The role of chronic disease management led by clinical pharmacists in preventing medication errors in discharged elderly patients with hypertension

Abstract

Objective To explore the role of chronic disease management led by clinical pharmacists in preventing medication errors in discharged elderly patients with hypertension. Methods The subjects were selected from hypertensive patients aged 60-85 years and hospitalized in Department of Cardiology, Beijing Jishuitan Hospital from March 2016 to September 2017. The patients were selected at admission and their basic information were recorded, including gender, age, mode of payment, education level, occupation, and type of combined chronic diseases. The patients were given homogeneous pharmaceutical care by clinical pharmacists during hospitalization and randomly divided into the intervention group and the control group when discharged. After discharge, they were followed up for 24 weeks. The patients in the intervention group were followed up once every 2 weeks from the 1st to the 12th week and once every 4 weeks from the 13th to the 24th week after discharge. The patients in the control group were followed up only once at the end of the 12th and the 24th week after discharge. The follow-up contents included the blood pressure, blood glucose, blood lipids, and other laboratory tests results, name and usage of all the drugs used, on-time medication condition, occurrence of adverse drug reactions, changes in lifestyle, and etc. If the patients were found to have medication errors, the time of error discovery, the content, level, and frequency of the error, and the classification of the drug involved were recorded in a special form. The clinical pharmacists provided individualized medication guidance to patients during the follow-up and gave timely intervention after discovering the medication errors. Results Forty patients in the intervention group and 44 patients in the control group were entered in the study. There were no significant differences in baseline information between the 2 groups (all P≥0.05). During the 24 weeks of follow-up, medication errors were found in 20 patients in the intervention group and 12 patients in the control group. The difference in detection rate of medication errors between the 2 groups was significant [50.0% (20/40) vs. 27.3% (12/44), χ2=0.043, P=0.032]. A total of 50 cases of medication errors were found in the 2 groups, including 34 (68.0%) in the intervention group and 16 (32.0%) in the control group. During the first 12 weeks of follow-up, 31 cases of medication errors (91.2%) in the intervention group and 8 cases (50.0%) in the control group were found by pharmacists, and the difference was statistically significant (P=0.002). The difference in the proportion of different medication errors classification between the 2 groups was not significant (P>0.05). The drug omission was with the highest proportion in the 2 groups [47.1% (16/34) in the intervention group and 31.2% (5/16) in the control group]. Among 50 cases of medication errors, 49 (98.0%) were defined as level 2 errors (with mistake, but no harm), including 20 cases of grade C errors and 29 cases of grade D errors; 1 (2.0%) was defined as level 3 (with mistake and harm) and grade F error. After the intervention of clinical pharmacists, all the level 2 errors were corrected. Level 3 errors led to re-hospitalization of patients. After pharmacists and physicians emphasized the importance of taking medicine according to doctor′s orders again, patients did not make medication errors again. There are 8 categories and 22 kinds of drugs involved in medication errors, including antiplatelet, antihypertensive, hypolipidemic, hypoglycemics, anti-gout, antiarrhythmic, anticoagulant, and anti-angina drugs. Conclusion Chronic disease management led by clinical pharmacists is helpful to find and correct the medication errors timely in discharged elderly patients with hypertension. Key words: Pharmacists; Aged; Hypertension; Patient discharge; Follow-up studies; Medication errors