Economic evaluation of the impact of medication errors reported by U.S. clinical pharmacists.

OBJECTIVE: Medication errors defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm" have been highlighted as a top national priority in a report issued by the Institute of Medicine. However, little information is available on precise costs of medication errors. This study estimated the cost of medication errors reported by clinical pharmacists using a modified societal perspective. METHODS: Information on 779 medication errors was collected in the Medication Error Detection, Amelioration and Prevention (MEDAP) study that documented medication errors observed by clinical pharmacists during a consecutive 14-day period. The rate of medication errors, outcomes (number of errors resulting in temporary/permanent patient harm, prolonged hospitalization, or life-sustaining therapy), and interventions (communication, medication changes, patient monitoring, and treatment referrals) were collected. A decision model was developed to estimate the economic impact of medication errors reported by clinical pharmacists. Event probabilities were derived from MEDAP data. Direct costs were obtained through reviews of the literature, hospital charge data, and Medicare and Medicaid reimbursement. One-way and Monte Carlo sensitivity analyses were used to explore uncertainty in the values. RESULTS: In the base case, the mean expected cost of a medication error was $88.57. In the Monte Carlo simulation, the mean cost was $89.35 (± $30.17 SD). One-way sensitivity analysis revealed that changes in the probability of medication errors causing hospitalization and the cost of hospitalization had the greatest variability on the outcome ($50.44-$155.81 [probability of hospitalization], $32.59-$136.40 [cost of hospitalization]). CONCLUSIONS: Medication errors are costly to the health care system. A better understanding of medication error costs may be used to justify initiatives to reduce the risk and inefficiency associated with these errors.

Drug errors and related interventions reported by United States clinical pharmacists: the American College of Clinical Pharmacy practice-based research network medication error detection, amelioration and prevention study.

OBJECTIVE: To describe and evaluate drug errors and related clinical pharmacist interventions. DESIGN: Cross-sectional observational study with an online data collection form. SETTING: American College of Clinical Pharmacy practice-based research network (ACCP PBRN). PARTICIPANTS: A total of 62 clinical pharmacists from the ACCP PBRN who provided direct patient care in the inpatient and outpatient practice settings. INTERVENTION: Clinical pharmacist participants identified drug errors in their usual practices and submitted online error reports over a period of 14 consecutive days during 2010. MEASUREMENTS AND MAIN RESULTS: The 62 clinical pharmacists submitted 924 reports; of these, 779 reports from 53 clinical pharmacists had complete data. Drug errors occurred in both the inpatient (61%) and outpatient (39%) settings. Therapeutic categories most frequently associated with drug errors were systemic antiinfective (25%), hematologic (21%), and cardiovascular (19%) drugs. Approximately 95% of drug errors did not result in patient harm; however, 33 drug errors resulted in treatment or medical intervention, 6 resulted in hospitalization, 2 required treatment to sustain life, and 1 resulted in death. The types of drug errors were categorized as prescribing (53%), administering (13%), monitoring (13%), dispensing (10%), documenting (7%), and miscellaneous (4%). Clinical pharmacist interventions included communication (54%), drug changes (35%), and monitoring (9%). Approximately 89% of clinical pharmacist recommendations were accepted by the prescribers: 5% with drug therapy modifications, 28% due to clinical pharmacist prescriptive authority, and 56% without drug therapy modifications. CONCLUSION: This study provides insight into the role clinical pharmacists play with regard to drug error interventions using a national practice-based research network. Most drug errors reported by clinical pharmacists in the United States did not result in patient harm; however, severe harm and death due to drug errors were reported. Drug error types, therapeutic categories, and clinical pharmacist interventions varied between the inpatient and outpatient settings. Nearly half of reported errors were prevented by clinical pharmacists before the drugs reached the patients. The majority of clinical pharmacist recommendations were accepted by prescribers.

Outcomes from a mentored research boot camp: Focused Investigator Training (FIT) Program.

STUDY OBJECTIVE: To evaluate the change in mentee self-efficacy with regard to research, number of grant submissions, and total amount of new monies awarded to graduates of a novel, mentored, investigator-training program-the Focused Investigator Training (FIT) Program. DESIGN: Retrospective observational analysis. SETTING: American College of Clinical Pharmacy Research Institute. PARTICIPANTS: Fifty-five mentees from the 2008, 2009, 2010, and 2011 FIT Programs. INTERVENTION: The FIT Program is a novel, intensive, 5-day, mentored development "boot camp" for mid-career investigators holding research-intensive positions. The program consists of proposal groups of two mentors and two-four mentees, one-on-one office hours, lectures, panel discussions, directed readings, and small group sessions. Twelve highly successful researchers and biostatisticians were recruited as mentors. Mentees submitted a detailed proposal and received faculty feedback before the program. MEASUREMENTS AND MAIN RESULTS: The main outcomes of the FIT Program were mentee self-efficacy with regard to research, number of grant submissions, and total amount of new monies awarded to 2008 and 2009 FIT Program graduates. Univariate statistical analysis was conducted to determine characteristics of those FIT attendees with subsequent successful grantsmanship. A combined measure of self-confidence in successful grantsmanship was significantly increased after completion of the FIT program. More than $2.7 million was funded to FIT graduates as principal investigators, and as coinvestigators or subcontractors, an additional $382,000 was awarded in new funds. Seven mentees from the 2008 and 2009 classes received new federal funding, mostly through various K-type award mechanisms. CONCLUSION: The FIT Program was associated with a significant increase in attendees' self-efficacy for obtaining external research funding. Program attendance was associated with numerous successfully funded grants by pharmacist investigators. Future FIT Program success hinges on attracting adequate numbers of qualified applicants.

Characterizing the American college of clinical pharmacy practice-based research network.

STUDY OBJECTIVE: To present the member registry survey methods and characterize the first national clinical pharmacy practice-based research network (PBRN). DESIGN: Cross-sectional online survey. SETTING: A national clinical pharmacy association. PARTICIPANTS: American College of Clinical Pharmacy (ACCP) full and associate members, integrated health system groups of pharmacists, and existing PBRNs were invited to participate in the registry and complete the survey. INTERVENTION: An association-wide invitation to join the ACCP PBRN was sent to ACCP members who were actively involved in direct patient care or who had access to a patient base for research purposes. Interested pharmacists completed a three-part online survey regarding professional background, practice site, and clinical pharmacy practice. MEASUREMENTS AND MAIN RESULTS: A total of 416 members completed the online registry. These pharmacists practice at 263 distinct clinical sites in 43 states. Forty-six percent of the sites were located within a university hospital, and 30% were within a community hospital setting. Of those working in these two hospital settings, 33% and 40%, respectively, practiced within an outpatient clinic. The ACCP PBRN member pharmacists spent an average of 5 half-days providing clinical pharmacy services and saw a median of 30 patients/week. The most common laboratory tests ordered by member pharmacists were metabolic panels, prothrombin times or international normalized ratios, liver function tests, and blood glucose levels. The most frequently managed conditions or disease states were pharmacotherapy and/or polypharmacy, anticoagulation, diabetes mellitus, and hypertension. Almost two thirds of the pharmacists used an electronic medical record system. Thirty-five percent operated with the use of collaborative practice documents within their sites, whereas 32% had scope of practice agreements. Ninety-five percent did not bill for clinical pharmacy services rendered. CONCLUSION: The ACCP PBRN is the first national clinical pharmacy PBRN. Its membership has a distinctive profile of primary care and specialty clinical pharmacists who work both within inpatient and outpatient settings. Both internal and external stakeholders are expected to use these ACCP PBRN registry data to support the capabilities and capacity of the ACCP PBRN.

Herbal products and dietary supplements: a survey of use, attitudes, and knowledge among older adults.

CONTEXT: Tens of millions of Americans use herbal products and/or dietary supplements, yet scant data are available regarding the purity, safety, or efficacy of these substances. A better understanding of usage trends and patient attitudes toward self-initiated supplementation is vital to obtaining accurate and complete medical history data. OBJECTIVE: To survey Americans aged approximately 60 years and older regarding their use of herbal products and dietary supplements and their attitudes and knowledge regarding the safety of these popular substances. METHODS: A face-to-face, 35-item survey was administered to 267 men and women residing in the Kansas City, Mo-metropolitan area. Researchers documented usage patterns for, attitudes about, and knowledge of herbal products and dietary supplements in this population. RESULTS: Fifty-six (21%) respondents were currently taking at least one herbal product or dietary supplement, and potential for adverse drug reactions was apparent in 12 (19%). Glucosamine, garlic, Echinacea, and Gingko biloba were the most frequently cited substances used by survey participants. White women with at least some college education were most likely to report taking these products. However, preservation of health was by far the most predictive indicator for use of herbal products and dietary supplements. Subjects were found to be receptive to patient education efforts for these products. CONCLUSION: Although substantial misconceptions about herbal products and dietary supplements exist among older Americans, most individuals in this population are interested in receiving additional information about these products. Excellent opportunities exist for expanded patient education--and improved patient care.

Aspirin for primary prevention in patients with diabetes mellitus.

BACKGROUND AND OBJECTIVES: Evidence supports the routine use of low-dose aspirin (ASA) in the prevention of cardiovascular (CV) events in patients with diabetes mellitus (DM). In 1997, the American Diabetes Association (ADA) recommended ASA prophylaxis for all diabetic patients over the age of 30 with one additional risk factor for cardiovascular disease (CVD). Our objective was to determine the adherence to the ADA guidelines for ASA therapy in DM using a national database. METHODS: Data from the 1997-2000 National Ambulatory Medical Care Survey (NAMCS) was used to determine the usage rates of ASA in patients with DM over age 30 years with one or more CV risk factors. Multiple logistic regression methods were used to determine what factors were related to ASA prophylaxis. RESULTS: During 1997-2000, more than one third of all diabetic patients should have been considered for ASA prophylaxis because they had one or more CV risk factors. Yet, from 1997-2000, the percentage of these patients given ASA for primary prevention was 2.8% in 1997, 2.9% in 1998, 2.1% in 1999, and 5.7% in 2000. Factors associated with increased ASA prophylaxis were non-white ethnicity, male gender, older age (more than 44 years old), rural clinic setting, preventative counseling given during visit, being prescribed more than two medications, having cardiovascular risk factors, and being seen by a cardiologist. CONCLUSIONS: Adherence rates to the ADA standard of care guideline regarding routine ASA prophylaxis in adults with DM and at least one CV risk factor are extremely low. National efforts directed at increasing these rates of ASA prophylaxis are indicated to meet the Healthy People 2010 goal of 30%.