Pharmacist Intervention Did Not Reduce Medication Errors after Discharge
Clinical question: Does pharmacist intervention reduce clinically important medication errors after hospital discharge for patients with acute coronary syndrome (ACS) or decompensated congestive heart failure?
Background: Research has shown adverse drug events, including discrepancies in medication regimens and nonadherence, affect 11% to 17% of discharged patients. Pharmacist interventions reduce medication errors in hospitalized patients, but their impact on recently discharged patients is unknown.
Study design: Blinded randomized controlled trial.
Setting: Two U.S. tertiary-care academic hospitals.
Synopsis: Investigators randomized 851 patients admitted with ACS or decompensated heart failure to receive pharmacist intervention or usual care. The intervention involved pharmacist medication reconciliation (“med rec”), inpatient pharmacist counseling, low-literacy adherence aids, and post-discharge follow-up phone calls.
The primary outcome of clinically important medication errors within 30 days of discharge occurred in 50.8% of all patients. The intervention and usual-care groups had similar mean number of errors, 0.87 and 0.92 events per patient, respectively. Results by intention-to-treat analysis favored the intervention but did not meet statistical significance (adjusted RR 0.92, CI 0.77-1.09).
Both hospitals had sufficient resources to support med rec and electronic health records. The study population was well-educated, with only a 10% prevalence of inadequate health literacy, compared with 26% noted in prior literature. These factors could help explain the study’s negative findings.
Study limitations include whether the results are generalizable to other settings or noncardiac populations. Further study is needed to determine characteristics of patients and settings that could benefit from pharmacist involvement to decrease medication errors.
Bottom line: A pharmacist intervention did not reduce medication errors in cardiac patients after discharge.
Citation: Kripalani S, Roumie CL, Dalal AK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge. Ann Int Med. 2012;157:1-10.
Hyperbaric Oxygen Therapy Saves Lives in Necrotizing Soft-Tissue Infections
Clinical question: Is the use of hyperbaric oxygen therapy in necrotizing soft-tissue infections (NSTIs) effective in improving patient outcomes?
Background: Studies evaluating the benefits of hyperbaric oxygen therapy (HBO2 therapy) in NSTIs are limited. The mainstay of management remains early surgical debridement and antibiotics. Given the significant risk of mortality and long-term disability from limb and tissue loss, alternative treatments need to be considered.
Study design: Retrospective analysis.
Setting: The Nationwide Inpatient Sample (NIS) database.
Synopsis: This study evaluated 45,913 patients in the NIS from 1988 to 2009, of which 405 patients received HBO2 therapy. Overall, those receiving HBO2 therapy had a lower mortality rate (4.5% vs. 9.4%). After adjusting for predictors and confounders, those receiving HBO2 therapy had a statistically significant lower risk of mortality, but they did have higher hospital costs and longer LOS.
The NIS database does not capture several predictors and confounders for NSTI patients. Additionally, the lack of data regarding the number of HBO2 therapy sessions received makes it impossible to estimate a dose response.
Bottom line: This retrospective analysis of NSTI patients found HBO2 therapy was associated with significantly lower mortality but higher hospitalization cost and longer LOS.
Citation: Soh CR, Pietrobon R, Freiberger JJ, et al. Hyperbaric oxygen therapy in necrotizing soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample. Intensive Care Med. 2012;38:1143-1151.
Worse Stroke Outcomes on Weekends
Clinical question: Does the day of admission alter the quality and safety of care received by stroke patients?
Background: There is growing concern of disparities in care between weekday and weekend admissions in many health conditions. Recent studies have sought to determine if such a disparity exists for stroke patients.