benefit from their services, and better models to determine cost effectiveness.

This study found a lower rate of preventable adverse drug events (ADEs) for patients who received medication review, counseling, and telephone follow-up from a hospital pharmacist. Investigators randomized nearly 100 medical patients to receive the pharmacy intervention and found that only 1% of those patients experienced a preventable ADE (11% in the control group). The overall rate of ADEs was similar in both groups. Additional findings included observation of unexplained discrepancies between preadmission and discharge medication regimens in nearly half the patients. This finding supports national interests in medication reconciliation. A past study suggested similar benefits of pharmacy participation in daily rounds in an intensive care unit.

The authors report a controlled, before-and-after comparative trial of having an experienced pharmacist participate in the daily rounds of physicians and nurses in an academic intensive care unit. The authors assessed the baseline rate of all adverse drug events (ADEs) and preventable ADEs by chart review and compared rates in the intervention and control units before and after the intervention. The authors found an almost threefold reduction in ADEs per 1000 patient-days with the intervention. Physicians and nurses were highly accepting of the pharmacist’s participation, with physicians accepting 99% of the pharmacist’s suggestions. The authors estimate a total cost savings of $270,000 per year in the 17-bed intervention unit. They assert that no additional resources were consumed because the pharmacist’s time spent on rounds was compensated for by relief from correcting physicians’ orders after they were placed.

This study investigated the impact of hospital pharmacists in preventing medication errors. For more than 123,000 medication orders at a single university teaching institution, the overall error rate was approximately 2%. Incorrect dosage, inappropriate dosing schedules, and omission of essential information represented the most common error types. Physicians confirmed an error in more than 90% of orders questioned by pharmacists. The authors conclude that the use of hospital pharmacists to screen every medication order prevents almost 9000 errors annually.

This study discusses a statistical model to estimate costs associated with drug-related problems in nursing facilities. Using decision analysis techniques and an expert panel of physicians and pharmacists, investigators designed conditional probabilities attributable to drug therapy. Their findings suggest that, for every dollar spent on drug therapy, nearly $1.33 in health care resources are consumed in the treatment of drug-related problems. The authors conclude that improved collaboration among physicians and pharmacists in the nursing home population is likely to reduce the economic impact of drug-related adverse events.