TY - JOUR
T1 - The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients – a multicenter interrupted time series study
AU - Klopotowska, Joanna E.
AU - Kuks, Paul F. M.
AU - Wierenga, Peter C.
AU - Stuijt, Clementine C. M.
AU - Arisz, Lambertus
AU - Dijkgraaf, Marcel G. W.
AU - de Keizer, Nicolette
AU - Smorenburg, Susanne M.
AU - de Rooij, Sophia E.
N1 - Funding Information: This work was supported by The Netherlands Organization for Health Research and Development (ZonMW grant SG300001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This study was conducted within the CAREFUL (pharmacist Coordinated ADE Reducing Efforts For Use in all Levels of healthcare) research program based on a collaboration between Leiden University Medical Centre, Amsterdam University Medical Centers, University Medical Centre Groningen and University Medical Centre Utrecht/Utrecht University. We thank all staff of Internal Medicine and Hospital Pharmacy departments of the participating hospitals for their support, and in particular hospital pharmacists Loraine Lie-A-Huen, Stefan Sanders, Irma Rigter, Kristel Crommentuijn, Tjalling van der Schors, Bea van der Kleij for implementing the intervention; pharmacy students Felix Korving and Sek Hung Chau; pharmacists Rianne Lantink and Ria van Haften; Internal Medicine residents Liffert Vogt, Mady van Welsem, Kathelijn Versteeg, Sanne van der Wiel and Annemarie Mensink; and Internal Medicine attending physicians Gooke Lagaay and Alexander Arntzenius, Wim Meijer, Joost Hoekstra and Suzanne Geerlings for their assistance in designing and implementing the intervention; research nurses Wendy van den Berg, José Popma-de Koning, Anouk Verburg-Eisma, Carla Kamp, and Vera Ruijter and hospital pharmacist Jolande van der Wildt for their assistance in data collection; and Miranda Roskam for building the database for the study. We would also like to acknowledge the help of pharmacy students Kayan Tsoi, Mila Tjoa, Jochem Schoonheim, Felix Korving, Sek Hung Chau, and Janneke Groen in the data entry for this study. Members of the Ward-oriented pharmacy In Newly admitted Geriatric Seniors (WINGS) Study Group are: Joost L.B. Hoekstra, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, The Netherlands; Minke E.P. Jansen, Department of Pharmacy and Clinical Pharmacology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Wim G. Meijer, Department of Internal Medicine, Dijklander Hospital, Hoorn, The Netherlands; Bea M. van der Kleij, Department of Hospital Pharmacy, Dijklander Hospital, Hoorn, The Netherlands; Anne M. Lagaay, Department of Internal Medicine and Geriatrics, Spaarne Hospital, Hoofddorp, The Netherlands; Ruud T.M. van der Hoeven, Director of Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method: The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results: The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions: The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011.
AB - Background: The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method: The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results: The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions: The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011.
KW - Adverse drug events
KW - Clinical pharmacist
KW - Elderly
KW - Inpatients
KW - Interrupted time series
KW - Medication review
UR - http://www.scopus.com/inward/record.url?scp=85132325432&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12877-022-03118-z
DO - https://doi.org/10.1186/s12877-022-03118-z
M3 - Article
C2 - 35715742
SN - 1471-2318
VL - 22
JO - BMC geriatrics
JF - BMC geriatrics
IS - 1
M1 - 505
ER -