Pharmacist- Versus Physician-Initiated Admission Medication Reconciliation: Impact on Adverse Drug Events

2012 ◽  
Vol 10 (4) ◽  
pp. 242-250 ◽  
Author(s):  
Kari A. Mergenhagen ◽  
Sharon S. Blum ◽  
Anne Kugler ◽  
Elayne E. Livote ◽  
Jonathan R. Nebeker ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events

scholarly journals Engaging hospital patients in the medication reconciliation process using tablet computers

2018 ◽  
Vol 25 (11) ◽  
pp. 1460-1469 ◽  
Author(s):  
Jennifer E Prey ◽  
Fernanda Polubriaginof ◽  
Lisa V Grossman ◽  
Ruth Masterson Creber ◽  
Demetra Tsapepas ◽  
...  
Keyword(s):  
Medication Review ◽  
Medication Safety ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication List ◽  
Medication Discrepancies ◽  
Home Medication ◽  
Verbal Participation ◽  
Hospital Patients ◽  
Home Medication Review

Abstract Objective Unintentional medication discrepancies contribute to preventable adverse drug events in patients. Patient engagement in medication safety beyond verbal participation in medication reconciliation is limited. We conducted a pilot study to determine whether patients’ use of an electronic home medication review tool could improve medication safety during hospitalization. Materials and Methods Patients were randomized to use a toolbefore orafter hospital admission medication reconciliation to review and modify their home medication list. We assessed the quantity, potential severity, and potential harm of patients’ and clinicians’ medication changes. We also surveyed clinicians to assess the tool’s usefulness. Results Of 76 patients approached, 65 (86%) participated. Forty-eight (74%) made changes to their home medication list [before: 29 (81%),after: 19 (66%),p = .170].Before group participants identified 57 changes that clinicians subsequently missed on admission medication reconciliation. Thirty-nine (74%) had a significant or greater potential severity, and 19 (36%) had a greater than 50-50 chance of harm.After group patients identified 68 additional changes to their reconciled medication lists. Fifty-one (75%) had a significant or greater potential severity, and 33 (49%) had a greater than 50-50 chance of harm. Clinicians reported believing that the tool would save time, and patients would supply useful information. Discussion The results demonstrate a high willingness of patients to engage in medication reconciliation, and show that patients were able to identify important medication discrepancies and often changes that clinicians missed. Conclusion Engaging patients in admission medication reconciliation using an electronic home medication review tool may improve medication safety during hospitalization.

scholarly journals Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

2017 ◽  
Vol 70 (6) ◽  
Author(s):  
Jo-Anne S Wilson ◽  
Matthew A Ladda ◽  
Jaclyn Tran ◽  
Marsha Wood ◽  
Penelope Poyah ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Quality Care ◽  
Community Pharmacists ◽  
Family Physicians ◽  
Dialysis Patients ◽  
Medication Discrepancies ◽  
Personnel Infirmier ◽  
Étude De Cohorte ◽  
Potential Level

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients.</p><p><strong>Objectives: </strong>To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service.</p><p><strong>Methods: </strong>This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepanciesidentified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation.</p><p><strong>Results:</strong> Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients.</p><p><strong>Conclusions: </strong>This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Le bilan comparatif des médicaments en soins ambulatoires peut réduire les divergences au chapitre des médicaments et les événements indésirables liés aux médicaments. Les divergences relatives aux médicaments représentent un risque élevé pour les patients dialysés, car ils souffrent normalement de multiples troubles comorbides, ils prennent souvent de nombreux médicaments et ils sont soignés par bon nombre de praticiens. Peu d’information existe sur les possibles avantages du bilan comparatif des médicaments en soins ambulatoires pour ces patients.</p><p><strong>Objectifs : </strong>Déterminer le nombre et la catégorie des divergences concernant les médicaments constatées lors d’un bilan comparatif des médicaments en soins ambulatoires ainsi que la gravité potentielle des préjudices consécutifs. De plus, établir la position des pharmaciens communautaires et des médecins de famille sur cette modalité du bilan comparatif des médicaments.</p><p><strong>Méthodes : </strong>La présente étude de cohorte rétrospective a été menée auprès de patients amorçant un traitement par hémodialyse pour qui un bilan comparatif des médicaments en soins ambulatoires a été réalisé dans le cadre d’un programme hospitalier des maladies du rein, entre juillet 2014 et juillet 2016. Les divergences trouvées dans les formulaires de bilan comparatif des médicaments ont été classées par catégorie et selon la gravité potentielle des préjudices. Le niveau du préjudice a été déterminé de manière indépendante par un pharmacien et un membre du personnel infirmier praticien à l’aide d’un système de notation défini. En cas de désaccord, le score final était établi par un néphrologue. Des sondages ont été envoyés à 52 pharmaciens communautaires et à 44 médecins de famille prodiguant des soins aux participants afin qu’ils expriment leurs opinions et leurs points de vue sur le bilan comparatif des médicaments en soins ambulatoires.</p><p><strong>Résultats : </strong>En tout, 296 bilans comparatifs des médicaments en soins ambulatoires ont été effectués auprès de 147 patients hémodialysés. Le nombre moyen de divergences constatées par patient était de 1,31 (écart-type de 2,00). Dans l’ensemble, 30 % de ces divergences ont été considérées comme une source potentielle d’un inconfort allant de modéré à grave ou de dégradation clinique. Selon les résultats du sondage, les praticiens communautaires ont jugé le bilan comparatif des médicaments en soins ambulatoires utile à la prestation de soins de qualité aux patients dialysés.</p><p><strong>Conclusions : </strong>D’après les résultats de l’étude, le bilan comparatif des médicaments en soins ambulatoires augmenterait la sécurité des patients et pourrait prévenir les événements indésirables liés aux divergences relatives aux médicaments.</p>

Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital Discharge and Primary Care Follow-Up

2014 ◽  
Vol 29 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Becky L. Armor ◽  
Avery J. Wight ◽  
Sandra M. Carter
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Transitions Of Care ◽  
Therapeutic Monitoring ◽  
Medication List ◽  
Medication Discrepancies

Approximately two-thirds of adverse events posthospital discharge are due to medication-related problems. Medication reconciliation is a strategy to reduce medication errors and improve patient safety. Objective: To evaluate adverse drug events (ADEs), potential ADEs (pADEs), and medication discrepancies occurring between hospital discharge and primary care follow-up in an academic family medicine clinic. Adult patients recently discharged from the hospital were seen by a pharmacist for medication reconciliation between September 1, 2011, and November 30, 2012. The pharmacist identified medication discrepancies and pADEs or ADEs from a best possible medication history obtained from the electronic medical record (EMR) and hospital medication list. In 43 study participants, an average of 2.9 ADEs or pADEs was identified ( N = 124). The most common ADEs/pADEs identified were nonadherence/underuse (18%), untreated medical problems (15%), and lack of therapeutic monitoring (13%). An average of 3.9 medication discrepancies per participant was identified (N = 171), with 81% of participants experiencing at least 1 discrepancy. The absence of a complete and accurate medication list at hospital discharge is a barrier to comprehensive medication management. Strategies to improve medication management during care transitions are needed in primary care.

A FORMAL MEDICATION RECONCILIATION PROGRAMME IN A HAEMODIALYSIS UNIT CAN IDENTIFY MEDICATION DISCREPANCIES AND POTENTIALLY PREVENT ADVERSE DRUG EVENTS

2015 ◽  
Vol 41 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Winnie WY Chan ◽  
Geetha Mahalingam ◽  
Robert MA Richardson ◽  
Olavo A Fernandes ◽  
Marisa Battistella
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Discrepancies

Improving medication reconciliation in ambulatory cancer care.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 224-224
Author(s):  
Carissa Milley-Daigle ◽  
Celina Dara ◽  
Genevieve Bouchard-Fortier ◽  
Anet Julius ◽  
Vishal Kukreti ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Median Number ◽  
Medication History ◽  
Time Motion ◽  
Motion Study ◽  
Study Results ◽  
Ambulatory Oncology ◽  
Medication Documentation

224 Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date; PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4th clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed; Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10; median number of medications per patient = 12.3). Conclusions: BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care. [Table: see text]

scholarly journals Electronic tools to support medication reconciliation: a systematic review

2016 ◽  
Vol 24 (1) ◽  
pp. 227-240 ◽  
Author(s):  
Sophie Marien ◽  
Bruno Krug ◽  
Anne Spinewine
Keyword(s):  
User Satisfaction ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Cochrane Library ◽  
Future Research ◽  
Successful Implementation ◽  
Multiple Sources ◽  
Medication History ◽  
Quality Of Reporting ◽  
Medication Discrepancies

Objectives: Medication reconciliation (MedRec) is essential for reducing patient harm caused by medication discrepancies across care transitions. Electronic support has been described as a promising approach to moving MedRec forward. We systematically reviewed the evidence about electronic tools that support MedRec, by (a) identifying tools; (b) summarizing their characteristics with regard to context, tool, implementation, and evaluation; and (c) summarizing key messages for successful development and implementation. Materials and Methods: We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and the Cochrane Library, and identified additional reports from reference lists, reviews, and patent databases. Reports were included if the electronic tool supported medication history taking and the identification and resolution of medication discrepancies. Two researchers independently selected studies, evaluated the quality of reporting, and extracted data. Results: Eighteen reports relative to 11 tools were included. There were eight quality improvement projects, five observational effectiveness studies, three randomized controlled trials (RCTs) or RCT protocols (ie, descriptions of RCTs in progress), and two patents. All tools were developed in academic environments in North America. Most used electronic data from multiple sources and partially implemented functionalities considered to be important. Relevant information on functionalities and implementation features was frequently missing. Evaluations mainly focused on usability, adherence, and user satisfaction. One RCT evaluated the effect on potential adverse drug events. Conclusion: Successful implementation of electronic tools to support MedRec requires favorable context, properly designed tools, and attention to implementation features. Future research is needed to evaluate the effect of these tools on the quality and safety of healthcare.

Medication Reconciliation at Hospital Discharge: Evaluating Discrepancies

2008 ◽  
Vol 42 (10) ◽  
pp. 1373-1379 ◽  
Author(s):  
Jacqueline D Wong ◽  
Jana M Bajcar ◽  
Gary G Wong ◽  
Shabbir MH Alibhai ◽  
Jin-Hyeun Huh ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Tertiary Care ◽  
Clinical Impact ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
General Internal ◽  
Discharge Medication ◽  
Number Of Patients

Background: Hospital discharge is an interlace of care when patients are at a high risk of medication discrepancies as they transition from hospital to home. These discrepancies are important, as they may contribute to drug-related problems, medication errors, and adverse drug events. Objective: To Identify, characterize, and assess the clinical impact of unintentional medication discrepancies at hospital discharge. Methods: All consecutive general internal medicine patients admitted for at least 72 hours to a tertiary care teaching hospital were prospectively assessed. Patients were excluded if they were discharged with verbal prescriptions; died during hospitalization; or transferred from or to a nursing home, another institution, or another unit within the same hospital. The primary endpoint was to determine the number of patients with at least one unintended medication discrepancy on hospital discharge. Medication discrepancies were assessed through comparison of a best possible medication discharge list with the actual discharge prescriptions. Secondary objectives were to characterize and assess the potential clinical impact of the unintentional discrepancies. Results: From March 14,2006, to June 2,2006,430 patients were screened for eligibility; 150 patients were included in the study. Overall, 106 (70.7%) patients had at least one actual or potential unintentional discrepancy. Sixty-two patients (41.3%) had at least one actual unintentional medication discrepancy al hospital discharge and 83 patients (55.3%) had at least one potential unintentional discrepancy. The most common unintentional discrepancies were an incomplete prescription requiring clarification, which could result in a patient delay in obtaining medications (49.5%), and the omission of medications (22.9%). Of the 105 unintentional discrepancies, 31 (29.5%) had the potential to cause possible or probable patient discomfort and/or clinical deterioration. Conclusions: Medication discrepancies occur commonly on hospital discharge. Understanding the type and frequency of discrepancies can help clinicians better understand ways to prevent them. Structured medication reconciliation may help to prevent discharge medication discrepancies.

scholarly journals Avoiding a Med-Wreck: a structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ali Elbeddini ◽  
Sarah Almasalkhi ◽  
Thulasika Prabaharan ◽  
Cindy Tran ◽  
Mohamed Gazarin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare System ◽  
Medication Errors ◽  
Continuous Quality Improvement ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Hospital Readmissions ◽  
Care Facility ◽  
Term Care ◽  
Continuous Quality

Abstract Background The incidence of preventable adverse drug events (ADE) is approximately one medication error per patient per hospital-day. A quality medication reconciliation (MedRec) process is a crucial intervention used to reduce ADE in the hospital and community setting. Amid the coronavirus disease 2019 (COVID-19) pandemic, preventing medication errors is vital to avoid patient readmission, reduce disease complications, and reduce cost and patient burden on the healthcare system. Objectives To develop a standardized MedRec framework that can be implemented in all healthcare settings to reduce patient and staff harm during COVID-19. Also, to create a standardized auditing tool used to assess the quality of the MedRec process and allow for continuous quality improvement. Methods A multi-site gap analysis (MGA) was performed to collect observational data that were collected from four different healthcare sites (two hospitals, a long-term care facility, and a community pharmacy). MGA consists of collecting data across several sites which answer a standardized questionnaire. A standardized MedRec framework and auditing tool were developed based on the gaps observed in each site and literature reviews. Results A standardized MedRec process was not implemented in any of the observed sites. The healthcare sites lacked a designated MedRec team and training related to the MedRec process leading to multiple discrepancies at discharge. Patients were not counselled on changes to home medications, and a discharge report was often not provided upon discharge. Communication mechanisms between community pharmacies and hospital physicians are not available or easily accessible. Conclusion The proposed structured MedRec framework is vital to reduce medication errors and patient harm amid COVID-19. Moreover, the comprehensive auditing tool developed in this study allows for continuous quality improvement resulting in superior quality care, reduction of workflow inefficiencies, cost savings on hospital readmissions, and overall enhanced healthcare system performance.

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