Background: Pharmacist-led peri-discharge interventions reduce adverse drug events. However, evidence is lacking as to whether there is a business case to fund these non-billable interventions. To test whether such interventions could drive reductions in post-discharge health care utilization to help build a business case, we conducted a pragmatic randomized controlled trial (RCT). Methods: The PHARMacist [...]

Background: Hospitalizations related to opioid use disorder (OUD) are rising, creating opportunities to initiate medications for opioid use disorder (MOUD) and connect patients with outpatient resources.1,2 Despite evidence that MOUD reduces morbidity and mortality, most patients fail to receive evidence-based treatment during hospitalization.3-6 Addiction consultation services are becoming the standard of care to address this [...]

Background: Despite a public health crisis – over 500,000 individuals have died from opioid overdoses since 2000 – and the availability of effective therapies, most patients with Opioid Use Disorder (OUD) are not offered treatment. Medication-Assisted Treatment (MAT), such as with buprenorphine, is associated with significantly higher rates of abstinence and follow-up, lower rates of [...]

Background: Post hospital discharge review during the transition from hospital to skilled nursing facility (SNF) is critical to avoid medication errors, improve patient outcomes and reduce hospital readmissions (1-3). Despite increased integration of electronic health records (EHR) across health entities, communication gaps and discharge-related medication errors still persist (2,4). These challenges can be more predominant [...]

Background: Medication reconciliation (MR) is critical for patient safety during hospital admissions and transitions, though MR completion may be complicated by factors such as lack of familiarity with the electronic medical record (EHR) or missing information at admission. Over the past three years, our urban academic quaternary care hospital has led a successful MR improvement [...]

Background: Despite a public health crisis – over 500,000 individuals have died from opioid overdoses since 2000 – and the availability of effective therapies, most patients with Opioid Use Disorder (OUD) are not offered treatment. Medication-Assisted Treatment (MAT), such as with buprenorphine, is associated with significantly higher rates of abstinence and follow-up, lower rates of [...]

Background: Post hospital discharge review during the transition from hospital to skilled nursing facility (SNF) is critical to avoid medication errors, improve patient outcomes and reduce hospital readmissions (1-3). Despite increased integration of electronic health records (EHR) across health entities, communication gaps and discharge-related medication errors still persist (2,4). These challenges can be more predominant [...]

Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order [...]

Background: Alcohol use disorder (AUD) is the most prevalent substance use disorder, but most patients with AUD do not receive evidence-based medications for AUD (MAUD), including naltrexone or acamprosate. Inpatient addiction consult services (ACS) may offer an opportunity to start medical treatment for hospitalized patients with AUD, but it is unknown if ACS are associated [...]

Background: Medication errors are common, with more than half of patients estimated to have greater than or equal to one unintended medication discrepancy at hospital admission.  Medication reconciliation can identify errors. Although there has been significant investigation into the most effective logistical strategies for performing medicine reconciliation within the healthcare system, there is little investigation [...]