Impact evaluation of the modified adverse inpatient medication event (AIME-Frail) model in hospitalised adults.

AIMS: To assess whether the AIME-Frail tool assists in medication management prioritisation and reduces inpatient medication harm events, evaluate tool implementation challenges and enablers, and identify predictive risk factors for medication harm.

METHODS

General and geriatric medicine patients at a tertiary hospital in Queensland, Australia were enrolled in a controlled study. Medication harm was identified through electronic medical record (EMR) reviews, a trigger tool, and discussions with treating teams. In the intervention group, pharmacists used the AIME-Frail tool for risk-based prioritisation of medication reviews, while the control group received usual care. Incidence and types of medication harm were compared between groups. Reflexive journaling was used to document insights on tool use by pharmacists, identifying barriers and enablers for implementation. Predictive risk factors were identified using regression models.

RESULTS

A total of 279 patients participated. Medication harm occurred in 51 patients (18.3%). The most common type was gastrointestinal harm, with opioids and antibacterials causing constipation and nausea/vomiting, while anticoagulants caused bleeding and bruising. There was no difference between intervention and control groups in incidence of medication harm 23/142 (16.2%) versus 28/137 (20.4%) respectively (P = 0.44). Key implementation challenges included lack of integration into the EMR and suboptimal compliance with tool use by pharmacists. Predictive risk factors for medication harm included renal impairment, dementia, depression, and longer hospital stay (P ≤ 0.05).

CONCLUSION

While the AIME-Frail tool identified high-risk patients, it did not significantly reduce medication harm, possibly due to implementation challenges. Future studies should aim to update the model using predictive risk factors and optimise the usability of the tool for pharmacists.