Scoring system could help reduce adverse drug events in hospital patients

University of Florida College of Pharmacy researchers are working closely with colleagues at UF Health to identify hospital patients at greatest risk for preventable adverse drug events.

The American Society of Health-System Pharmacists Research and Education Foundation has awarded a two-year, $499,000 grant to College of Pharmacy researcher Almut Winterstein, Ph.D., to lead a UF Health research team that will develop and validate a complexity score to help hospitals determine the best pharmacist staffing to prevent adverse drug events and improve patient safety.

“Adverse events in health care have received increasing attention over the past two decades because many are preventable,” said Winterstein, a professor of pharmaceutical outcomes and policy at the UF College of Pharmacy. “Errors surrounding the selection or dosing of medications have been described as one of the most prominent areas in health care that result in preventable adverse events.”


(l-r) UF Health research team members Tom Johns, Gigi Lipori, Almut Winterstein, Babette Brumback and Richard Segal meet to discuss their work.
(l-r) UF Health research team members Tom Johns, Gigi Lipori, Almut Winterstein, Babette Brumback and Richard Segal meet to discuss their work.

Health care reform measures call for better quality and safer health care with lower costs. To meet new challenges, the American Society of Health-System Pharmacists, or ASHP, together with the ASHP Research and Education Foundation, has proposed a pharmacy practice model that emphasizes pharmacists’ key role in medication therapy management. To place pharmacists at the bedside of those patients who need their services the most, guidance is needed, Winterstein said.

 The complexity score will use automated information in patients’ electronic health records to produce real-time predictions of which admitted patients are at greatest risk for having an adverse drug event and therefore need medication management services. Winterstein’s research team envisions a daily report generated to alert pharmacists of the patients who have the highest scores based on their medical history and current health conditions.

Initially, the complexity score will be developed and tested at UF Health Shands Hospital and UF Health Jacksonville. The final tool will be an automated scoring system integrated into electronic health records that can be implemented nationwide.

Pharmacy research collaborators Thomas Johns, Pharm.D., an assistant director for pharmacy services at UF Health Shands Hospital, and Richard Segal, R.Ph., Ph.D., a professor and chair in the UF College of Pharmacy, will lend their expertise in patient safety to the project. Johns will focus on the translation of targeted, preventable adverse drug events and their risk factors into variables that can be automatically extracted from UF Health’s electronic health record databases. Segal, the Dr. Robert and Barbara Crisafi chair in pharmaceutical outcomes and policy, will help establish a comprehensive set of preventable adverse drug events to target with the complexity score prediction model.

“Pharmacists are a valuable resource in protecting patients from adverse drug events, but they cannot be everywhere,” Johns said. “The complexity score is the first comprehensive approach to support pharmacist allocation at the bedside in terms of greatest medication therapy management needs.”

Rounding out the collaborative effort, Winterstein has invited Gigi Lipori, M.T., M.B.A., the senior director for operational planning and analysis at UF Health Shands Hospital, and Babette Brumback, Ph.D., a professor of biostatistics in the colleges of Public Health and Health Professions and Medicine, to join her team. Lipori leads the development of a data warehouse for research and quality improvement at UF Health. Brumback will oversee statistical aspects of model development and validation.

In the study’s second year, the complexity score will be validated in 13 hospitals, including the Malcom Randall Veterans Affairs Medical Center in Gainesville, Fla., seven Orlando-area hospitals within the Florida Hospital system, and five hospitals belonging to the Methodist LeBonheur Healthcare in Memphis, Tenn. The facilities range in size from 50 to nearly 1,100 beds and anywhere from two to more than 50 pharmacists. They also vary in medical specializations, geographic location, teaching affiliation and type of electronic health record system, which will allow researchers to fully test the effectiveness of the complexity score, Winterstein said.

“The ASHP Foundation is excited to support this groundbreaking work at the University of Florida,” said Stephen J. Allen, M.S., executive vice president and CEO of the ASHP Foundation. “We expect that use of this validated score in hospitals across the United States will result in better patient care and optimized use of pharmacists as the health care team members who are responsible and accountable for patients’ medication-related outcomes.”

Receiving the ASHP funding has special meaning to Winterstein. Her first grant as a junior faculty member at UF was from the ASHP Foundation. As a researcher and graduate coordinator in pharmaceutical outcomes and policy, Winterstein today has more than 200 peer-reviewed manuscripts and abstracts in pharmacoepidemiology and patient safety research.

“This new award will synthesize 15 years of experience in a tool that will hopefully make a significant contribution to hospital inpatient care and patient outcomes,” Winterstein said.