scholarly journals Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students

2021 ◽  
Vol 19 (3) ◽  
pp. 2471
Author(s):  
Louise Deep ◽  
Carl R. Schneider ◽  
Rebekah Moles ◽  
Asad E. Patanwala ◽  
Linda L. Do ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Alimentary Tract ◽  
Common Type ◽  
Pharmacy Students ◽  
Transitions Of Care ◽  
Patient Harm ◽  
Medication Discrepancies ◽  
Retrospective Audit ◽  
Hospital Inpatients

Background: Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution. Objective: To evaluate the number and type of medication discrepancies identified by pharmacy students. Methods: Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies. Results: There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system. Conclusions: Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.

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.

Discrepancies Identified Through a Telephone-Based, Student-Led Initiative for Medication Reconciliation in Ambulatory Psychiatry

2017 ◽  
Vol 31 (3) ◽  
pp. 304-311 ◽  
Author(s):  
Marie E. Albano ◽  
Jolene R. Bostwick ◽  
Kristen M. Ward ◽  
Thomas Fluent ◽  
Hae Mi Choe
Keyword(s):  
Retrospective Analysis ◽  
Medication Reconciliation ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Prescription Medications ◽  
Medication Discrepancies ◽  
Team Members ◽  
Practice Experience ◽  
Call Schedule ◽  
Clinically Significant

Purpose: To identify the number of medication discrepancies following establishment of a telephone-based, introductory pharmacy practice experience student-driven, medication reconciliation service for new patients in an ambulatory psychiatry clinic. Secondarily, to identify factors impacting medication discrepancies to better target medication profiles to reconcile and to evaluate whether the implementation of a call schedule effected clinic no-show rates. Methods: This was a retrospective analysis of a telephone-based medication reconciliation service from June 2014 to January 2016. Results: At least 1 medication discrepancy was identified among 84.7% of medication profiles (N = 438), with a total of 1416 medication discrepancies reconciled (3.2 discrepancies per patient). Of the 1416 discrepancies, 38.6% were deletions, 38.9% were additions, and 22.5% were changes in dosage strength or frequency. Discrepancies pertaining to prescription medications totaled 57.8%. Student pharmacists were critical team members in the service. Patient’s age, number of medications on the patient’s list, and number of days since the last medication reconciliation were not clinically significant determinants for targeting medication profiles. There was a statistically significant reduction in the clinic no-show rates following implementation of a call schedule compared with no-show rates prior to call schedule implementation. Conclusion: This student pharmacist–led telephone medication reconciliation service demonstrated the importance of medication reconciliation in ambulatory psychiatry by identifying numerous discrepancies within this population. Further, we demonstrated pharmacy students across various levels of education can assist in this process under the supervision of a pharmacist.

Medication discrepancies in hospitalized cancer patients: Do we need medication reconciliation?

2020 ◽  
pp. 107815522094638
Author(s):  
Maram Abu Moghli ◽  
Rana Abu Farha ◽  
Khawla Abu Hammour
Keyword(s):  
Cancer Patients ◽  
Critically Ill ◽  
Medical Records ◽  
Medication Reconciliation ◽  
Treatment Plan ◽  
Common Type ◽  
University Hospital ◽  
High Rate ◽  
Convenience Sample ◽  
Medication Discrepancies

Objective This study aimed to identify and point out the number and types of medication discrepancies among cancer patients admitted to Jordan University Hospital. Method This is a cross-sectional observational study that was conducted on cancer patients in the internal medicine department at Jordan University Hospital, Amman, Jordan. During a period of six months, a convenience sample of cancer patients was recruited, and their medical records were reviewed to collect information regarding their demographics, clinical, and medication information. Also, patients’ Best Possible Medication History (BPMH) was collected using different methods, and a comparison between patients’ BPMH and their current medications was conducted where discrepancies were recognized. Results Seventy-eight medical records were reviewed, with a total of 166 discrepancies identified. Of these, 110 discrepancies (66.3%) were unintentional. Exactly 67.9% of the study participants ( n = 53) were found to have at least one unintentional discrepancy, with the most common type being omissions ( n = 71, 65.1%,) and the second most common type being additions ( n = 16, 14.7%). Most of the discrepancies ranged between low to moderate in severity. Fifty-six (33.7%) intentional undocumented discrepancies (documentation errors) were also identified. Conclusion This study revealed a high rate of medication discrepancies among hospitalized cancer patients, most commonly unintentional omissions. Nevertheless, undocumented intentional discrepancies can equally harm this critically ill population. So, do we need medication reconciliation in cancer patients? Yes. Cancer patients are critically ill, and therefore more effort should be paid towards implementing medication reconciliation services in their treatment plan.

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.

Medication Reconciliation During Transitions of Care as a Patient Safety Strategy

2013 ◽  
Vol 158 (5_Part_2) ◽  
pp. 397 ◽  
Author(s):  
Janice L. Kwan* ◽  
Lisha Lo* ◽  
Margaret Sampson ◽  
Kaveh G. Shojania
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Transitions Of Care ◽  
Safety Strategy

scholarly journals Code Status Reconciliation to Improve Identification and Documentation of Code Status in Electronic Health Records

2017 ◽  
Vol 26 (01) ◽  
pp. 226-234
Author(s):  
Viral G Jain ◽  
Peter J Greco ◽  
David C Kaelber
Keyword(s):  
Patient Safety ◽  
End Of Life ◽  
Medication Reconciliation ◽  
Healthcare Delivery ◽  
Clinical Decision ◽  
Care Quality ◽  
Transitions Of Care ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Electronic Health

Summary Background: Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues. Objective: To study the tools, workflow, and impact of clinical decision support (CDS) for CSR. Methods: We established rules for CS implementation in our EHR. At admission, a CS is required as part of a patient’s admission order set. Using standard CDS tools in our EHR, we built an interruptive alert for CSR at discharge if a patient did not have the same inpatient (current) CS at discharge as that prior to admission CS. Results: Of 80,587 admissions over a four year period (2 years prior to and post CSR implementation), CS discordance was seen in 3.5% of encounters which had full code status prior to admission, but Do Not Resuscitate (DNR) CS at discharge. In addition, 1.4% of the encounters had a different variant of the DNR CS at discharge when compared with CS prior to admission. On pre-post CSR implementation analysis, DNR CS per 1000 admissions per month increased significantly among patients discharged and in patients being admitted (mean ± SD: 85.36 ± 13.69 to 399.85 ± 182.86, p<0.001; and 1.99 ± 1.37 vs 16.70 ± 4.51, p<0.001, respectively). Conclusion: EHR enabled CSR is effective and represents a significant informatics opportunity to help honor patients’ end-of-life wishes. CSR represents one example of non-medication reconciliation at transitions of care that should be considered in all EHRs to improve care quality and patient safety.

scholarly journals Roles for Pharmacy Technicians in Medication Reconciliation During Transitions of Care

2016 ◽  
Vol 33 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Nicole A. Fabiilli ◽  
Mary F. Powers
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Transitions Of Care ◽  
Care Providers ◽  
Medication Discrepancies ◽  
Pharmacy Technician ◽  
Pharmacy Technicians

Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.

scholarly journals Patient Harm Resulting From Medication Reconciliation Process Failures: A Study of Serious Events Reported by Pennsylvania Hospitals

2021 ◽  
pp. 10-22
Author(s):  
Amy Harper ◽  
Elizabeth Kukielka ◽  
Rebecca Jones
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Comprehensive Evaluation ◽  
Improve Patient Safety ◽  
Transition Of Care ◽  
Patient Harm ◽  
Reduction Strategies ◽  
Wrong Dose ◽  
Clinically Significant ◽  
Reconciliation Process

Medication reconciliation broadly defined includes both formal and informal processes that involve the comprehensive evaluation of a patient’s medications during each transition of care and change in therapy. The medication reconciliation process is complex, and studies have shown that up to 91% of medication reconciliation errors are clinically significant and 1–2% are serious or potentially life-threatening. We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) and identified 93 serious events related to the medication reconciliation process reported between January 2015 and August 2020. Serious events related to medication reconciliation were most common among patients 65 years or older (55.9%; 52 of 93). The majority of events (58.1%; 54 of 93) contributed to or resulted in temporary harm and required treatment or intervention. Permanent harm or death occurred as a result of 3.3% (3 of 93) of the events. Admission/triage was the most frequent transition of care associated with events (69.9%; 65 of 93). The most common stage of the medication reconciliation process at which failures most directly contributed to patient harm was order entry/transcription (41.9%; 39 of 93) and resulted most frequently in wrong dose (n=21) or dose omission (n=13). Most events were discovered after the patient had a change in condition (76.3%; 71 of 93), and patients most often required readmission, hospitalization, emergency care, intensive care, or transfer to a higher level of care (58.0%; 54 of 93). Among 128 medications identified across all events, neurologic or psychiatric medications were the most common (39.1%; 50 of 128), and anticonvulsants were the most common pharmacologic class among neurologic or psychiatric medications (42.0%; 21 of 50). Based on our findings, risk reduction strategies that may improve patient safety related to the medication reconciliation process include defined clinician roles for medication reconciliation, listing the indication for each medication prescribed, and for facilities to consider adding anticonvulsants to their processes for medications with a high risk for harm.

Clinical Cybersecurity Training Through Novel High Fidelity Simulations (Preprint)

2018 ◽  
Author(s):  
Christian Dameff ◽  
Jordan Selzer ◽  
Jonathan Fisher ◽  
James Killeen ◽  
Jeffrey Tully
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Systems ◽  
High Fidelity ◽  
Protected Health Information ◽  
Patient Harm ◽  
Security Vulnerabilities ◽  
Clinical Simulations ◽  
Medical Infrastructure

BACKGROUND Cybersecurity risks in healthcare systems have traditionally been measured in data breaches of protected health information but compromised medical devices and critical medical infrastructure raises questions about the risks of disrupted patient care. The increasing prevalence of these connected medical devices and systems implies that these risks are growing. OBJECTIVE This paper details the development and execution of three novel high fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices. METHODS Clinical simulations were developed which incorporated patient care scenarios with hacked medical devices based on previously researched security vulnerabilities. RESULTS Clinician participants universally failed to recognize the etiology of their patient’s pathology as being the result of a compromised device. CONCLUSIONS Simulation can be a useful tool in educating clinicians in this new, critically important patient safety space.

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