title: Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial.
abstract: BACKGROUND
  Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs).
  
  
  OBJECTIVE
  To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge.
  
  
  METHODS
  Randomized, controlled trial with concealed allocation and blinded outcome assessors. (ClinicalTrials.gov registration number: NCT00632021)
  
  
  METHODS
  Two tertiary care academic hospitals.
  
  
  METHODS
  Adults hospitalized with acute coronary syndromes or acute decompensated heart failure.
  
  
  METHODS
  Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge.
  
  
  METHODS
  The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable ADEs, as well as potential ADEs.
  
  
  RESULTS
  Among 851 participants, 432 (50.8%) had 1 or more clinically important medication errors; 22.9% of such errors were judged to be serious and 1.8% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential ADEs in 253 patients (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (unadjusted incidence rate ratio, 0.92 [95% CI, 0.77 to 1.10]) or ADEs (unadjusted incidence rate ratio, 1.09 [CI, 0.86 to 1.39]). Patients in the intervention group tended to have fewer potential ADEs (unadjusted incidence rate ratio, 0.80 [CI, 0.61 to 1.04]).
  
  
  CONCLUSIONS
  The characteristics of the study hospitals and participants may limit generalizability.
  
  
  CONCLUSIONS
  Clinically important medication errors were present among one half of patients after hospital discharge and were not significantly reduced by a health-literacy-sensitive, pharmacist-delivered intervention.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute.
authors: Department of Medicine, Vanderbilt University, 1215 21st Avenue South, Suite 6000 Medical Center East, Nashville, TN 37232, USA. sunil.kripalani@vanderbilt.edu
authors: Sunil
authors: S
authors: Kripalani
authors: Christianne L
authors: CL
authors: Roumie
authors: Anuj K
authors: AK
authors: Dalal
authors: Courtney
authors: C
authors: Cawthon
authors: Alexandra
authors: A
authors: Businger
authors: Svetlana K
authors: SK
authors: Eden
authors: Ayumi
authors: A
authors: Shintani
authors: Kelly Cunningham
authors: KC
authors: Sponsler
authors: L Jeff
authors: LJ
authors: Harris
authors: Cecelia
authors: C
authors: Theobald
authors: Robert L
authors: RL
authors: Huang
authors: Danielle
authors: D
authors: Scheurer
authors: Susan
authors: S
authors: Hunt
authors: Terry A
authors: TA
authors: Jacobson
authors: Kimberly J
authors: KJ
authors: Rask
authors: Viola
authors: V
authors: Vaccarino
authors: Tejal K
authors: TK
authors: Gandhi
authors: David W
authors: DW
authors: Bates
authors: Mark V
authors: MV
authors: Williams
authors: Jeffrey L
authors: JL
authors: Schnipper
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000458:organization & administration; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods; D010595:Pharmacists; D012959:Socioeconomic Factors