scholarly journals Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety

2021 ◽  
Vol 14 (12) ◽  
pp. 1207
Author(s):  
Kelly L. Hayward ◽  
Patricia C. Valery ◽  
Preya J. Patel ◽  
Catherine Li ◽  
Leigh U. Horsfall ◽  
...  
Keyword(s):  
High Risk ◽  
Usual Care ◽  
Medication Safety ◽  
Medication Reconciliation ◽  
Decompensated Cirrhosis ◽  
Medication Regimen ◽  
Medication Discrepancies ◽  
Medication Regimen Complexity ◽  
Regimen Complexity

Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm.

Impact of a medication reconciliation program on cardiac surgery patients

2017 ◽  
Vol 25 (9) ◽  
pp. 579-585 ◽  
Author(s):  
Abdulrazaq S Al-Jazairi ◽  
Lujain Khalid Al-Suhaibani ◽  
Rayd A Al-Mehizia ◽  
Salma Al-Khani ◽  
Glyn Lewis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Significance ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Medication Regimen ◽  
Medication Discrepancies ◽  
Team Care ◽  
Medication Regimen Complexity ◽  
Complexity Index ◽  
Regimen Complexity

Background Cardiac surgery patients are at high risk of medication errors. Resumption of home medications reduces the significance and number of medication errors. This could be achieved by implementing a medication reconciliation program. Patients and Methods Patients were eligible for inclusion in this prospective study if they were admitted, transferred, and/or discharged under cardiac surgery team care from September 2015 to March 2016. The primary outcome was the number and proportion of unintentional medication discrepancies. Secondary outcomes included the number of interventions to resolve discrepancies and their clinical significance, and the medication regimen complexity index and its correlation with discrepancies. Results There were 374 patients included and 1000 encounters tracked. Four-hundred and seventy (47%) of the included encounters were for adult patients. Of the 260 medication discrepancies detected, 181 (69.61%) were detected during admission. Discrepancies among adults were 0.913, 0.307, and 0.176 on admission, transfer, and discharge, respectively. Two-hundred (76.92%) of the interventions recommended by the pharmacy residents were accepted by the medical team, and the remaining were accepted with modifications, with no rejections. One-hundred and sixty-six (83%) of the accepted interventions were of high clinical significance. There was a significant correlation between the number of medication discrepancies and medication regimen complexity index on admission ( p < 0.0001, r = 0.34), transfer, and discharge. Conclusion Implementation of a medication reconciliation program in cardiac surgery units and its step-down units can be a powerful mean of identifying medication errors in post-cardiac surgery patients at admission and throughout the transition of care.

Effect of Pharmacist Intervention on 30-Adverse Drug Event after Discharge in Elderly Patients through a Comprehensive Medication Reconciliation: A Randomized Clinical Trial

2021 ◽  
Author(s):  
SunMin Lee ◽  
Yun Mi Yu ◽  
Euna Han ◽  
Min Soo Park ◽  
Jung-Hwan Lee ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Pharmacist Intervention ◽  
Phone Call ◽  
Control Group ◽  
Medication Regimen ◽  
Medication Regimen Complexity ◽  
Regimen Complexity

Abstract Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July–December 2020. Comprehensive medication reconciliation comprises medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity (MRCI-K). Adverse drug events (ADEs) were monitored throughout hospitalization and 30 days after discharge. Of the 32 patients, 34.4% (n = 11) reported ADEs before discharge, and 19.2% (n = 5) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p = 0.039) on the 30-day phone call. The intervention group showed a greater score reduction than the control group in terms of the number of medications, MRCI-K, and PIMs. As a result of the pharmacist intervention, we identified the feasibility of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge (Clinical trial number: KCT0005994, 03/12/2021).

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 High level of medication regimen complexity index correlate with worse quality of life in people living with HIV

2021 ◽  
Author(s):  
Enrique Contreras-Macías ◽  
◽  
Antonio Gutiérrez-Pizarraya ◽  
María Aguas Robustillo-Cortés ◽  
Ramón Morillo-Verdugo
Keyword(s):  
Quality Of Life ◽  
Outpatient Service ◽  
Care Plan ◽  
People Living With Hiv ◽  
Medication Regimen ◽  
Medication Regimen Complexity ◽  
Complexity Index ◽  
Regimen Complexity ◽  
Living With Hiv

Objectives. People living with HIV (PLWHIV) have now a near-normal life expectancy and thus, a higher risk of polypharmacy. The main objective was to assess the correlation between medication regimen complexity index (MRCI) and quality of life (EQ-5D) and health utilities among PLWHIV patients on ART. Patients and methods. Observational prospective single-center study including adult PLWHIV on ART from January to March-2020 attended at hospital pharmacy outpatient service according to a Capacity-Motivation-Opportunity (CMO) pharmaceutical care model. Results. A total of 428 patients were included, mean age of 50 ± 10.9 years, 82.2% males. Negative correlation (r2=−0.147; p= 0.0002) between MRCI and EQ-5D was found. Relationship between the comorbidity pattern and quality of life, was also observed. Regarding MRCI, Anxiety/Depression, Pain/discomfort and Self-Care were the dimensions with the worst assessment. Conclusions. A new multidimensional revised care plan for PLWHIV focussed on optimising overall patient care, not limited to viral load goal achievement alone but also in their pharmacotherapeutic complexity and quality of life is needed.

scholarly journals Polypharmacy and high Medication Regimen Complexity Index in the elderly assisted in primary health care / Polifarmácia e Índice de Complexidade Farmacoterapêutico elevado em idosos atendidos na atenção básica de saúde / Polifarmacia y alto Índice de Complejidad Farmacoterapéutica en personas mayores asistidas en la atención..

2020 ◽  
Vol 9 ◽  
Author(s):  
Kananda Pizano De Freitas ◽  
Márcia Regina Martins Alvarenga
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
The Elderly ◽  
Medication Regimen ◽  
Medication Regimen Complexity ◽  
Primary Health ◽  
Complexity Index ◽  
Regimen Complexity

Objetivo: identificar a associação entre polifarmácia e Índice de Complexidade Farmacoterapêutico (ICFT) elevado em idosos atendidos na atenção básica de saúde. Metodologia: pesquisa transversal realizada nas Unidades Básicas de Saúde de Dourados, MS, com idosos. As variáveis pesquisadas foram socioeconômicas, condições de saúde, uso de medicamentos e complexidade da farmacoterapia. Dados analisados por meio de estatística descritiva e correlação de Pearson. Aprovação do Comitê de Ética em pesquisa nº 1.406.745. Resultados: entrevistados 16 idosos em situação de polifarmácia e portadores de alguma doença crônica não transmissivel. O ICFT obteve média 16,96 (± 9,186) e mediana 15,75, que foi adotada como ponto de corte para identificar complexidade do esquema farmacoterapêutico elevado. Oito idosos apresentaram dificuldades para cumprir o esquema terapêutico devido a múltiplas doses no mesmo horário e recordarem-se das medicações. Conclusão: prevalência de idosas, com hipertensão arterial, baixa escolaridade e que precisam de orientação dos profissionais de saúde frente às dificuldades apresentadas quanto à terapia medicamentosa.Descritores: Saúde do idoso. Tratamento farmacológico. Atenção Primária à Saúde.

Predicting Potential Postdischarge Adverse Drug Events and 30-Day Unplanned Hospital Readmissions From Medication Regimen Complexity

2014 ◽  
Vol 10 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Hilary Schoonover ◽  
Cynthia F. Corbett ◽  
Douglas L. Weeks ◽  
Megan N. Willson ◽  
Stephen M. Setter
Keyword(s):  
Adverse Drug Events ◽  
Hospital Readmissions ◽  
Medication Regimen ◽  
Medication Regimen Complexity ◽  
Regimen Complexity
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