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Yamada Y, Kobayashi R, Yamamoto T, Fujii H, Iihara H, Hiroko KH, Nishida S, Hoshino R, Niwa T, Kumada K, Shimizu M, Suzuki A. Medication reconciliation by pharmacists for pre-admission patients improves patient safety. J Pharm Health Care Sci 2024; 10:19. [PMID: 38671535 PMCID: PMC11046811 DOI: 10.1186/s40780-024-00340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Medication errors related to the pre-admission medication history obtained on admission are a major cause of medication error during hospitalization. Medication reconciliation (MR) improves patient safety through the detection of inadvertent medication discrepancies at transitions of care. The aim of this study was to evaluate the effect of MR by pharmacists for patients prior to hospital admission on the incidence of medication errors in the early post-admission period. PATIENTS AND METHODS Patients admitted to the orthopedic ward for surgery between April 2012 and March 2020 were included. Pharmacist-led MR for pre-admission patients was started on April 1, 2017. The incidence of medication errors related to pre-admission medications that occurred during hospitalization were compared between the pre- and post-initiation of pharmacist-led MR (pre-initiation: April 1, 2012 to March 31, 2015, post-initiation: April 1, 2017 to March 31, 2020). RESULT In the post-initiation group, 94.2% (1245/1321) of patients who were taking medications on admission had a pharmacist-led MR before admission. The proportion of patients whose physicians ordered the prescription of their pre-admission medications at the time before hospitalization to continue from admission was significantly higher in the post-initiation group than in the pre-initiation group (47.4% vs. 1.0%, p < 0.001). The incidence of medication errors related to pre-admission medications during hospitalization was significantly lower in the post-initiation group than in the pre-initiation group (1.83% vs. 0.85%, p = 0.025). Pharmacist-led MR prior to admission was a significant protective factor against incidents related to pre-admission medication (odds ratio (OR), 0.3810; 95% confidence interval (CI); 0.156-0.9320, p = 0.035). CONCLUSION Pharmacist-led MR for patients prior to hospital admission led to a reduction in medication errors related to pre-admission medications during hospitalization. Patient safety during hospitalization can be improved by accurate medication histories provided early by pharmacists.
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Affiliation(s)
- Yunami Yamada
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.
| | - Taishi Yamamoto
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Patient Safety Division, Gifu University Hospital, Gifu, Japan
| | | | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Ryo Hoshino
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Keisuke Kumada
- Patient Safety Division, Gifu University Hospital, Gifu, Japan
- Department of Emergency & Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahito Shimizu
- Patient Safety Division, Gifu University Hospital, Gifu, Japan
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. FARMACIA HOSPITALARIA 2023; 47:106-112. [PMID: 36842862 DOI: 10.1016/j.farma.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019-June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge. 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.
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Affiliation(s)
| | | | | | | | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. FARMACIA HOSPITALARIA 2023; 47:T106-T112. [PMID: 37032197 DOI: 10.1016/j.farma.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.
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Affiliation(s)
| | | | | | - Alfonso García Aranda
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
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