• Sunil Kripalani, Christianne L Roumie, Anuj K Dalal, Courtney Cawthon, Alexandra Businger, Svetlana K Eden, Ayumi Shintani, Kelly Cunningham Sponsler, L Jeff Harris, Cecelia Theobald, Robert L Huang, Danielle Scheurer, Susan Hunt, Terry A Jacobson, Kimberly J Rask, Viola Vaccarino, Tejal K Gandhi, David W Bates, Mark V Williams, Jeffrey L Schnipper, and PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group.
• Department of Medicine, Vanderbilt University, 1215 21st Avenue South, Suite 6000 Medical Center East, Nashville, TN 37232, USA. sunil.kripalani@vanderbilt.edu
• Ann. Intern. Med. 2012 Jul 3; 157 (1): 1-10.

BackgroundClinically 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).ObjectiveTo determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge.DesignRandomized, controlled trial with concealed allocation and blinded outcome assessors. (ClinicalTrials.gov registration number: NCT00632021)SettingTwo tertiary care academic hospitals.PatientsAdults hospitalized with acute coronary syndromes or acute decompensated heart failure.InterventionPharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge.MeasurementsThe 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.ResultsAmong 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]).LimitationThe characteristics of the study hospitals and participants may limit generalizability.ConclusionClinically 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.Primary Funding SourceNational Heart, Lung, and Blood Institute.

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