Advanced Medication Reconciliation: A Systematic Review of the Impact on Medication Errors and Adverse Drug Events Associated with Transitions of Care

2021 ◽  
Author(s):  
Lauren Killin ◽  
Areej Hezam ◽  
Kelly K. Anderson ◽  
Blayne Welk
Keyword(s):  
Systematic Review ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Transitions Of Care ◽  
The Impact

scholarly journals P54 Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

2020 ◽  
Vol 105 (9) ◽  
pp. e35.1-e35
Author(s):  
Adam Sutherland ◽  
Denham Phipps ◽  
Steve Tomlin ◽  
Darren Ashcroft
Keyword(s):  
Systematic Review ◽  
Medication Errors ◽  
Adverse Drug Events ◽  
Improve Patient Safety ◽  
Medical Officer ◽  
Cochrane Library ◽  
List Type ◽  
Drug Related Problems ◽  
Prescribing Errors ◽  
The Uk

AimsProblems with medication account for 10–20% of all adverse healthcare events in the NHS, costing between £200–400 million per year.1 Children are more likely to experience medication related harm.2 International reviews of the prevalence of drug-related problems are over ten years old.3 There is a need for a focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK to support the development and targeting of interventions to improve medication safety.4MethodsNine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to September 2018. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children, and quality appraisal of the studies was conducted.Results26 studies were included; none of which specifically reported on the prevalence of ADEs. Three ADR studies reported a median prevalence of 28.3% of patients (IQR 13); >70% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors and the median prescribing error rate in all paediatric contexts was 10.7% of prescriptions (IQR 6) Seven studies explored prescribing errors in PICU and the prevalence was twice that in non-ICU areas (11.1% prescriptions; IQR 2.9 versus 6.5% prescriptions; IQR 4.3). The median rate of dose prescribing errors was 11.1% doses prescribed (IQR 10.6). Four studies reported administration errors of which three used consistent methods. Across these three studies, a median prevalence of 12.4% of administrations (IQR 7.3) was found. Administration technique errors represented 53% of these errors (IQR 14.7). Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 33% (IQR 13) of prescribed medication with 70.3% (IQR 14) classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.ConclusionsChildren are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm, there is an urgent need for outcome-focussed research on preventable ADEs in paediatric hospital settings in the UK. A deeper understanding of medication processes for children in hospital from a systems and theoretical perspective will also support the development and tragetting of effective interventions to improve patient safety.ReferencesChief Medical Officer. An Organisation With a Memory. London; 2000.Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285:2114–2120.Ghaleb MA, Barber N, Franklin BD, Yeung VWS, Khaki ZF, Wong ICK. Systematic review of medication errors in pediatric patients. Ann Pharmacother 2006;40:1766–1776.

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.

scholarly journals Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis

2016 ◽  
Vol 24 (2) ◽  
pp. 413-422 ◽  
Author(s):  
Mirela Prgomet ◽  
Ling Li ◽  
Zahra Niazkhani ◽  
Andrew Georgiou ◽  
Johanna I Westbrook
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Medication Errors ◽  
Meta Analysis ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Order Entry ◽  
Icu Mortality ◽  
Computerized Provider Order Entry ◽  
The Impact

Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design. Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change. Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.

scholarly journals THE IMPACT OF BARCODE MEDICATION ADMINISTRATION ON PATIENT SAFETY: A SYSTEMATIC REVIEW

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Seham Sahal Aloufi
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Medication Error ◽  
Medication Errors ◽  
Improve Patient Safety ◽  
Hospital Setting ◽  
Medication Administration ◽  
Bar Code ◽  
The Impact ◽  
Improve Patient

Patient safety is considered as an essential feature of healthcare system. Many trials have been conducted in order to find ways to improve patient safety, and many reports indicate that medication errors pose a threat to patient safety. Thus, some studies have investigated the impact of bar code medication administration (BCMA) system on medication error reduction during the medication administration procedure. This systematic review (SR) reports the impact of BCMA system on reducing medication errors to improve patient safety; it also compares traditional medication administration with the BCMA system. The review concentrates on the effectiveness of BCMA technology on medication administration errors, and on the accuracy of medication administration. This review also focused on different designs of quantitative studies, as they are more effective at investigating the impact of the intervention than qualitative studies. The findings from this systematic review show various results depending on the nature of the hospital setting. Most of the studies agree that the BCMA system enhances compliance with the 'five rights’' requirement (right drug, right patient, right dose, right time and right route) of medication administration. In addition, BCMA technology identified medication error types that could not be identified with the traditional approach which is applying the 'five rights' of medication administration. The findings of this systematic review also confirm the impact of BCMA system in reducing medication error, preventing adverse events and increasing the accuracy of the medication administration rate. However, BCMA technology did not consistently reduce the overall errors of medication administration. Keyword: Patient Safety, Impact, BCMA, eMAR

Implementation of a Discharge Education Program to Improve Transitions of Care for Patients at High Risk of Medication Errors

2019 ◽  
Vol 54 (6) ◽  
pp. 561-566
Author(s):  
Andrew J. Crannage ◽  
Erin K. Hennessey ◽  
Laura M. Challen ◽  
Alison M. Stevens ◽  
Tricia M. Berry
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Medication Errors ◽  
Education Program ◽  
Transitions Of Care ◽  
Patient Contact ◽  
Contact Points ◽  
The Impact ◽  
Discharge Education

Background: Transitions of care (TOC) points are those where patient outcomes can be affected, especially patients at high risk for medication errors. Pharmacist-led postdischarge telephone counseling positively affects patient outcomes, though challenges exist relating to successful patient contact. Objective: The objective of this study was to develop and evaluate a discharge education service bridging the inpatient and outpatient setting to increase successful patient contact points during the TOC process from hospital to home. Methods: This prospective, single-centered observational study examined the impact of a discharge medication education program on successful telephone follow-up contact. The primary outcome was the percentage of high-risk patients educated at hospital discharge who were successfully reached via follow-up telephone contact within 2 business days of discharge. Secondary end points included hospital readmission rates and patient survey responses. Results: A total of 50 patients were included in the initial evaluation of this service; 78% of patients were successfully contacted within 2 business days after discharge, an increase from a 20% success rate prior to service implementation. At follow-up telephone calls, patients reported taking an average of 16 medications. The 30-day readmission rate was 10% for patients receiving this service, compared with 19% prior to implementation. When asked if they understood the medication component of their care and if they found the TOC service to be satisfactory, 100% and 96% of patients strongly agreed or agreed with these statements, respectively, and none disagreed. Conclusion and Relevance: This service demonstrates how pharmacists can interact with a high-risk population and increase contact points to optimize care at crucial health care transition points.

scholarly journals Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization

2020 ◽  
Vol 36 (2) ◽  
pp. 68-71
Author(s):  
Rebecca L. Stauffer ◽  
Abigail Yancey
Keyword(s):  
Medication Reconciliation ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Medication Discrepancies ◽  
Institutional Review ◽  
The Impact ◽  
Medication Changes

Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies. Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified. Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board. Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group ( P = .054). Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.

scholarly journals Analysis of Clinical Interventions and the Impact of Pediatric Pharmacists on Medication Error Prevention in a Teaching Hospital

2012 ◽  
Vol 17 (4) ◽  
pp. 365-373 ◽  
Author(s):  
Kelli J. Cunningham
Keyword(s):  
Medication Errors ◽  
Teaching Hospital ◽  
Neonatal Intensive Care ◽  
Adverse Drug Events ◽  
Neonatal Intensive Care Units ◽  
Limited Information ◽  
Pediatric Inpatient ◽  
Cause Of Error ◽  
The Impact ◽  
Medication Error Prevention

OBJECTIVE Research has shown that the potential risk for medication errors within the pediatric inpatient population is about 3 times as high as for adults; however, there is limited information regarding the impact of a pediatric pharmacist's contribution to decreasing medication errors and adverse drug events (ADEs). The purpose of this study was to record and analyze all interventions during a 2-month time span in a pediatric teaching hospital to determine the benefit of having a pediatrics-trained clinical pharmacist on the floor. METHODS Pediatric pharmacists prospectively collected data for all interventions and medication errors made between July 1 and August 31, 2010. The pediatric hospital comprises 87 beds, and data were collected during the influx of new pediatric resident interns on the general pediatric ward and pediatric and neonatal intensive care units. RESULTS During the study period, 1315 interventions were recorded, which is an average of 21 interventions per day. Most interventions were made through order entry. Errors made up 24.5% of all interventions, with the most common cause of error being prescribing. Physicians with the least amount of training made the most errors. Of order pages scanned, 5.9% contained an error in the order; however, only 0.2% of all errors reached the patient. CONCLUSIONS This study highlighted the impact a pediatric pharmacist can make on prevention of ADEs and medication errors. Only 0.2% of all errors made during the study period reached the patient owing to interventions made by the pediatric pharmacists, which shows a vast improvement in patient safety.

scholarly journals Incidence of medication errors and adverse drug events in the ICU: a systematic review

2010 ◽  
Vol 19 (5) ◽  
pp. e7-e7 ◽  
Author(s):  
A. Wilmer ◽  
K. Louie ◽  
P. Dodek ◽  
H. Wong ◽  
N. Ayas
Keyword(s):  
Systematic Review ◽  
Medication Errors ◽  
Adverse Drug Events
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