Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool

Nishat Afreen, Eimeira Padilla-Tolentino, Brandy McGinnis, Nishat Afreen, Eimeira Padilla-Tolentino, Brandy McGinnis

Abstract

Background and introduction: Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient's active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions.

Materials and methods: Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process.

Results: During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge.

Discussion: Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year.

Conclusion: This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.

Keywords: Electronic Health Records; High-risk medication errors; High-risk medications; Medication errors; Pharmacy; Telehealth; Telepharmacy; Web-based.

Conflict of interest statement

Conflicts of interest: None

© Individual authors.

Figures

Figure 1.
Figure 1.
Ascension Texas Medication History Survey tool breakdown. Abbreviations used: HR, high-risk.
Figure 2.
Figure 2.
High-Risk Medication Errors Categorized By Error Type A total of 261 potential medication errors were identified from 191 patients in emergency departments of Ascension Texas from April 2019 to October 2020.

References

    1. Slight SP, Seger DL, Franz C, Wong A, Bates DW. The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States. J. Am. Med. Inform. Assoc. 2018 Sep;25(9):1183–8.
    1. Hug BL, Keohane C, Seger DL, Yoon C, Bates DW. The costs of adverse drug events in community hospitals. Jt Comm J Qual Saf. 2012 Mar 1;38(3):120–6.
    1. Aspden Philip, Philip Aspden. Preventing medication errors. National Acad. Press; 2007.
    1. Kramer JS, Stewart MR, Fogg SM, et al. A quantitative evaluation of medication histories and reconciliation by discipline. Hosp Pharm. 2014;49(9):826–838.
    1. McGinnis B, Padilla E., Garret P., Aziz S. Using pharmacy technicians and telepharmacy to obtain medication histories in the emergency department. J Am Pharm Ass. 2019;59(3):390–397. doi: 10.1016/j.japh.2019.01.019. doi:
    1. Beuscart JB, Petit S, Gautier S, Wierre P, Balcaen T, Lefebvre JM, Kambia N, Bertoux E, Mascaut D, Barthélémy C, Cuny D. Polypharmacy in older patients: identifying the need for support by a community pharmacist. BMC geriatr. 2019 Dec 1;19(1):277.
    1. Morrison, et al. Promoting Safer Use of High-Risk Pharmacotherapy: Impact of Pharmacist-Led Targeted Medication Reviews. Drugs Real World Outcomes. 2015 Sep;2(3):2241–281.
    1. Burton MM, Hope C, Murray MD, Hui S, Overhage JM. The cost of adverse drug events in ambulatory care. AMIA Symposium. 2007 Oct;:90–93.
    1. Pippins, et al. Classifying and Predicting Errors of Inpatient Medication Reconciliation. J Gen Intern Med. 2008 Sep;23(9):1414–22.
    1. Mekonnen AB, McLachlan AJ, Brien JA. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016 Apr;41(2):128–44.
    1. American Society of Health-System Pharmacists ASHP statement on the pharmacist’s role in medication reconciliation. Am J Health Syst Pharm. 2013;70(5):453–456.
    1. Sachita S, Siemianowski L, Murphy M. Implementation of a pharmacy technician-centered medication reconciliation program at an urban teaching medical center. Am J Health Syst Pharm. 2014 Jan 1;71(1):51–56.
    1. Balon J, Thomas SA. Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists. J Nurs Scholarsh. 2011;43(3):292–300.
    1. Pavlov A, Muravyev R, Amoateng-Adjepong Y, Manthous CA. Inappropriate discharge on bronchodilators and acid-blocking medications after ICU admission: importance of medication reconciliation. Respir Care. 2014;59(10):1524–1529.
    1. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481–493.
    1. PubMed NIH National Center for Biotechnology Information. n.d. Available from:
    1. Saedder, et al. Identifying high-risk medication: a systematic literature review. Eur J Clin Pharmacol. 2014 Jun;70(6):637–45.
    1. Otero, et al. Developing a list of high-alert medications for patients with chronic diseases. Eur J Intern Med. 2014 Dec;25(10):900–8.
    1. Buajordet, et al. Fatal adverse drug events: the paradox of drug treatment. J Intern Med. 2001 Oct;250(4):327–41.
    1. Howard, et al. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study. Qual Saf Health Care. 2003 Aug;12(4):280–5.
    1. Lin, et al. Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study. Sci Rep. 2017 Jan 23;7(1):1–9.
    1. Blix, et al. Drugs with narrow therapeutic index as indicators in the risk management of hospitalised patients. Phar Prac. 2010 Jan-Mar;8(1):50–55.
    1. John, et al. Antiplatelet agents do not impact the hospital course in patients with gastrointestinal bleeding. J Clin Gastroenterol. 2011 Aug;45(7):583–589.
    1. ISMP List of High-alert medications in acute care settings Institute for Safe Medicine Practices (ISMP) 2018. Available from:
    1. Budnitz, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011 Nov 24;365(21):2002–12.
    1. Masud, et al. Central nervous system medications and falls risk in men aged 60-75 years: the Study on Male Osteoporosis and Aging (SOMA) Age Ageing. 2013 Jan;42(1):121–4.
    1. A to Z List of Cancer Drugs [Internet] National Cancer Institute. Available from:
    1. Stein Stephanie Aleskow, Lamos Elizabeth Mary, Davis Stephen N. A Review of the Efficacy and Safety of Oral Antidiabetic Drugs. Expert Opin Drug Saf. 2013;12(2):153–175.
    1. Ustulin M., Woo J., Woo J. T., Rhee S. Y. Characteristics of frequent emergency department users with type 2 diabetes mellitus in Korea. J Diabetes Investig. 2018;9(2):430–437.
    1. Detournay Bruno, et al. Hypoglycemia Hospitalization Frequency in Patients with Type 2 Diabetes Mellitus: A Comparison of Dipeptidyl Peptidase 4 Inhibitors and Insulin Secretagogues Using the French Health Insurance Database. Vasc Health and Risk Manag. 2015;11:417–425.
    1. Anelli, et al. Old and new antirheumatic drugs and the risk of hepatotoxicity. Ther Drug Monit. 2012 Dec;34(6):622–8.
    1. Murdaca, et al. Infection risk associated with anti-TNF-α agents: a review. Expert Opin Drug Saf. 2015 Apr;14(4):571–82.
    1. CDC . Antibiotic Use in the United States, 2017: Progress and Opportunities. Atlanta, GA: US Department of Health and Human Services, CDC; 2017.
    1. Shehab N, Lovegrove M, Geller A. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 2016 Nov 22;316(20):2115–25.
    1. Zucker J, Mittal J, Jen SP, Cheng L, Cennimo D. Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study. Pharmacotherapy. 2016 Mar 6;36(3):245–51.
    1. USP Therapeutic Categories Model Guidelines FDA. 2018. Mar 28, Available from:
    1. AHFS Classification – Drug Assignments AHFS Clinical Drug Information. 2020. Feb 6, Available from:
    1. Clark CM, Shaver AL, Aurelio LA, Feuerstein S, Wahler Jr RG, Daly CJ, Jacobs DM. Potentially Inappropriate Medications Are Associated with Increased Healthcare Utilization and Costs. J Am Geriatr Soc. 2020 Aug 5;
    1. Weir DL, Lee TC, McDonald EG, Motulsky A, Abrahamowicz M, Morgan S, Buckeridge D, Tamblyn R. Both new and chronic potentially inappropriate medications continued at hospital discharge are associated with increased risk of adverse events. J Am Geriatr Soc. 2020 Mar 31;
    1. American Geriatrics Society 2019 Update Expert Panel American Geriatrics Society 2019 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Jan 01;00(00):00–21. doi: 10.1111/jgs.15767. doi.
    1. O’Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Expert Rev. Clin. Pharmacol. 2020 Jan 2;13(1):15–22.
    1. Choosing Wisely . Ten Things Clinicians and Patients Should Question. American Geriatrics Society; 2015.
    1. Kim, et al. Development of a List of Potentially Inappropriate Drugs for the Korean Elderly Using the Delphi Method. Healthc Infor Res. 2010;16(4):231–252.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81.
    1. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. REDCap Consortium, The REDCap consortium: Building an international community of software partners. J Biomed Inform. 2019 May 9; doi: 10.1016/j.jbi.2019.103208. doi.
    1. Sharma AE, Yang J, Del Rosario JB, Hoskote M, Rivadeneira NA, Council SR, Sarkar U. What Safety Events Are Reported For Ambulatory Care? Analysis of Incident Reports from a Patient Safety Organization. Jt Comm J Qual Saf. 2020 Aug 21;
    1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–1428.
    1. Inflation Calculator: Find US Dollar's Value from 1913-2020 US Inflation Calculator. 2020 Dec 10; Available from:

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe