scholarly journals Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events and Improves Satisfaction in a Community Hospital

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
L. Hayley Burgess ◽  
Joan Kramer ◽  
Carley Castelein ◽  
Joseph M. Parra ◽  
Victoria Timmons ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Community Hospital

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>

scholarly journals Directed intervention to improve the rate of admission medication reconciliation in an acute care hospital

2019 ◽  
Vol 8 (4) ◽  
pp. e000784
Author(s):  
Htay Htay Kyi ◽  
Saira Sundus ◽  
Huda Marcus ◽  
Jason Sotzen ◽  
Parker Suit ◽  
...  
Keyword(s):  
Older Patients ◽  
Medication Reconciliation ◽  
Community Hospital ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Prescribing Errors ◽  
Provider Education ◽  
Interventional Study ◽  
Post Intervention ◽  
Male Patients

IntroductionElectronic medication reconciliation systems are known to reduce medication errors. We hypothesised that refinement of the electronic medical record (EMR) and provider education could improve adherence to completion of admission medication reconciliation, thereby potentially limiting prescribing errors. Our goal was to improve the percentage of patients with medication reconciliation completed within 24 hours of admission to at least 90%.MethodsA prospective interventional study was conducted at a university-affiliated community hospital between 1 January 2017 and 30 September 2018. We determined the baseline percentage of medication reconciliations performed within 24 hours of admission, and those completed at any time prior to discharge from the hospital. Three plan-do-study-act cycles were then performed, with interventions including live and email reminders to complete medication reconciliation and addition of a column to EMR patient lists indicating whether reconciliation had been completed.ResultsThe percentage of medication reconciliations completed within 24 hours of admission was lowest for the pre-intervention cycle (62.4%) and was highest for Cycle 3 (80.9%). The percentage of reconciliations completed any time prior to discharge was higher and increased in a similar stepwise fashion from 71.1% to 88.4% through Cycle 3. There was a post-intervention trend toward a higher rate of reconciliation completion for patients aged 18–40. Male patients were also more likely to have their admission medication reconciliations completed prior to discharge.ConclusionOur interventions resulted in a statistically significant 18.5% increase in the rate of admission reconciliation completion. Though this increase fell short of our goal, this study demonstrates that provider education and optimisation of the EMR can sustainably improve adherence with medication reconciliation, thereby fostering improved patient care. Further improvement could be achieved by focusing on the medication lists of our older patients and female patients.

scholarly journals Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

2019 ◽  
Vol 36 (2) ◽  
pp. 47-53
Author(s):  
Julie B. Cooper ◽  
Elizabeth Jeter ◽  
Cory John Sessoms
Keyword(s):  
Internal Medicine ◽  
Hospital Readmission ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
General Internal ◽  
Hospital Readmission Rates ◽  
Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

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.

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

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]

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