A new study from researchers at Johns Hopkins University finds that nurse-pharmacist teams trained to find and resolve discrepancies between the drugs patients take at home and those they are given in the hospital could significantly reduce adverse drug interactions and the likelihood that patients will fail to take prescribed medicine. The study was funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI) of the Robert Wood Johnson Foundation (RWJF).
Leonard Feldman, MD, Linda Costa, PhD, RN, and colleagues examined 563 cases at a large urban hospital in which doctors and nurses both took a medication history from each patient. Nurses reviewed electronic medical records in instances where patients could not recall their medications or the frequency with which they took them. If necessary, nurses also called the patient's family, primary care physician and pharmacists for more information. They compared the resulting lists with admission medication orders to identify discrepancies. The nurses then consulted with a pharmacist, as needed, and informed physicians about any apparently unintentional discrepancies. They followed a similar protocol when patients were discharged.
According to the researchers, the medication lists of nearly 40 percent of patients had at least one unintended discrepancy. Most of these unintended discrepancies were on admission, but the discrepancies with the potential to cause the most harm were more common upon discharge. In addition to providing improved tracking of patients' medication, the researchers concluded that the approach also saved money—costing $114 per identified discrepancy, but saving the hospital thousands of dollars. Researchers calculated that the nurse-pharmacist collaboration saved 81 times the break-even cost for the program.
The study was published in the May/June issue of the Journal of Hospital Medicine.
Nurse "burnout" in hospitals is associated with increased rates of hospital-acquired infections (HAIs), costing hospitals millions of dollars a year, according to a study in the August issue of the American Journal of Infection Control.
Researchers analyzed Pennsylvania data from several sources, working to gauge the effect of nurse staffing and burnout on catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI), two common HAIs.
More than one-third of nurse respondents to a survey registered "emotional exhaustion" scores that qualified them for "burnout" status. The data showed that each 10-percent increase in a hospital's number of high-burnout nurses was associated with nearly one additional CAUTI and two additional SSIs per 1,000 patients annually. The researchers also calculated that each additional patient assigned to a nurse led to roughly one additional infection per 1,000 patients per year.
Applying the average costs associated with CAUTIs and SSIs, the researchers estimated that reducing burnout rates to 10 percent from the current average of 30 percent would prevent an estimated 4,160 infections, saving approximately $41 million annually.
"Health care facilities can improve nurse staffing and other elements of the care environment and alleviate job-related burnout in nurses at a much lower cost than those associated with health-care-associated infections," write the authors. "By reducing nurse burnout, we can improve the well-being of nurses while improving the quality of patient care."
Study co-authors include Jeannie P. Cimiotti, DNSc, MS, MFA, of the New Jersey Collaborating Center for Nursing, and Linda Aiken, PhD, of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Both institutions are supported by RWJF.