Authors: Lexi Barbush, PharmD; Sheshadri Hoque, PharmD; Evan Hurley, PharmD, BCIDP Learning Objective: Identify common medication errors at discharge in patients initially admitted with sepsis to implement effective pharmacist-led review processes Self-Assessment Question: True/False Pharmacist intervention led to a decrease in medication errors attributable to readmissions after being hospitalized for sepsis Background/Objective: Sepsis hospitalizations often require reassessment of chronic medications due to changes in clinical baseline, yet optimization at discharge may be overlooked as focus remains on the acute infection. Methods: This was a pre- and post-implementation study that was conducted September 2025 through March 2026. This study included patients ≥18 years old who were hospitalized with sepsis. Patients were excluded if they were discharged to hospice, or left against medical advice. A pharmacist assessed antihypertensives, antimicrobials, antidiabetics, and anticoagulants. Types of interventions involved dose adjustments, discontinuation of duplicate or unindicated therapies, identification of discharge list discrepancies, and initiation of indicated therapies. The primary outcome was 30-day readmissions in patients with reviewed discharge lists versus unreviewed discharge lists. Secondary outcomes included types of interventions and the number of accepted vs rejected interventions. Results: Preliminary results for January through February 2026 show that the readmission rate in unreviewed patients is 21% vs 13% in the reviewed patient group (p=0.2). The most common intervention type was adding a medication at discharge and most interventions were concerning antihypertensives. The most frequently rejected intervention was removing an antimicrobial from the discharge list, as providers preferred to extend therapy past IDSA guidelines recommended durations. Most notably, of the reviewed patients who were readmitted (n=11), zero were due to reasons relating to the pre-defined drug classes and the disease states they manage versus 9 of the 50 readmitted patients in the pre-implementation group. Conclusion: Preliminary data demonstrates that in patients initially admitted with sepsis, the pharmacist-reviewed group had a lower readmission rate compared to non-reviewed patients (13% vs 21%, p=0.2). The pharmacist-review process led to a decrease in readmissions attributable to errors in the pre-defined drug classes or the disease states they target compared to Phase I readmitted patients (0% vs 18%).
