Reducing errors through discharge medication reconciliation by pharmacy services.

OBJECTIVE: Adverse drug events are an important cause of admissions to hospitals. Discrepancies in admission and discharge medications can contribute significantly to these adverse events. Patients are at risk of discrepancies in medications any time they experience a transition of care. Medication discrepancies occur more commonly when patients are discharged. Prevention of errors by undergoing medication reconciliation with review by a pharmacist can help avoid medication discrepancy-related errors. The objective of this study was to determine whether integration of pharmacist review in the process of medication reconciliation at discharge identifies and corrects discrepancies. METHODS: In the study population of internal medicine patients cared for by hospitalist physicians, we prospectively collected data from medication lists via chart review and patient interview and identified, using a pharmacist, any medication discrepancies. We then counted the number of discrepancies for each patient and categorized them by severity of potential adverse effect to the patient. RESULTS: There were 63 medication discrepancies in 104 included patients found by pharmacist's review and 41% (43) of patients had at least one medication discrepancy. Patients with 8 or more discharge medications were found to be at an increased risk of discrepancy (OR 8.5, p <0.001, 95% CI 2.8,25.5). Most discrepancies were considered minimal risk, 44.4% (28/63), or moderate risk, 49.2% (20/63) for adverse effect. CONCLUSION: About 2 out of 5 patients on the hospitalist service studied have discrepancies in their medications at discharge that can be identified and corrected by pharmacist intervention. Inclusion of pharmacists could improve the process by correcting these discrepancies to help avoid preventable adverse drug events.

Targeted in vitro photodynamic therapy via aptamer-labeled, porphyrin-loaded virus capsids.

Virus capsids have emerged as multifunctional platform systems for development of bio-derived nanomaterials. In this work we investigate the use of aptamer decorated MS2 bacteriophage capsids, loaded with photosensitizer for targeted photodynamic therapy in vitro. MS2 capsids were loaded with approximately 250 cationic porphyrins through a novel assembly packaging mechanism, followed by exterior decoration of the capsid with a cancer-targeting nucleic acid aptamer via chemical conjugation. The ability of these aptamer-virus-porphyrin constructs to specifically target and eradicate MCF-7 human breast cancer cells upon photoactivation was assessed. Photoinduced cytotoxicity was evaluated via live/dead staining and a metabolic activity assay with MCF-10A cells as a control. Results show that MCF-7 cells incubated with targeted, porphyrin-loaded virus capsids exhibited cell death whereas the MCF-10A cells did not. Furthermore, MCF-7 cells incubated with porphyrin-loaded viruses decorated with a non-targeting aptamer exhibited no observable phototoxicity. Combined, the results presented in this work demonstrate our unique virus-based loading strategy offers a viable approach for efficient targeted delivery of photoactive compounds for site-specific photodynamic cancer therapy using bio-derived nanomaterials.

Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle.

RATIONALE: Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. OBJECTIVE: To assess the impact of a supplemental care bundle targeting high-risk elderly inpatients implemented by hospital-based staff compared to usual care on a composite outcome of hospital readmission and/or ED visitation at 30 and 60 days following discharge. PATIENTS/METHODS: Randomized controlled pilot study in 41 medical inpatients predisposed to unplanned readmission or postdischarge ED visitation, conducted at Baylor University Medical Center. The intervention group care bundle consisted of medication counseling/reconciliation by a clinical pharmacist (CP), condition specific education/enhanced discharge planning by a care coordinator (CC), and phone follow-up. RESULTS: Groups had similar baseline characteristics. Intervention group readmission/ED visit rates were reduced at 30 days compared to the control group (10.0% versus 38.1%, P = 0.04), but not at 60 days (30.0% versus 42.9%, P = 0.52). For those patients who had a readmission/postdischarge ED visit, the time interval to this event was longer in the intervention group compared to usual care (36.2 versus 15.7 days, P = 0.05). Study power was insufficient to reliably compare the effects of the intervention on lengths of index hospital stay between groups. CONCLUSIONS: A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger populations across a variety of inpatient settings.