A new study finds that about 50 percent of cardiac patients experience medication errors once they are discharged from the hospital, up from previous estimates of 20 percent. Even when patients have personalized assistance from a pharmacist, including follow-up, errors occur.
About the Study
The study, published in the Annals of Internal Medicine, focused on 851 patients from Vanderbilt University Hospital or Brigham and Women’s Hospital in Boston, Massachusetts. The patients, whose ages averaged 60 years, had been admitted to the hospital for heart problems, such as heart attack and heart failure.
About half of the patients got standard care, which included receiving instructions and information about their medications at discharge from their doctors and hospital nurses. The rest of the patients were assigned extra help from a pharmacist, which included the following:
- one or two counseling sessions on how they could prevent medication errors;
- an evaluation of how well they understood the instructions for their medications;
- verbal inquiry into their social support;
- pill boxes and illustrated medication schedules; and
- a phone call one to four days following discharge to check for issues or problems with the medication.
Research Findings
After keeping track of medication errors for one month after the patients were discharged from the hospital, the researchers came up with the following information:
- Out of the entire group of 851 patients, 432 (more than 50 percent) experienced at least one medication error.
- In the standard-care group, 407 medication errors occurred that were deemed “clinically important,” versus 370 in the extra-help group.
- Of the clinically important medication errors, seven in each group were life threatening, although none resulted in death of the patient.
One of the researchers was Sunil Kripalani, M.D., associate professor of medicine at Vanderbilt University School of Medicine in Nashville. “We found that approximately 50 percent of patients had either a potentially avoidable adverse drug event or some other problem with their medicine that had the potential to cause harm if left uncorrected,” Dr. Kripalani said.
The types of medications that were most frequently the source of errors include the following:
- heart disease medicine;
- diuretics;
- opioids for pain;
- cholesterol medicine;
- vitamins, herbal remedies, and other supplements;
- drugs for diabetes; and
- anticoagulants.
The researchers pointed out that some of the mistakes were avoidable, had the doctors or pharmacists monitored the patients more closely. These were some of the most common medication errors:
- missing a dose, or taking the wrong dosage;
- discontinuing a medication without a doctor’s instructions;
- not getting a prescription filled; and
- taking the medication more or less often than prescribed.
Even though having more intensive counseling for half the group didn’t make much of a difference in the total number of medication errors, some of the patients derived real benefit out of the extra attention.
“What our subgroup analysis hinted at is that patients with more complex medication regimens, those with low health literacy, patients who tend to have more trouble understanding and managing their health, and those who had cognitive problems, tended to benefit more,” he says.
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