A Randomized Control Trial Testing a Medication Safety Dashboard in Veteran Transplant Recipients

Prog Transplant. 2023 Jun;33(2):121-129 doi: 10.1177/15269248231164177.
Abstract
INTRODUCTION:

Medication errors, adverse events, and nonadherence in organ transplant recipients are common and can lead to suboptimal outcomes. A medication safety dashboard was developed to identify issues in medication therapy.

RESEARCH QUESTIONS:

Can a multicenter bioinformatics dashboard accurately identify clinically relevant medication safety issues in US military Veteran transplant recipients?

DESIGN:

The dashboard was tested through a 24-month, prospective, cluster-randomized controlled multicenter study. Pharmacists used the dashboard to identify and address potential medication safety issues, which was compared with usual care.

RESULTS:

Across the 10 sites (5 control sites and 5 intervention sites), 2012 patients were enrolled (1197 intervention vs 831 control). The mean age was 65 (10) years, 95% male, and 27% Black. The dashboard produced 18 132 alerts at a rate of 0.61(0.32) alerts per patient-month, ranging from 0.44 to 0.72 across the 5 intervention sites. Lab-based issues were most common (83.4%), followed by nonadherence (9.4%) and transitions in care (6.4%); 56% of alerts were addressed, taking an average of 43 (29) days. Common responses to alerts included those already resolved by another provider (N = 4431, 44%), the alert not clinically relevant (N = 3131, 31%), scheduling of follow-up labs (N = 591, 6%), and providing medication reconciliation/education (N = 99, 1%). Inaccurate flags significantly decreased over the study by a mean of -0.6% per month (95% CI -0.1 to -1.0; P = .0265), starting at 13.4% and ending at 2.6%.

CONCLUSION:

This multicenter cluster-randomized controlled trial demonstrated that a medication safety dashboard was feasibly deployable across the VA healthcare system, creating valid alerts.

Methodological quality
Jadad score 2
Allocation concealment NO
Data analysis PER PROTOCOL
Metadata
Funding: Non-industry funding
Publication type: Randomized Controlled Trial, Multicenter Study, Randomised Controlled Trial
Trial registration: ClinicalTrials.gov - NCT03860818
Organ: Kidney; Pancreas; Liver; Heart; Heart/Lung; Lung; Intestine; Various
Language: English
Author email: david.taber2@va.gov
MeSH terms: Humans; Male; Aged; Female; Veterans; Transplant Recipients; Prospective Studies; Medication Errors; Pharmacists; Heart Transplantation; Heart-Lung Transplantation; Kidney Transplantation; Lung Transplantation; Liver Transplantation; Pancreas Transplantation