Impact of clinical decision support therapeutic interchanges on hospital discharge medication omissions and duplications. (23rd May 2021)

• Record Type: Journal Article
• Authors: Maxwell, Erin; Amerine, James; Carlton, Glenda; Cruz, Jennifer L; Pappas, Ashley L; Heindel, Gregory A
• Is Part Of: American journal of health-system pharmacy. Volume 78(2021)supplement 3
• Page Start: S88
• Page End: S94
• Publication Date: 2021-05-23
• Subjects: formulary stewardship -- medication reconciliation -- medication-use policy -- pharmacy technology -- therapeutic interchange; Hospital pharmacies -- United States -- Periodicals; 615.1
• DOI: 10.1093/ajhp/zxab219
• Languages: English
• ISSNs: 1079-2082

Abstract

Abstract: Purpose: Automatic therapeutic substitution (ATS) protocols are formulary tools that allow for provider-selected interchange from a nonformulary preadmission medication to a formulary equivalent. Previous studies have demonstrated that the application of clinical decision support (CDS) tools to ATS can decrease ATS errors at admission, but there are limited data describing the impact of CDS on discharge errors. The objective of this study was to describe the impact of CDS-supported interchanges on discharge prescription duplications or omissions. Methods: This was a single-center, retrospective cohort study conducted at an academic medical center. Patients admitted between June 2017 and August 2019 were included if they were 18 years or older at admission, underwent an ATS protocol–approved interchange for 1 of the 9 included medication classes, and had a completed discharge medication reconciliation. The primary outcome was difference in incidence of therapeutic duplication or omission at discharge between the periods before and after CDS implementation. Results: A total of 737 preimplementation encounters and 733 postimplementation encounters were included. CDS did not significantly decrease the incidence of discharge duplications or omissions (12.1% vs 11.2%; 95% confidence interval [CI], –2.3% to 4.2%) nor the incidence of admission duplication or inappropriate reconciliation (21.4% vs 20.7%; 95% CI, –3.4% to 4.8%) when comparing the pre- and postimplementation periods. Inappropriate reconciliation was the primary cause of discharge medication errors for both groups. Conclusion: CDS implementation was not associated with a decrease in discharge omissions, duplications, or inappropriate reconciliation. Findings highlight the need for thoughtful medication reconciliation at the point of discharge.