Effect of a Pharmacist on Adverse Drug Events and Medication Errors in Outpatients With Cardiovascular Disease

Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB 7360, Kerr Hall, Room 2212, Chapel Hill, NC 27599-7360, USA.
Archives of internal medicine (Impact Factor: 13.25). 05/2009; 169(8):757-63. DOI: 10.1001/archinternmed.2009.59
Source: PubMed

ABSTRACT Adverse drug events and medication errors are threats to quality care. Inpatient studies suggest that a pharmacist may reduce these events, but outpatient studies have not been forthcoming.
We conducted a pooled analysis of 2 randomized controlled trials to determine the effect of pharmacist intervention on adverse drug events and medication errors. We studied 800 outpatient cases of hypertension stratified into complicated (n = 535) and uncomplicated (n = 265). Patients in the complicated stratum had heart failure or other cardiovascular complication. Computer programs examined 1-year electronic record data to identify events classified as adverse drug events and preventable or potential adverse drug events. Medication errors included preventable and potential adverse drug events.
Of the 800 participants (mean [SD] age, 59 [10] years), 484 (90.5%) and 258 (97.4%) participants remained in the complicated and uncomplicated strata, respectively, at 12 months. Compared with the control group, the risk of any event was 34% lower in the intervention group (risk ratio, 0.66; 95% confidence interval [CI], 0.50-0.88), including a lower risk of adverse drug events (risk ratio, 0.65; 95% CI, 0.47-0.90), preventable adverse drug events (risk ratio, 0.52; 95% CI, 0.25-1.09), potential adverse drug events (risk ratio, 0.70; 95% CI, 0.40-1.22), and medication errors (risk ratio, 0.63; 95% CI, 0.40-0.98).
This post hoc analysis suggests that pharmacist intervention to improve medication use in outpatients with cardiovascular disease decreases the risk of adverse drug events and medication errors. Further studies are needed to confirm this finding.

Download full-text


Available from: Jingwei Wu, Aug 02, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.
    Hospital pharmacy 12/1122; 41. DOI:10.1310/hpj4311-937
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper proposes a new method of torque control for a sinusoidal current controlled voltage source inverter drive that is used with sinusiodal flux permanent magnet synchronous machines in the higher speed (>3500 rpm) operating range. The method uses the dynamic machine model component values to predict current vector control trajectories for machine operation at either maximum torque per stator current ampere, or maximum torque conversion efficiency. The requirements for dynamic parameter control for maximum torque conversion efficiency are developed. The predicted trajectories are compared with those commonly used in conventional control algorithms based on a static machine model. The results presented in this paper indicate that the nonlinearity of the machine model components can not be ignored when performing torque control at higher speed operating points.
    Power Electronic Drives and Energy Systems for Industrial Growth, 1998. Proceedings. 1998 International Conference on; 01/1999
  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary form only given. A μ-synthesis power system stabilizer (MPSS) design is presented for a two-area system in This work. The uncertainty is modeled based on structural information of the system and the bifurcation parameter induced nonlinear change in the bifurcation subsystem that experiences, produces, and causes the full system bifurcation. The control objective is to damp out the interarea oscillation as well as maintaining the bus voltages for the variation of the uncertainty parameter. The determination of the robust control device location that is expected to give better control performance is discussed. The performance index definition reflects the desired control purpose. A very flexible robust control configuration, that can be easily applied for different control designs, is shown. The RGA matrix is studied to evaluate the robust power system stabilizer design. RGA matrix information suggests that the control structure and capability of disturbance rejection have been drastically improved by MPSS design. The time simulation verifies the improvement of control performance and robustness.
Show more