ABSTRACT
Background: Limited literature exists on the positive impact of pharmacists specifically on hospital readmission of patients with acute myocardial infarction (AMI). Objective: To evaluate the overall effect of clinical pharmacist interventions on preventing hospital readmissions and improving the health of patients with AMI. Secondary objectives include identifying trends in the demographic characteristics of AMI patients, identifying potential barriers to adherence, and assessing the average time spent by a pharmacist counseling AMI patients. Methods: This prospective, nonrandomized, single-center study was approved by the institutional review board. The hospital's 30-day AMI readmission rate prior to study initiation was used as the control group. An AMI report was generated daily to identify patients admitted to the hospital diagnosed with either non-ST or ST segment elevation myocardial infarction. The clinical pharmacist then counseled the included patient prior to discharge and provided a follow-up phone call 48 hours after discharge. The primary outcome was the all-cause 30-day readmission rate for AMI patients. Results: Out of 71 patients screened, 50 patients were included in the study. Only 3 of the 50 patients included were readmitted (6.0%). The prestudy rate from October 2012 to October 2013 was 11.6%, or 58 readmissions out of 498 AMI admissions. Although the study group was much smaller in size, a 6% readmission rate is encouraging and offers potential for a future intervention. Conclusion: Clinical pharmacist services for AMI patients, including counseling, interventions, and a follow-up phone call after discharge, may benefit decreasing the 30-day AMI readmission rate; however, further studies are needed.
ABSTRACT
BACKGROUND: Treatment with highly active antiretroviral therapy (HAART) decreases morbidity and mortality associated with HIV infection. Unfortunately, HAART medication errors are prevalent in hospitalized patients with HIV infection. Appropriate regimen administration and adherence are essential for treatment success. OBJECTIVE: To assess the impact of pharmacist interventions on the rate of medication errors in HIV-infected hospitalized patients who had been prescribed HAART in the outpatient setting. METHODS: Hospitalized patients aged 18 years or older receiving HAART and/or opportunistic infection (OI) prophylaxis were screened for inclusion. Data collection for each enrolled patient included demographic information, pertinent laboratory results, and inpatient and outpatient medication regimens. Patient medication profiles were reviewed within 72 hours of admission. HAART and/or OI prophylaxis errors were classified by type and frequency. Following the pharmacist intervention, prescribers' responses to each recommendation and the estimated time per intervention were recorded. RESULTS: Eighty-six patients were included in this investigation and 210 HAART and OI prophylaxis errors were documented. Of patients receiving HAART and/or OI prophylaxis, 54.7% had at least 1 medication error on admission. An average of 2.4 errors per patient was identified. Dose omission (45.5%) was the most common error type among combined HAART and OI prophylaxis regimens, followed by incorrect regimen (17.1%) and incorrect dose (15.1%). Prescribers accepted 90% of pharmacist recommendations. A pharmacist was able to amend 94.7% of correctable HAART errors, as well as 89.9% of correctable combined HAART and OI prophylaxis errors. An estimated 18.5 minutes of pharmacist time were spent per patient requiring an intervention. CONCLUSIONS: A clinical pharmacist's targeted review of outpatient-prescribed HAART and/or OI primary prophylaxis regimens of hospitalized HIV-infected patients can reduce most medication errors during hospitalization.
