Strengthened clinician collaboration to reduce medication errors in Aussie hospitals

This model of collaborative prescribing has been proven to drastically reduce medication error rates. [Shutterstock]

Key Points:

  • Research shows two medication errors are made on admission to hospital for every three patients, and an error occurs 1 in 10 times a medication is administered
  • Those aged 65 and older experience three times as many medication errors during hospital stays than younger patients
  • The CARe-MED study will implement and evaluate a patient-centred, partnered medication charting and deprescribing model in hospitals using electronic medical records

Pharmacists will partner with patients and doctors in a new national project to reduce patient medication errors that frequently occur for older people during hospital stays.

By bringing pharmacists into the fold to collaborate with doctors and patients on an electronic medication and prescription model, the CARe-MED project team expects to see a marked reduction in the number of medication errors being made in hospitals.

While some medication-related errors are minor, in extreme cases they can cause permanent disability or even death. 

The $1.4 million Federal Government-funded project will be led by Doctor Jacinta Johnson, a University of South Australia pharmacist, who is also responsible for driving research development across South Australian public hospital pharmacies.

Why do medication errors occur more for older patients?

Dr Johnson said the project aims to improve the quality of care for people aged 65 years and older, a demographic that tends to present to hospitals with more chronic conditions, comorbidities and complex health histories that may require the administration of several different medications and doses, increasing the complexity of their medication regimens. 

“Coexisting conditions may require medications with overlapping side effects or contraindications, increasing the likelihood of medication-related harm […] Medication errors are the most frequent and preventable mistakes being made in hospitals today.”

Furthermore, older patients are also more likely to experience frequent transitions between healthcare settings, such as hospital admissions, transfers to rehabilitation facilities, or residential aged care. Dr Johnson explained that these transitions can lead to medication discrepancies, incomplete medication reconciliation, or miscommunication between healthcare providers, increasing the risk of errors. 

Older patients are also often more vulnerable to adverse events related to medicines, such as delirium or falls, so if medication errors do occur they can cause greater harm in older people.

“We certainly hope this partnered charting model will improve both the safety and the efficiency of medication-related handover during transition from hospital to aged care facilities,” Dr Johnson said.

“We aim to integrate development of a collaborative discharge medication plan as part of the discharge process.”

Currently, when a patient is being discharged to an aged care facility, the doctor will prepare the medication chart and the pharmacist will then reconcile and review it prior to the patient leaving the hospital. If any issues are identified the pharmacist has to seek out the prescriber to discuss and modify as appropriate, and this reactive process can slow things down. Sometimes the pharmacist doesn’t have an opportunity to review the chart at all. 

Dr Johnson explained that the CARe-MED model will, “Streamline this process by ensuring pharmacists can contribute proactively, rather than reactively at the time of discharge.” 

The new study will advance current evidence by:

  • Exploring the impact of partnered pharmacist charting using electronic medical records
  • Assessing the impact of partnered pharmacist charting on medication-related harm directly
  • Examining the impact of integrated partnered deprescribing on hospital discharge
  • Measuring how clinicians’ work is altered through partnered pharmacist medication charting

This work will build on a range of paper-based pharmacist charting models that have been evaluated in Australia, demonstrating significant reductions in medication errors (from 66% to 3.6%), cutting average hospital stays by 10% and reducing the cost per admission by $726.

However, Dr Johnson did say it is important to validate the partnered charting model of care in digital settings as electronic prescribing is known to introduce new error types and patterns but hopes the deprescribing model can minimise risk and be scaled to support millions of older people both in hospital and in aged care settings.

The model will be evaluated at metropolitan and rural hospitals in South Australia and Queensland over the next four years in collaboration with SA Pharmacy, Metro South Health and the University of Queensland.

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