scholarly journals 147 Prevalence and Drug Classes of Medication Discrepancies among Elderly Patients Discharged from a Tertiary Hospital

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv34-iv39
Author(s):  
Izzati Abdul Halim Zaki ◽  
Rizah Mazzuin Razali ◽  
Mahmathi Karuppannan ◽  
Shubashini Gnanasan ◽  
Rosmaliah Alias
Keyword(s):  
Elderly Patients ◽  
Medication Reconciliation ◽  
Tertiary Hospital ◽  
Geriatric Ward ◽  
Medication History ◽  
Medication Discrepancies ◽  
Mortality And Morbidity ◽  
Drug Classification ◽  
Reconciliation Process

Abstract Introduction Medication-related hospital admission may lead to the development of harmful and unwanted side effects that increase the risk of mortality and morbidity. Multiple steps are being executed to overcome the medication errors and one of the strategies is through conducting the medication reconciliation process. This process involves creating an accurate list of patient’s medications which to be compared with the current medications list upon transfer from different point of care or discharge. Any differences detected are categorized as medication discrepancies either being intentional or unintentional. This study aims to determine the prevalence and drug classification of medications discrepancies among patient discharged from a geriatric ward. Method This study was conducted retrospectively for three months in a geriatric ward. Comparisons were made between medications list on admission from the Medication History Assessment Form with the in-patient medication chart and medications upon discharge by a pharmacist to detect any discrepancies. Descriptive analysis was used to identify prevalence and the drug classification of medication discrepancies among elderly patients discharged from tertiary hospital. Results 1056 medications for 74 patients were screened for discrepancies. 689 (65.3%) discrepancies were detected with a mean of 9.31 ± SD 4.02. The highest number of intentional and unintentional medication discrepancies were detected in cardiovascular drugs (29.1%, n = 155) and (36.5%, n = 57). The drugs on admission and upon discharged that involved in discrepancies were diuretics, antihypertensives and antilipemic agents. Conclusion The number of medication discrepancies was found to be common among elderly patients discharged from the geriatric wards. Findings from this study have highlighted the importance of comprehensive medication reconciliation process prior to discharge in preventing medication discrepancies.

scholarly journals A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

2018 ◽  
Vol 25 (11) ◽  
pp. 1488-1500
Author(s):  
Sophie Marien ◽  
Delphine Legrand ◽  
Ravi Ramdoyal ◽  
Jimmy Nsenga ◽  
Gustavo Ospina ◽  
...  
Keyword(s):  
Web Application ◽  
Medication Reconciliation ◽  
Qualitative Data ◽  
Improve Patient Safety ◽  
Three Dimensions ◽  
Medication List ◽  
Medication History ◽  
Medication Discrepancies ◽  
System Usability Scale ◽  
User Centered

Abstract Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the “patient app” and the “MedRec app.” This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in “real-world” conditions. To achieve adoption and sustained use by patients, the app should meet patients’ needs while also efficiently improving the quality of MedRec.

scholarly journals Transitions in Care: Medication Reconciliation in the Community Pharmacy Setting After Discharge

2013 ◽  
Vol 4 (2) ◽  
Author(s):  
Jeff E. Freund ◽  
Beth A. Martin ◽  
Mara A. Kieser ◽  
Staci M. Williams ◽  
Susan L. Sutter
Keyword(s):  
Community Pharmacy ◽  
Medication Reconciliation ◽  
Comfort Level ◽  
Original Research ◽  
Patient Counseling ◽  
Term Care ◽  
Medication Discrepancies ◽  
Transitions In Care ◽  
Pharmacy Setting ◽  
Reconciliation Process

Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care. Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service. Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24%) and patient notpresent during consultation (11%). A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists' comfort level performing medication reconciliation improved through the 13 weeks of the study. Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.   Type: Original Research

An On-Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation

2019 ◽  
Author(s):  
Amanda S Mixon ◽  
Sunil Kripalani ◽  
Jason Stein ◽  
Tosha B Wetterneck ◽  
Peter Kaboli ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Evidence Based ◽  
Health Record ◽  
Medication History ◽  
Pharmacy Staff ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Implementation Period ◽  
Treatment Analysis ◽  
And Training

It is unclear which medication reconciliation interventions are most effective at reducing inpatient medication discrepancies. Five United States hospitals’ interdisciplinary quality improvement (QI) teams were distance mentored by QI-trained physicians. Sites implemented one to seven evidence-based interventions in 791 patients during the 25-month implementation period. Three interventions were associated with significant decreases in potentially harmful discrepancy rates: (1) defining clinical roles and responsibilities, (2) training, and (3) hiring staff to perform discharge medication reconciliation. Two interventions were associated with significant increases in potentially harmful discrepancy rates: training staff to take medication histories and implementing a new electronic health record (EHR). Hospitals should focus first on hiring and training pharmacy staff to assist with medication reconciliation at discharge and delineating roles and responsibilities of clinical staff. We caution hospitals implementing a large vendor EHR, as medication discrepancies may increase. Finally, the effect of medication history training on discrepancies needs further study.

scholarly journals An On-Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation

2019 ◽  
Vol 14 (10) ◽  
Author(s):  
Amanda S Mixon ◽  
Sunil Kripalani ◽  
Jason Stein ◽  
Tosha B Wetterneck ◽  
Peter Kaboli ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Evidence Based ◽  
Health Record ◽  
Medication History ◽  
Pharmacy Staff ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Implementation Period ◽  
Treatment Analysis ◽  
And Training

It is unclear which medication reconciliation interventions are most effective at reducing inpatient medication discrepancies. Five United States hospitals’ interdisciplinary quality improvement (QI) teams were virtually mentored by QI-trained physicians. Sites implemented one to seven evidence-based interventions in 791 patients during the 25-month implementation period. Three interventions were associated with significant decreases in potentially harmful discrepancy rates: (1) defining clinical roles and responsibilities, (2) training, and (3) hiring staff to perform discharge medication reconciliation. Two interventions were associated with significant increases in potentially harmful discrepancy rates: training staff to take medication histories and implementing a new electronic health record (EHR). Hospitals should focus first on hiring and training pharmacy staff to assist with medication reconciliation at discharge and delineating roles and responsibilities of clinical staff. We caution hospitals implementing a large vendor EHR, as medication discrepancies may increase. Finally, the effect of medication history training on discrepancies needs further study.

scholarly journals Identifying Unintentional Medication Discrepancies at Admission among Elderly Inpatients in Vietnam

2021 ◽  
Author(s):  
Phuong Thi Xuan Dong ◽  
Van Thi Thuy Pham ◽  
Linh Thi Nguyen ◽  
Thao Thi Nguyen ◽  
Huong Thi Lien Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Medication Reconciliation ◽  
Negative Impact ◽  
Medication History ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
Chronic Medication ◽  
Elderly Inpatients

Abstract Background Elderly patients are at high risk of unintentional medication discrepancies during transition care as they are more likely to have multiple comorbidities and chronic diseases that require multiple medications. The main objective of the study was to measure the occurrence and identify risk factors for unintentional medication discrepancies in elderly inpatients during hospital admission.Methods A prospective observational study was conducted from July to December 2018 in a 800-bed geriatric hospital in Hanoi, North Vietnam. Patients over 60 years of age, admitted to one of selected internal medicine wards, taking at least one chronic medication before admission, and staying at least 48 hours were eligible for enrolment. Medication discrepancies of chronic medications before and after admission of each participant were identified by a pharmacist using a step-by-step protocol for the medication reconciliation process. The identified discrepancies were then classified as intentional or unintentional by an assessment group comprised of a pharmacist and a physician. A logistic regression model was used to identify risk factors of medication discrepancies.Results Among 192 enrolled patients, 328 medication discrepancies were identified; of which 87 (26.5%) were unintentional. 32.3% of patients had at least one unintentional medication discrepancy. The most common unintentional medication discrepancy was omission of drugs (75.9% of 87 medication discrepancies). The logistic regression analysis revealed a positive association between the number of discrepancies at admission and the type of treatment wards. Conclusions Medication discrepancies are common at admission among Vietnamese elderly inpatients. This study confirms the importance of obtaining a comprehensive medication history at hospital admission and supports implementing a medication reconciliation program to reduce the negative impact of medication discrepancy, especially for the elderly population.

scholarly journals Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026259 ◽  
Author(s):  
Olivier Giannini ◽  
Nicole Rizza ◽  
Michela Pironi ◽  
Saida Parlato ◽  
Brigitte Waldispühl Suter ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Regression Model ◽  
Poisson Regression ◽  
Medication Reconciliation ◽  
Secondary Outcome ◽  
Poisson Regression Model ◽  
Internal Medicine Ward ◽  
Medication History ◽  
Medication Discrepancies ◽  
Standard Medication

ObjectiveMedication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including abest possible medication history(BPMH) compared with a standard medication history in patients admitted to an internal medicine ward.DesignProspective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model.SettingInternal medicine ward in a secondary care hospital in Southern Switzerland.ParticipantsThe first 100 consecutive patients admitted in an internal medicine ward.Primary and secondary outcome measuresMedication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified.ResultsThe median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model.ConclusionEven in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.

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.

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