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Marsteller JA, Rosen MA, Wyskiel R, Chang BH, Hsu YJ, Thompson DA, Kim G, Speck K, Ijagbemi M, Huang S, Gurses AP. Multi-Team Shared Expectations Tool (MT-SET): An Exercise to Improve Teamwork Across Health Care Teams. Jt Comm J Qual Patient Saf 2024; 50:737-744. [PMID: 39033060 DOI: 10.1016/j.jcjq.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.
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Lim A, Abeyaratne C, Reeve E, Desforges K, Malone D. Using Kane's Validity Framework to Compare an Integrated and Single-Skill Objective Structured Clinical Examination. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100756. [PMID: 39002863 DOI: 10.1016/j.ajpe.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/11/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE The aim of this study was to compare the validity of an integrated objective structured clinical examination (OSCE) station assessing both oral and written components with that of an OSCE station assessing 1 single skill (oral only), both targeted at assessing taking a best possible medication history. METHODS A convergent mixed-methods design that used the 4 inferences of Kane's validity framework (scoring, generalization, extrapolation, and implications) as a scaffold to integrate qualitative data (post-OSCE reflections) and quantitative data (assessment grades and categories of medication errors) was applied. RESULTS In 2022, 216 students completed the OSCE station with the oral component alone, while in 2023, 254 students completed the integrated (oral and written) OSCE station. Students in 2023 performed significantly better, with a median score of 88% vs 80% in 2022. There was a greater proportion of commission errors in the integrated assessment (20.4% vs 15.3%), but fewer omission errors (29.9% vs 31.8%) and patient profile errors (5.1% vs 69.4%). Student reflections revealed that conversations were rushed in the integrated assessment, with a greater focus on written formatting, but an appreciation for the authenticity and structured format of the integrated OSCE compared with the single-skill OSCE alone. CONCLUSION Students completing the integrated OSCE (with oral and written components) had fewer patient profile and medication omission errors than students who completed the oral-only OSCE. Considering Kane's validity framework, there was a stronger argument for the more authentic integrated OSCE in terms of the inferences of extrapolation and implications.
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Affiliation(s)
- Angelina Lim
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Australia.
| | - Carmen Abeyaratne
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
| | - Emily Reeve
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; University of South Australia, Quality Use of Medicines and Pharmacy Research Centre, Adelaide, Australia; University of South Australia, Clinical and Health Sciences, Adelaide, Australia
| | - Katherine Desforges
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia; Université de Montréal, Faculty of Pharmacy, Montréal, Canada
| | - Daniel Malone
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
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Terstegen T, Niestroj C, Stangl J, Scherkl C, Morath B, Haefeli WE, Seidling HM. Approaches to medication history taking in different hospital settings: A scoping review. Am J Health Syst Pharm 2024; 81:e419-e430. [PMID: 38660785 DOI: 10.1093/ajhp/zxae112] [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: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE A comprehensive medication history can contribute to safe therapy. Many approaches aiming to improve medication history taking require significant human resources. To design an efficient process that delivers high-quality medication histories, the individual requirements and resources of a given setting need to be considered. We aimed to provide an overview of existing approaches to medication history taking and their performance in different settings to potentially support the selection of an appropriate procedure. METHODS We searched 3 literature databases (PubMed/MEDLINE, CINAHL, PsycINFO) for publications on approaches to medication history taking and analyzed them with regard to their key components as well as the setting, patient population, assessed outcomes, and efficacy. RESULTS In total, 65 publications were included and analyzed. The majority of the reported approaches relied on involvement of dedicated staff (n = 43), followed by process-oriented interventions (eg, checklists; n = 15) and information technology (IT)-guided interventions (n = 11). A mean (SD) of 6 (2.9) outcomes were described in each study. Medication discrepancies were reported in 89% of all studies, yet about 75 different descriptions of this outcome were used, making it difficult to compare study results. Only 11 studies applied a sample size calculation and statistical tests. Of those, 10 reported a positive effect of their respective intervention on the quality of medication histories. CONCLUSION Most approaches focused on pharmacy staff, which are associated with considerable cost and resources. Therefore, IT-based approaches and patient engagement should be investigated as cost-effective alternatives and tested for superiority in the same setting. Reporting guidelines and standardized methodology are needed to improve the comparability of such studies.
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Affiliation(s)
- Theresa Terstegen
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
| | | | - Julia Stangl
- Hospital Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
| | - Camilo Scherkl
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - Benedict Morath
- Hospital Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E Haefeli
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
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Alboudi A, Bank AM. Medication Reconciliation Errors on Discharge for Epilepsy Monitoring Unit Patients. J Epilepsy Res 2024; 14:17-20. [PMID: 38978525 PMCID: PMC11227923 DOI: 10.14581/jer.24003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 07/10/2024] Open
Abstract
Background and Purpose Medication errors are common in the inpatient setting. Epilepsy patients who miss doses of their antiseizure medications are at risk for breakthrough seizures and subsequent complications. The purpose of this study was to quantify and characterize anti-seizure medications reconciliation errors on discharge from the epilepsy monitoring unit (EMU). Methods Consecutive admissions to an academic medical center EMU were retrospectively reviewed. Medication reconciliation errors on discharge, including drug errors, dosing errors, and dose timing errors, were recorded. Associations between medication errors and clinical and demographic variables were analyzed using binary logistic regression for continuous variables and Fisher exact tests for categorical variables. Results One hundred and eleven admissions between January 1, 2021 and December 31, 2021 were identified. Fourteen anti-seizure medication reconciliation errors were recorded during 11 unique admissions (9.9% of admissions). The most common error type was dosing error (10/14 errors; 71.4%). Number of antiseizure medications on admission (p=0.004), total number of medications on admission (p=0.013), number of medication changes during admission (p=0.0007), and length of stay (p=0.0001) were associated with increased likelihood of errors. Conclusions Medication reconciliation errors upon discharge from the EMU occur during approximately 10% of admissions. A higher number of preadmission antiseizure medications, higher total number of preadmission medications, higher number of medication changes during admission, and longer length of stay are associated with increased risk of discharge medication reconciliation errors. Careful attention should be paid to patients with these risk factors.
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Affiliation(s)
- Ayman Alboudi
- Department of Neurology, Lenox Hill Hospital, New York, NY,
USA
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
- Department of Neurology, Staten Island University Hospital (Northwell Health), Staten Island, NY,
USA
| | - Anna M. Bank
- Department of Neurology, Lenox Hill Hospital, New York, NY,
USA
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
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Houskamp EJ, Liu Y, Silva Pinheiro do Nascimento J, Jahromi BS, Lindholm PF, Kwaan HC, Naidech AM. P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage. Ann Clin Transl Neurol 2024; 11:1535-1540. [PMID: 38654459 PMCID: PMC11187947 DOI: 10.1002/acn3.52070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Hematoma expansion (HE) predicts disability and death after acute intracerebral hemorrhage (ICH). Aspirin and anticoagulants have been associated with HE. We tested the hypothesis that P2Y12 inhibitors predict subsequent HE in patients. We explored laboratory measures of P2Y12 inhibition and dual antiplatelet therapy with aspirin (DAPT). METHODS We prospectively identified patients with ICH. Platelet activity was measured with the VerifyNow-P2Y12 assay. Hematoma volumes for initial and follow-up CTs were calculated using a validated semi-automated technique. HE was defined as the difference between hematoma volumes on the initial and follow-up CT scans. Nonparametric statistics were performed with Kruskal-Wallis H, and correction for multiple comparisons performed with Dunn's test. RESULTS In 194 patients, 15 (7.7%) were known to take a P2Y12 inhibitor (clopidogrel in all but one). Patients taking a P2Y12 inhibitor had more HE compared to patients not taking a P2Y12 inhibitor (3.5 [1.2-11.9] vs. 0.1 [-0.8-1.4] mL, p = 0.004). Patients taking DAPT experienced the most HE (7.2 [2.6-13.8] vs. 0.0 [-1.0-1.1] mL, p = 0.04). The use of P2Y12 inhibitors was associated with less P2Y12 activity (178 [149-203] vs. 288 [246-319] P2Y12 reaction units, p = 0.005). INTERPRETATION Patients taking a P2Y12 inhibitor had more HE and less P2Y12 activity. The effect was most pronounced in patients on DAPT, suggesting a synergistic effect of P2Y12 inhibitors and aspirin with respect to HE. Acute reversal of P2Y12 inhibitors in acute ICH requires further study.
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Affiliation(s)
- Ethan J. Houskamp
- Department of NeurologyFeinberg School of MedicineChicagoIllinoisUSA
| | - Yuzhe Liu
- Department of NeurologyFeinberg School of MedicineChicagoIllinoisUSA
| | | | - Babak S. Jahromi
- Department of Neurological SurgeryFeinberg School of MedicineChicagoIllinoisUSA
| | - Paul F. Lindholm
- Division of Hematology/Oncology, Department of MedicineFeinberg School of MedicineChicagoIllinoisUSA
| | - Hau C. Kwaan
- Division of Hematology/Oncology, Department of MedicineFeinberg School of MedicineChicagoIllinoisUSA
| | - Andrew M. Naidech
- Department of NeurologyFeinberg School of MedicineChicagoIllinoisUSA
- Department of Neurological SurgeryFeinberg School of MedicineChicagoIllinoisUSA
- Institute for Public Health and MedicineFeinberg School of MedicineChicagoIllinoisUSA
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Gunkelman SM, Jamerino-Thrush J, Genet K, Blackford M, Jones K, Bigham MT. Improving Accuracy of Medication Reconciliation for Hospitalized Children: A Quality Project. Hosp Pediatr 2024; 14:300-307. [PMID: 38529561 DOI: 10.1542/hpeds.2023-007396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Medication reconciliation is a complex, but necessary, process to prevent patient harm from medication discrepancies. Locally, the steps of medication reconciliation are completed consistently; however, medication errors still occur, which suggest process inaccuracies. We focused on removal of unnecessary medications as a proxy for accuracy. The primary aim was to increase the percentage of patients admitted to the pediatric hospital medicine service with at least 1 medication removed from the home medication list by 10% during the hospital stay by June of 2022. METHODS Using the Model for Improvement, a multidisciplinary team was formed at a children's hospital, a survey was completed, and multiple Plan-Do-Study-Act cycles were done focusing on: 1. simplifying electronic health record processes by making it easier to remove medications; 2. continuous resident education about the electronic health record processes to improve efficiency and address knowledge gaps; and 3. auditing charts and real-time feedback. Data were monitored with statistical process control charts. RESULTS The project exceeded the goal, improving from 35% to 48% of patients having at least 1 medication removed from their home medication list. Improvement has sustained for 12 months. CONCLUSIONS The combination of interventions including simplifying workflow, improving education, and enhancing accountability resulted in more patients with medications removed from their home medication list.
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Affiliation(s)
- Samantha M Gunkelman
- Divisions of Pediatric Hospital Medicine
- Departments of Quality Services
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
| | | | - Katherine Genet
- Emergency Medicine
- Medical Education
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
| | - Martha Blackford
- Clinical Pharmacology and Toxicology
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
| | - Kerwyn Jones
- Orthopedic Surgery, Akron Children's Hospital, Akron, Ohio
| | - Michael T Bigham
- Critical Care Medicine
- Departments of Quality Services
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
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Babadagli HE, Koshman SL, Graham M, Pearson GJ. Pharmacist-Led Follow-Up Program for Rural Patients with Acute Coronary Syndrome: The PLURAL-ACS Pilot Program. Can J Hosp Pharm 2024; 77:e3472. [PMID: 38357302 PMCID: PMC10846798 DOI: 10.4212/cjhp.3472] [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: 03/26/2023] [Accepted: 07/19/2023] [Indexed: 02/16/2024]
Abstract
Background Patients living in rural settings have poorer access to care and more frequent readmissions after treatment for acute coronary syndrome (ACS) than patients in urban settings. It is unclear what types of medication-related issues are encountered by this cohort and whether pharmacist-led care could resolve them. Objectives To describe the issues related to cardiac medications encountered by rural patients after treatment for ACS and the impact of a pharmacist-led virtual follow-up pilot program in this population. Methods A quality improvement initiative was developed whereby a cardiology pharmacist provided follow-up to post-ACS rural patients in Alberta, Canada, between March and May 2022. For each patient, the pharmacist identified and resolved cardiac medication-related issues through regular telephone visits over a 30-day period following hospital discharge. The primary outcome was the number of cardiac medication-related issues identified. Secondary outcomes included the types of medication-related issues identified and actions taken by the pharmacist to resolve them. Results During the 15-week program, 40 patients received care, and 139 virtual visits were completed. The median time spent per visit was 60 (interquartile range [IQR] 50-80) minutes. In total, 255 cardiac medication-related issues (6 per patient, IQR 3.75-8.25) were identified, of which 233 (91%) were resolved by the pharmacist. Prescription errors, adverse effects, and drug therapy optimization were the most common issues identified on days 1, 10, and 30, respectively. The pharmacist commonly undertook patient counselling (n = 126, 54%) and medication prescribing (n = 63, 27%) to address medication-related issues. Conclusions A substantial number of cardiac medication-related issues were identified and resolved through a pharmacist-led virtual follow-up program in rural post-ACS patients. These findings could assist in the development of future follow-up programs to improve care for this high-risk population.
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Affiliation(s)
- Hazal Ece Babadagli
- , BScPharm, PharmD, ACPR-2, was, at the time of this study, with Pharmacy Services, Alberta Health Services, Edmonton, Alberta. She is now with Vancouver Coastal Health, Vancouver, British Columbia. In spring 2024, Hazal will graduate from the MSc program, Department of Medicine, University of Alberta
| | - Sheri L Koshman
- , BScPharm, PharmD, ACPR, FCSHP, is with the Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Michelle Graham
- , MD, FRCPC, FCCS, is with the Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Glen J Pearson
- , BSc, BScPhm, PharmD, FCSHP, FCCS, is with the Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
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Ahmadimoghaddam D, Akbari P, Mehrpooya M, Entezari-Maleki T, Rangchian M, Zamanirafe M, Parvaneh E, Mohammadi Y. Comparison between proactive and retroactive models of medication reconciliation in patients hospitalized for acute decompensated heart failure. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:143-158. [PMID: 38457155 DOI: 10.3233/jrs-230034] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. OBJECTIVE This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. METHODS This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran. Eligible patients were those hospitalized for acute decompensated heart failure using a minimum of five regular medications before admission. Medication reconciliation was performed in 81 cases using the proactive model and in 81 using the retroactive model. RESULTS 556 medications were reconciled using the retroactive model, and 581 were reconciled using the proactive model. In the retroactive cases, 341 discrepancies (both intentional and unintentional) were identified, compared to 231 in the proactive cases. The proportion of patients with at least one unintentional discrepancy was significantly lower in the proactive cases than in the retroactive cases (23.80% versus 74.03%). Moreover, the number of unintentional discrepancies was significantly lower in the proactive cases compared to the retroactive cases (22 out of 231 discrepancies versus 150 out of 341 discrepancies). In the retroactive cases, medication omission was the most frequent type of unintentional discrepancy (44.00). About, 42.70% of reconciliation errors detected in the retroactive cases were judged to have the potential to cause moderate to severe harm. While the average time spent obtaining medication history was similar in both models (00:27 [h: min] versus 00:30), the average time needed to complete the entire process was significantly shorter in the proactive model compared to the retroactive model (00:41 min versus 00:51). CONCLUSION This study highlighted that the proactive model is a timely and effective method of medication reconciliation, particularly in improving medication safety for high-risk patients.
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Affiliation(s)
- Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Paniz Akbari
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rangchian
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Medical Faculty, Hamadan University of Medical Science, Hamadan, Iran
| | - Erfan Parvaneh
- Department of Cardiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Cardinale S, Saraon T, Lodoe N, Alshehry A, Raffoul M, Caspers C, Vider E. Clinical Pharmacist Led Medication Reconciliation Program in an Emergency Department Observation Unit. J Pharm Pract 2023; 36:1156-1163. [PMID: 35465767 DOI: 10.1177/08971900221091174] [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] [Indexed: 11/16/2022]
Abstract
Objectives: Medication reconciliation is the process of comparing a patient's hospital medication orders to all of the medications that the patient has been taking prior to admission. The primary aim of this study was to evaluate the effectiveness of pharmacist-led medication reconciliation in reducing ED visit rates. The secondary aim of this study was to evaluate if a clinical pharmacist reduces medication errors in an ED observation unit (OBS). Methods: This was a retrospective, IRB approved, chart review conducted at New York University Langone Health-Tisch Hospital. The study defines the year before a clinical pharmacist was present on the unit (July 5, 2016 through July 4, 2017) as the control group and the first year a clinical pharmacist was present on the unit (July 5, 2017 through July 4, 2018) as the intervention group. The primary endpoint was 30-day ED re-visits. The secondary endpoints were 60-and 90-day ED re-visits, number, type and severity of medication history and reconciliation discrepancies. Results: The primary endpoint of 30-day ED visits occurred in 153 patients in the no pharmacist group and 88 patients in the OBS clinical pharmacist group (19.1% vs 9.9%, P < .00001). The secondary endpoint of 60- day ED visits occurred in 53 patients in the no pharmacist group and 39 patients in the OBS clinical pharmacist group (8.2% vs 4.9%, P = .01). The secondary endpoint of 90- day ED visits occurred in 31 patients in the no pharmacist group and 26 patients in the OBS clinical pharmacist group (5.2% vs 3.4%, P = .01). Conclusion: The benefits of having a clinical pharmacist perform medication reconciliation are highlighted by the reduction in ED visits, cost savings, and the prolific amount of errors corrected.
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Affiliation(s)
| | | | | | | | - Melanie Raffoul
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | | | - Etty Vider
- Department of Pharmacy Practice, LIU Pharmacy, Brooklyn, NY, USA
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Correard F, Arcani R, Montaleytang M, Nakache J, Berard C, Couderc AL, Villani P, Daumas A. [Medication reconciliation: Interests and limits]. Rev Med Interne 2023; 44:479-486. [PMID: 36841717 DOI: 10.1016/j.revmed.2023.02.001] [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: 10/24/2022] [Revised: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.
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Affiliation(s)
- F Correard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Arcani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Montaleytang
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - J Nakache
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Berard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A L Couderc
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France; Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.
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Coiffard J, Aubry A, Bleibtreu A, Fourniols E, Junot H. Impact of clinical pharmacist interventions in a bone and joint infection orthoseptic surgery unit. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:826-832. [PMID: 37075975 DOI: 10.1016/j.pharma.2023.04.004] [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: 08/02/2022] [Revised: 02/09/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the impact of interventions of a clinical pharmacist in a unit of orthopedic surgery specialized in bone and joint infections. METHODS Daily, in routine, a clinical pharmacist analyzed medication prescribed to inpatients via a computerized physician order entry (CPOE) (Phedra software). His attention was particularly focused on the impact of antibiotics on other medications. For this study, all of the pharmacist interventions (PI) have been retrospectively collected, then anonymized, and assessed over a two-month period. RESULTS Thirty-eight patients were hospitalized during the study period, with a mean age of 63 years old. Forty-five interventions were identified which represents a mean of 1.18 pharmaceutical interventions per patient. Most of them concerned lack of follow-up (24%) and drug-drug interactions (22%) and widely non-anti-infectious medication (35 interventions) with levothyroxine (10 interventions) as the most involved non-anti-infectious molecule. Among antibiotics, with respectively 9 and 8 interventions, rifampicin and fluoroquinolones (6 interventions for moxifloxacin) were the most concerned notably for drug-drug interactions with usual treatment. CONCLUSION In this observational retrospective study, 1.18 pharmacist interventions (PI) per patient were observed. Most of them are lack of follow-up and drug-drug interactions especially with usual treatment of patients. Moxifloxacin and rifampicin were the most antibiotics involved. Patients' characteristics (older, polypharmacy), long-term hospitalization and surgery are known to be predictive factors of medication errors and this study highlights the importance of the presence of clinical pharmacist in orthopedic surgery wards.
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Affiliation(s)
- Julie Coiffard
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France.
| | - Alexandra Aubry
- Laboratory of bacteriology, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Bleibtreu
- Infectious and tropical diseases ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Eric Fourniols
- Orthopaedic surgery ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Helga Junot
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France
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Korup SG, Almarsdóttir AB, Magnussen L. Comparison of prioritisation algorithms for the selection of patients for medication reviews in the emergency department: a cross-sectional study. Int J Clin Pharm 2023; 45:884-892. [PMID: 37081169 PMCID: PMC10366030 DOI: 10.1007/s11096-023-01582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Risk prioritisation algorithms provide patients with a risk category that guides pharmacists to choose those needing medication reviews (MRs) the most. For this study the Medicine Risk Score (MERIS) and a modified Assessment of Risk Tool (ART) were used. AIM To examine how the selection of patients by the clinical pharmacists in an emergency department for MRs compared with the categorisation provided by MERIS and a modified version of ART (mART). Furthermore, examine the agreement between MERIS and mART. METHOD A cross-sectional study was conducted using data on all admitted patients during a two-month period. Data were entered into the prioritisation algorithms and independently ranked by the six pharmacists who were observed as they selected patients for MR. Risk scores and categorisations were compared between the algorithms and the pharmacists' ranking using t-test, Z-test, Chi square, Kruskal Wallis H-test, or Kappa statistics. RESULTS The study included 1133 patients. Significant differences were found between the pharmacists and the algorithms. The sensitivity and specificity of MERIS were 37.8% and 73.6%, for mART, 33.0% and 75.9%. Kappa was 0.58, showing moderate agreement. No significant differences were observed between the individual pharmacists' selection, but differences were significant between how pharmacists ranked the importance of the provided MRs. CONCLUSION Pharmacists disagreed with the risk categorisation provided by MERIS and mART. However, MERIS and mART had similar sensitivity, specificity, and moderate agreement. Further research should focus on how clinical algorithms affect the selection of patients and on the importance of the MRs carried out by pharmacists.
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Affiliation(s)
- Signe Gejr Korup
- Social and Clinical Pharmacy Research Group, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark
| | - Anna Birna Almarsdóttir
- Social and Clinical Pharmacy Research Group, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - Line Magnussen
- Capital Region Hospital Pharmacy, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
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Schnipper JL, Reyes Nieva H, Yoon C, Mallouk M, Mixon AS, Rennke S, Chu ES, Mueller SK, Smith GR, Williams MV, Wetterneck TB, Stein J, Dalal AK, Labonville S, Sridharan A, Stolldorf DP, Orav EJ, Gresham M, Goldstein J, Platt S, Nyenpan CT, Howell E, Kripalani S. What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study. BMJ Qual Saf 2023; 32:457-469. [PMID: 36948542 PMCID: PMC11046420 DOI: 10.1136/bmjqs-2022-014806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The second Multicenter Medication Reconciliation Quality Improvement Study demonstrated a marked reduction in medication discrepancies per patient. The aim of the current analysis was to determine the association of patient exposure to each system-level intervention and receipt of each patient-level intervention on these results. METHODS This study was conducted at 17 North American Hospitals, the study period was 18 months per site, and sites typically adopted interventions after 2-5 months of preintervention data collection. We conducted an on-treatment analysis (ie, an evaluation of outcomes based on patient exposure) of system-level interventions, both at the category level and at the individual component level, based on monthly surveys of implementation site leads at each site (response rate 65%). We then conducted a similar analysis of patient-level interventions, as determined by study pharmacist review of documented activities in the medical record. We analysed the association of each intervention on the adjusted number of medication discrepancies per patient in admission and discharge orders, based on a random sample of up to 22 patients per month per site, using mixed-effects Poisson regression with hospital site as a random effect. We then used a generalised linear mixed-effects model (GLMM) decision tree to determine which patient-level interventions explained the most variance in discrepancy rates. RESULTS Among 4947 patients, patient exposure to seven of the eight system-level component categories was associated with modest but significant reductions in discrepancy rates (adjusted rate ratios (ARR) 0.75-0.97), as were 15 of the 17 individual system-level intervention components, including hiring, reallocating and training personnel to take a best possible medication history (BPMH) and training personnel to perform discharge medication reconciliation and patient counselling. Receipt of five of seven patient-level interventions was independently associated with large reductions in discrepancy rates, including receipt of a BPMH in the emergency department (ED) by a trained clinician (ARR 0.40, 95% CI 0.37 to 0.43), admission medication reconciliation by a trained clinician (ARR 0.57, 95% CI 0.50 to 0.64) and discharge medication reconciliation by a trained clinician (ARR 0.64, 95% CI 0.57 to 0.73). In GLMM decision tree analyses, patients who received both a BPMH in the ED and discharge medication reconciliation by a trained clinician experienced the lowest discrepancy rates (0.08 per medication per patient). CONCLUSION AND RELEVANCE Patient-level interventions most associated with reductions in discrepancies were receipt of a BPMH of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were associated with modest reduction in discrepancies for the average patient but are likely important to support patient-level interventions and may reach more patients. These findings can be used to help hospitals and health systems prioritise interventions to improve medication safety during care transitions.
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Affiliation(s)
- Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Harry Reyes Nieva
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Yoon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Meghan Mallouk
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Amanda S Mixon
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie Rennke
- UCSF Health and Department of Medicine, Division of Hospital Medicine, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Eugene S Chu
- Parkland Health and Hospital System and Hospital Medicine Service, Department of Internal Medicine, University of Texas Southwestern School of Medicine, Dallas, Texas, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - G Randy Smith
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Mark V Williams
- Division of Hospital Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Tosha B Wetterneck
- Department of Medicine, Center for Quality and Productivity Improvement, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin, USA
| | - Jason Stein
- Section of Hospital Medicine, Emory University Hospital and 1Unit, Atlanta, Georgia, USA
| | - Anuj K Dalal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Stephanie Labonville
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anirudh Sridharan
- Department of Medicine, Howard County General Hospital, Columbia, Maryland, USA
| | - Deonni P Stolldorf
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Endel John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Marcus Gresham
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Jenna Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Sara Platt
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | | | - Eric Howell
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Komenan K, Bouveret P, Delecluse C, Robinet P, Puisieux F, Visade F. A Qualitative Analysis of the Optimal Discharge Summary: Effective Communication of Medication Changes for Older Patients. J Appl Gerontol 2023; 42:871-878. [PMID: 36514276 DOI: 10.1177/07334648221145847] [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] [Indexed: 12/15/2022] Open
Abstract
Background: The importance of the discharge summary (DS) is well recognized. The format to be used is also important, but this aspect has not yet been studied in the literature. The purpose of this work was to establish a DS format for older patients that ensures effective communication with general practitioners (GPs). Methods: This study was based on the grounded theory approach to qualitative analysis. Data was collected from GPs during semi-structured and directive interviews. Results: Semi-structured interviews were conducted with 12 GPs and directive interviews with 39 GPs. A consensus was reached on one DS version providing selected information items such as trends in laboratory results (rising/falling) and information about planned drug withdrawals or specialist consultations. Conclusion: This work led to a consensus on the most appropriate format for the DS for older patients returning home. Its use in routine practice is needed to confirm its reception by GPs.
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Affiliation(s)
- Ked Komenan
- General Medicine Department, 27023University of Lille, Lille, France
| | - Perrine Bouveret
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Céline Delecluse
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Pierre Robinet
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | | | - Fabien Visade
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
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15
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Trivedi SP, Corderman S, Berlinberg E, Schoenthaler A, Horwitz LI. Assessment of Patient Education Delivered at Time of Hospital Discharge. JAMA Intern Med 2023; 183:417-423. [PMID: 36939674 PMCID: PMC10028544 DOI: 10.1001/jamainternmed.2023.0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/05/2023] [Indexed: 03/21/2023]
Abstract
Importance Patient education at time of hospital discharge is critical for smooth transitions of care; however, empirical data regarding discharge communication are limited. Objective To describe whether key communication domains (medication changes, follow-up appointments, disease self-management, red flags, question solicitation, and teach-back) were addressed at the bedside on the day of hospital discharge, by whom, and for how long. Design, Setting, and Participants This quality improvement study was conducted from September 2018 through October 2019 at inpatient medicine floors in 2 urban, tertiary-care teaching hospitals and purposefully sampled patients designated as "discharge before noon." Data analysis was performed from September 2018 to May 2020. Exposures A trained bedside observer documented all content and duration of staff communication with a single enrolled patient from 7 am until discharge. Main Outcomes and Measures Presence of the key communication domains, role of team members, and amount of time spent at the bedside. Results Discharge days for 33 patients were observed. Patients had a mean (SD) age of 63 (18) years; 14 (42%) identified as White, 15 (45%) were female, and 6 (18%) had a preferred language of Spanish. Thirty patients were discharged with at least 1 medication change. Of these patients, 8 (27%) received no verbal instruction on the change, while 16 of 30 (53%) were informed but not told the purpose of the changes. About half of the patients (15 of 31, 48%) were not told the reason for follow-up appointments, and 18 of 33 (55%) were not given instructions on posthospital disease self-management. Most patients (27 of 33, 81%) did not receive guidance on red-flag signs. While over half of the patients (19 of 33, 58%) were asked if they had any questions, only 1 patient was asked to teach back his understanding of the discharge plan. Median (IQR) total time spent with patients on the day of discharge by interns, senior residents, attending physicians, and nurses was 4.0 (0.75-6.0), 1.0 (0-2.0), 3.0 (0.5-7.0), and 22.5 (15.5-30.0) minutes, respectively. Most of the time was spent discussing logistics rather than discharge education. Conclusions and Relevance In this quality improvement study, patients infrequently received discharge education in key communication domains, potentially leaving gaps in patient knowledge. Interventions to improve the hospital discharge process should address the content, method of delivery, and transparency among team members regarding patient education.
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Affiliation(s)
- Shreya P. Trivedi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
| | - Sara Corderman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elyse Berlinberg
- NYU Grossman School of Medicine, New York University, New York, New York
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Leora I. Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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16
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Montazeri M, Khajouei R, Mahdavi A, Ahmadian L. Developing a minimum data set for cardiovascular Computerized Physician Order Entry (CPOE) and mapping the data set to FHIR: A multi-method approach. J Med Syst 2023; 47:47. [PMID: 37058148 DOI: 10.1007/s10916-023-01943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
Many medical errors occur in the process of treating cardiovascular patients, and most of these errors are related to prescription errors. There are several, one of the methods to prevent prescription errors is the use of a computerized physician order entry (CPOE) system. One of the obstacles of implementing this system is improper design and non-compliance with user needs. one of the issues that should be considered in designing information systems is having a standard minimum data set (MDS). Although many computerized physicians order entry (CPOE) systems have been developed in the world, no study has identified the necessary data and minimum data set (MDS) of CPOE system, and published the process of creating this MDS. This study aimed to develop an MDS for cardiovascular CPOE and standardize it with Fast Healthcare Interoperability Resources (FHIR). A multi-method approach including systematic review for identifying data elements of CPOE, reviewing the content of medical records, validation of the data elements using the expert panel and, determination of the necessary data elements using a survey was conducted. Classification of the data elements and mapping them to FHIR were done to facilitate data sharing and integration with the electronic health record (EHR) system as well as to reduce data diversity. The final data elements of MDS were categorized into 5 main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. Mapping was done by one of the researchers and checked and verified by the second researcher. Non-mapped data elements were added to relevant resources as extensions of existing FHIR resources. In total, 270 data elements were identified from the systematic review. After reviewing the content of 20 patients' medical records, 28 data elements were identified. After combination of data elements of two previous phases and removing duplication, 282 data elements remained. Data elements that were considered necessary to be included in CPOE by conducting a survey among cardiovascular physicians were 109 elements. From 146 resources of FHIR, the data elements of this MDS are covered by 5 resources. This study introduced an MDS for cardiovascular CPOE by combining suggested data elements of previous research, and the practical and local requirements identified in patients' medical records. To facilitate data sharing and integration with EHR, reduce data diversity, and also to categorize data, this MDS was standardized with FHIR. The steps we used to develop this MDS could be a model for creating MDS in other CPOEs and health information systems. This is the first time that the process of developing an MDS for cardiovascular CPOE has been presented in the literature.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Mahdavi
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Science, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Hoornaert C, Pochet S, Lorent S. Development and Delphi validation of a Best Possible Medication History form. Eur J Hosp Pharm 2023; 30:77-85. [PMID: 35414586 PMCID: PMC9986933 DOI: 10.1136/ejhpharm-2021-003095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/14/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and validate a standardized Best Possible Medication History (BPMH) form that could be used by clinical pharmacists. METHODS The draft version was presented to a focus group and was adapted following their comments. A three-rounds e-Delphi method was used to validate content, usability and face validity of the BPMH form. We supplemented the quantitative analysis with a qualitative analysis of comments for each Delphi round. RESULTS The draft BPMH form contained 23 items grouped into eight tabs. Refinement of these tabs and items by the focus group resulted in 7 tabs and 21 items, which were included in the Delphi survey. The consensus was obtained for all tabs within the second round (p=0.072). Consensus was reached on 76% (16/21) of items in the third round. 20 items were included following the qualitative analysis of the experts' comments in the third round. CONCLUSIONS The findings of this study provide data on the content of the BPMH form. This form can be used to help clinical pharmacists to collect a complete and accurate medication list on admission. It could have an impact on inpatient safety and improve inpatient management. Studies with an international e-Delphi should be conducted for wider use.
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Affiliation(s)
- Camille Hoornaert
- Camille Hoornaert, Pharmacy Department, Hôpital Erasme, Bruxelles, Belgium
| | - Stéphanie Pochet
- Unité de recherche en Pharmacologie, Pharmacothérapie et suivi pharmaceutique (PPSP), ULB, Bruxelles, Bruxelles, Belgium
| | - Sophie Lorent
- Pharmacy Department, Hôpital Erasme, Bruxelles, Belgium
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Kabir R, Liaw S, Cerise J, Yi J, Mulvany C, Qiu M, Beizer JL, Sinvani LD. Obtaining the Best Possible Medication History at Hospital Admission: Description of a Pharmacy Technician-Driven Program to Identify Medication Discrepancies. J Pharm Pract 2023; 36:19-26. [PMID: 34080461 DOI: 10.1177/08971900211021254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Describe the process of obtaining the best possible medication history (BPMH) by Certified Pharmacy Technicians (CPhTs) on hospital admission to identify medication discrepancies. METHODS Cross-sectional, descriptive study conducted between December 2016 and June 2017 at a quaternary center in New York, including all patients 18 years and older admitted to the medicine service through the Emergency Department (ED) and seen by a CPhT. CPhTs obtained the BPMH using a systematic approach involving a standardized interview, checking medications with secondary sources and updating the electronic health record (EHR). Medication discrepancies were identified and categorized by type and risk. Summary statistics were provided as average and standard deviation (SD) for continuous variables, and as frequencies and percentages for categorical variables. Multivariable regression was used to test for associations between patient factors and presence of a medication discrepancy. RESULTS Of the 3,087 patient visits, the average age was 69 (SD 17.8), 54% were female (n = 1652) and 65% white (n = 2017); comorbidity score breakdown was: 0 (25%, n = 757), 1-2 (33%, n = 1023), 3-4 (23%, n = 699), > 4 (20%, n = 608). The average number of home and discharge medications were 10 (SD 6.1) and 10 (SD 5.4), respectively. The average time spent obtaining the BPMH was 30.6 minutes (SD 12.9). 69% of patients (n = 2130) had at least 1 discrepancy with an average of 4.2 (SD 4.6), of which 43% (n = 920) included high-risk medications. Having a medication discrepancy was associated with a higher number of home medications (p < 0.0001) comorbidities (p < 0.0001), and source of information (p < 0.04). CONCLUSION Obtaining the BPMH by CPhTs on hospital admission frequently identifies medication discrepancies. Further studies are needed to evaluate the association between obtaining the BPMH and clinical outcomes.
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Affiliation(s)
- Rubiya Kabir
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Samantha Liaw
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jane Cerise
- Feinstein Institute for Medical Research-Biostatistics Unit, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jungen Yi
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Colm Mulvany
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Judith L Beizer
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Liron D Sinvani
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Medicine, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
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Vargas V, Blakeslee WW, Banas CA, Teter C, Dupuis-Dobson K, Aboud C. Use of complete medication history to identify and correct transitions-of-care medication errors at psychiatric hospital admission. PLoS One 2023; 18:e0279903. [PMID: 36696376 PMCID: PMC9876239 DOI: 10.1371/journal.pone.0279903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/16/2022] [Indexed: 01/26/2023] Open
Abstract
Methods for categorizing the scale and severity of medication errors corrected by pharmacy staff during admission medication reconciliation using complete medication history continue to evolve. We established a rating scale that is effective for generating error reports to health system quality leadership. These reports are needed to quantify the value of investment in transitions-of-care pharmacy staff. All medication errors that were reported by pharmacy staff in the admission medication reconciliation process during a period of 6 months were eligible for inclusion. Complete medication history data source was utilized by admitting providers and all pharmacist staff and a novel medication error scoring methodology was developed. This methodology included: medication error category, medication error type, potential medication error severity, and medication non-adherence. We determined that 82 medication errors were detected from 72 patients and assessed that 74 of these errors may have harmed patients if they were not corrected through pharmacist intervention. Most of these errors were dosage discrepancies and omissions. With hospital system budgets continually becoming leaner, it is important to measure the effectiveness and value of staff resources to optimize patient care. Pharmacists performing admission medication reconciliation can detect subtle medication discrepancies that may be overlooked by other clinician types. This methodology can serve as a foundation for error reporting and predicting the severity of adverse drug events.
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Affiliation(s)
- Victoria Vargas
- Department of Pharmacy, McLean Hospital, Belmont, Massachusetts, United States of America
| | - Weston W. Blakeslee
- Applied Clinical Research Division, DrFirst.COM, Inc., Rockville, Maryland, United States of America
| | - Colin A. Banas
- Applied Clinical Research Division, DrFirst.COM, Inc., Rockville, Maryland, United States of America
| | - Christian Teter
- Department of Pharmacy, McLean Hospital, Belmont, Massachusetts, United States of America
| | | | - Carol Aboud
- Department of Pharmacy, McLean Hospital, Belmont, Massachusetts, United States of America
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Chu ES, El-Kareh R, Biondo A, Chang J, Hartman S, Huynh T, Medders K, Nguyen A, Yam N, Succari L, Koenig K, Williams MV, Schnipper J. Implementation of a Medication Reconciliation Risk Stratification Tool Integrated within an electronic health record: A Case Series of Three Academic Medical Centers. Healthcare (Basel) 2022; 10:100654. [DOI: 10.1016/j.hjdsi.2022.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/25/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
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21
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Sallevelt BTGM, Egberts TCG, Huibers CJA, Ietswaart J, Drenth-van Maanen AC, Jennings E, O'Mahony C, Jungo KT, Feller M, Rodondi N, Sibille FX, Spinewine A, van Puijenbroek EP, Wilting I, Knol W. Detectability of Medication Errors With a STOPP/START-Based Medication Review in Older People Prior to a Potentially Preventable Drug-Related Hospital Admission. Drug Saf 2022; 45:1501-1516. [PMID: 36319944 PMCID: PMC9700573 DOI: 10.1007/s40264-022-01237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Multimorbidity and polypharmacy are risk factors for drug-related hospital admissions (DRAs) in the ageing population. DRAs caused by medication errors (MEs) are considered potentially preventable. The STOPP/START criteria were developed to detect potential MEs in older people. OBJECTIVE The aim of this study was to assess the detectability of MEs with a STOPP/START-based in-hospital medication review in older people with polypharmacy and multimorbidity prior to a potentially preventable DRA. METHODS Hospitalised older patients (n = 963) with polypharmacy and multimorbidity from the intervention arm of the OPERAM trial received a STOPP/START-based in-hospital medication review by a pharmacotherapy team. Readmissions within 1 year after the in-hospital medication review were adjudicated for drug-relatedness. A retrospective assessment was performed to determine whether MEs identified at the first DRA were detectable during the in-hospital medication review. RESULTS In total, 84 of 963 OPERAM intervention patients (8.7%) were readmitted with a potentially preventable DRA, of which 72 patients (n = 77 MEs) were eligible for analysis. About half (48%, n = 37/77) of the MEs were not present during the in-hospital medication review and therefore were not detectable at that time. The pharmacotherapy team recommended a change in medication regimen in 50% (n = 20/40) of present MEs, which corresponds to 26% (n = 20/77) of the total identified MEs at readmission. However, these recommendations were not implemented. CONCLUSION MEs identified at readmission were not addressed by a prior single in-hospital medication review because either these MEs occurred after the medication review (~50%), or no recommendation was given during the medication review (~25%), or the recommendation was not implemented (~25%). Future research should focus on optimisation of the timing and frequency of medication review and the implementation of proposed medication recommendations. REGISTRATION ClinicalTrials.gov identifier: NCT02986425. December 8, 2016. FUNDING European Union HORIZON 2020, Swiss State Secretariat for Education, Research and Innovation (SERI), Swiss National Science Foundation (SNSF).
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Affiliation(s)
- Bastiaan T G M Sallevelt
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Corlina J A Huibers
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jimmy Ietswaart
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - A Clara Drenth-van Maanen
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Cian O'Mahony
- School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | | | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - François-Xavier Sibille
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium
| | - Anne Spinewine
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Eugène P van Puijenbroek
- The Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
- Division of Pharmacotherapy, -Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Wilting
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Costa E Silva T, Dias P, Alves E Cunha C, Feio J, Lavrador M, Oliveira J, Figueiredo IV, Rocha MJ, Castel-Branco M. [Medication Reconciliation During Admission to an Internal Medicine Department: A Pilot Study]. ACTA MEDICA PORT 2022; 35:798-806. [PMID: 35245429 DOI: 10.20344/amp.16892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of medication reconciliation is to promote patient safety by reducing medication errors and adverse events due to medication discrepancies in transition of care. The aim of this pilot study of medication reconciliation at the time of hospital admission was to identify the necessary resources for its implementation in clinical practice. MATERIAL AND METHODS Pilot study with 100 patients admitted to an Internal Medicine department between October and December 2019, aged 18 and over, and chronically taking at least one medicine. The best possible medication history was obtained systematically, with subsequent identification, classification and resolution of the discrepancies. RESULTS The study sample, in general characterized by polypharmacy and by having multiple long-term conditions, presented a mean age of 77.04 ± 13.74 years, being 67.0% male. Overall, 791 discrepancies were identified. Intentional discrepancies were 95.7% and 50.9% of them were documented. The difficulties encountered were mainly related with the access and quality of therapeutic information and communication problems between different healthcare professionals. The key priority resources that were identified were related with the process, tools, and personnel categories. CONCLUSION The data revealed weaknesses in the clinical records available at the primary/hospital care interface. Optimization of data sources, standardization and informatization of the process, multidisciplinary approach and definition of priority groups were identified as opportunities for optimization.
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Affiliation(s)
- Thaís Costa E Silva
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra.Portugal
| | - Patrícia Dias
- Serviço de Medicina Interna. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Catarina Alves E Cunha
- Unidade de Farmacologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - José Feio
- Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Marta Lavrador
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
| | - Joelizy Oliveira
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Fundação Capes. Ministério da Educação. Brasília. Brasil. Centro de Documentação e Informação em Educação Superior. Ministério da Educação Superior e Pesquisa do Governo do Grão-Ducado de Luxemburgo. Luxemburgo
| | - Isabel Vitória Figueiredo
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
| | - Marília João Rocha
- Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Margarida Castel-Branco
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
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23
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Malik MA, Motta-Calderon D, Piniella N, Garber A, Konieczny K, Lam A, Plombon S, Carr K, Yoon C, Griffin J, Lipsitz S, Schnipper JL, Bates DW, Dalal AK. A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts. Diagnosis (Berl) 2022; 9:446-457. [PMID: 35993878 PMCID: PMC9651987 DOI: 10.1515/dx-2022-0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/12/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To test a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. METHODS We adapted validated tools (Safer Dx, Diagnostic Error Evaluation Research [DEER] Taxonomy) to assess the diagnostic process during the hospital encounter and categorized 13 postulated e-triggers. We created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and underwent our institution's mortality case review process. After excluding patients with a length of stay of more than one month, each case was reviewed by two blinded clinicians trained in our process and by an expert panel. Inter-rater reliability was assessed. We compared the frequency of DE contributing to death in both cohorts, as well as mean DPFs and e-triggers for DE positive and negative cases within each cohort. RESULTS Twenty-seven (96.4%) preventable and 24 (85.7%) non-preventable cases underwent our review process. Inter-rater reliability was moderate between individual reviewers (Cohen's kappa 0.41) and substantial with the expert panel (Cohen's kappa 0.74). The frequency of DE contributing to death was significantly higher for the preventable compared to the non-preventable cohort (56% vs. 17%, OR 6.25 [1.68, 23.27], p<0.01). Mean DPFs and e-triggers were significantly and non-significantly higher for DE positive compared to DE negative cases in each cohort, respectively. CONCLUSIONS We observed substantial agreement among final consensus and expert panel reviews using our structured EHR case review process. DEs contributing to death associated with DPFs were identified in institutionally designated preventable and non-preventable cases. While e-triggers may be useful for discriminating DE positive from DE negative cases, larger studies are required for validation. Our approach has potential to augment institutional mortality case review processes with respect to DE surveillance.
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Affiliation(s)
- Maria A. Malik
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel Motta-Calderon
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicholas Piniella
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alison Garber
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kaitlyn Konieczny
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alyssa Lam
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Savanna Plombon
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kevin Carr
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Catherine Yoon
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Stuart Lipsitz
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey L. Schnipper
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David W. Bates
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anuj K. Dalal
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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An electronic pillbox intervention designed to improve medication safety during care transitions: challenges and lessons learned regarding implementation and evaluation. BMC Health Serv Res 2022; 22:1304. [PMID: 36309744 PMCID: PMC9618185 DOI: 10.1186/s12913-022-08702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adverse drug events are common during transitions of care. As part of the Smart Pillbox study, a cluster-randomized controlled trial of an electronic pillbox designed to reduce medication discrepancies and improve medication adherence after hospital discharge, we explored barriers to successful implementation and evaluation of this intervention. Methods Eligible patients were those admitted to a medicine service of a large teaching hospital with a plan to be discharged home on five or more chronic medications. The intervention consisted of an electronic pillbox with pre-filled weekly blister pack medication trays given to patients prior to discharge. Pillbox features included alarms to take medications, detection of pill removal from each well, alerts to patients or caregivers by phone, email, or text if medications were not taken, and adherence reports accessible by providers. Greater than 20% missed doses for three days in a row triggered outreach from a pharmacist. To identify barriers to implementation and evaluation of the intervention, we reviewed patient exit surveys, including quantitative data on satisfaction and free-text responses regarding their experiences; technical issue logs; and team meeting minutes. Themes were derived by consensus among the study authors and organized using the Consolidated Framework for Implementation Research. Results Barriers to implementation included intervention characteristics such as perceived portability issues with the pillbox and time required by pharmacists to enter medication information into the software; external policies such as lack of insurance coverage for early refills and regulatory prohibitions on repackaging medications; implementation climate issues such as the incompatibility between the rushed nature of hospital discharge with the time required to deploy the intervention; and patient issues such as denial of previous problems with medication adherence. We founds several obstacles to conducting the study, including patients declining study enrollment and limited attempts by the hospital to streamline logistics by building the intervention into usual care. Several solutions to address many of these challenges were implemented or planned. Despite these challenges, many patients with the pillbox were pleased with the service and believed the intervention worked well for them. Conclusions In this evaluation, several barriers to implementing and conducting a study of the effectiveness of the intervention were identified. Our findings provide lessons learned for others wishing to implement and evaluate HIT-related interventions designed to improve medication safety during care transitions. Trial registration Clinicaltrials.gov NCT03475030
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25
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Moges TA, Akalu TY, Sema FD. Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation. BMC Health Serv Res 2022; 22:1251. [PMID: 36243696 PMCID: PMC9571466 DOI: 10.1186/s12913-022-08628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Medication reconciliation (MedRec) is a widely accepted tool for the identification and resolution of unintended medication discrepancies (UMD). Objective This study aimed at assessing the magnitude and associated factors of UMD identified through medication reconciliation upon patient admission to the internal medicine wards. Methods Prospective cross-sectional study was conducted at the internal medicine wards of Felege Hiwot and Tibebe Ghion comprehensive specialized hospitals in Bahir Dar city, Northwest Ethiopia, from May 01 to July 30, 2021. Data were collected by using a data abstraction format prepared based on standard MedRec tools and previous studies on medication discrepancy. Pharmacists-led MedRec was made by following the WHO High5s “retroactive medication reconciliation model”. SPSS® (IBM Corporation) version 25.0 was used to analyze the data with descriptive and inferential statistics. A binary logistic regression analysis was used to identify factors associated with UMD. A statistical significance was declared at a p-value < 0.05. Results Among 635 adult patients, 248 (39.1%) of them had at least one UMD. The most frequent types of UMDs were omission (41.75%) and wrong dose (21.9%). The majority (75.3%) of pharmacists’ interventions were accepted. Polypharmacy at admission (p-value < 0.001), age ≥ 65 (p-value = 0.001), a unit increase on the number of comorbidities (p-value = 0.008) and information sources used for MedRec (p-value < 0.001), and medium (p-value = 0.019) and low adherence (p-value < 0.001) were significantly associated with UMD. Conclusion The magnitude of UMD upon patient admission to the internal medicine wards was considerably high. Omission and the wrong dose of medication were common. Older age, polypharmacy, low and medium adherence, and an increase in the number of comorbidities and information sources used for MedRec are significantly associated with UMDs. Pharmacists' interventions were mostly acceptable. Thus, the implementation of pharmacists-led MedRec in the two hospitals is indispensable for patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08628-5.
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Affiliation(s)
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Faisel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Lesselroth B, Church VL, Adams K, Mixon A, Richmond-Aylor A, Glasscock N, Wiedrick J. Interprofessional survey on medication reconciliation activities in the US Department of Veterans' Affairs: development and validation of an Implementation Readiness Questionnaire. BMJ Open Qual 2022; 11:bmjoq-2021-001750. [PMID: 36229073 PMCID: PMC9562315 DOI: 10.1136/bmjoq-2021-001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication reconciliation (MR) can detect medication history discrepancies at interfaces-in-care and help avoid downstream adverse drug events. However, organisations have struggled to implement high-quality MR programmes. The literature has identified systems barriers, including technology capabilities and data interoperability. However, organisational culture as a root cause has been underexplored. OBJECTIVES Our objectives were to develop an implementation readiness questionnaire and measure staff attitudes towards MR across a healthcare enterprise. METHODS We developed and distributed a questionnaire to 170 Veterans' Health Affairs (VHA) sites using Research Electronic Data Capture (REDCap) software. The questionnaire contained 21 Likert-scale items that measured three constructs, such as: (1) the extent that clinicians valued MR; (2) perceptions of workflow compatibility and (3) perceptions concerning organisational climate of implementation. RESULTS 8704 clinicians and staff responded to our questionnaire (142 of 170 VHA facilities). Most staff believed reconciling medications can improve medication safety (approximately 90% agreed it was 'important'). However, most (approximately 90%) also expressed concerns about changes to their workflow. One-third of respondents prioritised other duties over MR and reported barriers associated with implementation climate. Only 47% of respondents agreed they had enough resources to address discrepancies when identified. INTERPRETATION Our findings indicate that an MR readiness assessment can forecast challenges and inform development of a context-sensitive implementation bundle. Clinicians surveyed struggled with resources, technology challenges and implementation climate. A strong campaign should include clear leadership messaging, credible champions and resources to overcome technical challenges. CONCLUSIONS This manuscript provides a method to conduct a readiness assessment and highlights the importance of organisational culture in an MR campaign. The data can help assess site or network readiness for an MR change management programme.
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Affiliation(s)
- Blake Lesselroth
- Department of Medical Informatics, The University of Oklahoma-Tulsa, Tulsa, Oklahoma, USA,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Victoria Lee Church
- US Department of Veterans Affairs, Office of Nursing Services, Washington, DC, USA
| | - Kathleen Adams
- US Department of Veterans Affairs, Office of Human Factors Engineering, Washington, DC, USA
| | - Amanda Mixon
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy Richmond-Aylor
- Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Naomi Glasscock
- Specialty Care Services, Prescription Drug Monitoring Program, Veterans Health Administration, Washington, DC, USA
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon, USA
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Zheng F, Wang D, Zhang X. The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China. BMC Health Serv Res 2022; 22:1157. [PMID: 36104805 PMCID: PMC9472438 DOI: 10.1186/s12913-022-08505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs. METHODS A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication. RESULTS The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001). CONCLUSION The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur. TRIAL REGISTRATION This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020-087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn , number ChiCTR2000035321 date: 08/08/2020).
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Affiliation(s)
- Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Huangjiahu West Road No.16, Hongshan District, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Schnipper JL. Web Exclusive. Annals for Hospitalists Inpatient Notes - Improving Medication Reconciliation in Hospitals. Ann Intern Med 2022; 175:HO2-HO3. [PMID: 35969870 DOI: 10.7326/m22-1954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.L.S.)
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29
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Schnipper JL, Reyes Nieva H, Mallouk M, Mixon A, Rennke S, Chu E, Mueller S, Smith GRR, Williams MV, Wetterneck TB, Stein J, Dalal A, Labonville S, Sridharan A, Stolldorf DP, Orav EJ, Levin B, Gresham M, Yoon C, Goldstein J, Platt S, Nyenpan CT, Howell E, Kripalani S. Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study. BMJ Qual Saf 2022; 31:278-286. [PMID: 33927025 PMCID: PMC10964422 DOI: 10.1136/bmjqs-2020-012709] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The objective of this study was to determine the effects of a refined toolkit on a larger group of hospitals. METHODS We conducted a pragmatic quality improvement study (MARQUIS2) at 18 North American hospitals or hospital systems from 2016 to 2018. Incorporating lessons learnt from MARQUIS1, we implemented a refined toolkit, offering 17 system-level and 6 patient-level interventions. One of eight physician mentors coached each site via monthly calls and performed one to two site visits. The primary outcome was number of unintentional medication discrepancies in admission or discharge orders per patient. Time series analysis used multivariable Poisson regression. RESULTS A total of 4947 patients were sampled, including 1229 patients preimplementation and 3718 patients postimplementation. Both the number of system-level interventions adopted per site and the proportion of patients receiving patient-level interventions increased over time. During the intervention, patients experienced a steady decline in their medication discrepancy rate from 2.85 discrepancies per patient to 0.98 discrepancies per patient. An interrupted time series analysis of the 17 sites with sufficient data for analysis showed the intervention was associated with a 5% relative decrease in discrepancies per month over baseline temporal trends (adjusted incidence rate ratio: 0.95, 95% CI 0.93 to 0.97, p<0.001). Receipt of patient-level interventions was associated with decreased discrepancy rates, and these associations increased over time as sites adopted more system-level interventions. CONCLUSION A multicentre medication reconciliation QI initiative using mentored implementation of a refined best practices toolkit, including patient-level and system-level interventions, was associated with a substantial decrease in unintentional medication discrepancies over time. Future efforts should focus on sustainability and spread.
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Affiliation(s)
- Jeffrey L Schnipper
- Hospital Medicine Unit, Brigham Health, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Harry Reyes Nieva
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Mallouk
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Amanda Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Stephanie Rennke
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Eugene Chu
- Division of Hospital Medicine, Parkland Health and Hospital System and Department of Internal Medicine, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Stephanie Mueller
- Hospital Medicine Unit, Brigham Health, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregory Randy R Smith
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark V Williams
- Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky Medical Center, Lexington, KY, USA
| | - Tosha B Wetterneck
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Anuj Dalal
- Hospital Medicine Unit, Brigham Health, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - E John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | - Brian Levin
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcus Gresham
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cathy Yoon
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jenna Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Sara Platt
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | | | - Eric Howell
- Society of Hospital Medicine, Philadelphia, PA, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Clinical Quality and Implementation Research, Nashville, TN, USA
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Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF, Vasilevskis EE. Sources of medication omissions among hospitalized older adults with polypharmacy. J Am Geriatr Soc 2022; 70:1180-1189. [PMID: 34967444 PMCID: PMC8986578 DOI: 10.1111/jgs.17629] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies. METHODS Cross-sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post-acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies. RESULTS Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources-pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies. CONCLUSION A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.
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Affiliation(s)
- Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Amanda S Mixon
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
| | - Eduard Eric Vasilevskis
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gallagher D, Greenland M, Lindquist D, Sadolf L, Scully C, Knutsen K, Zhao C, Goldstein BA, Burgess L. Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention. BMJ Open Qual 2022; 11:bmjoq-2021-001560. [PMID: 35241436 PMCID: PMC8896047 DOI: 10.1136/bmjoq-2021-001560] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/20/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Reducing unplanned hospital readmissions is an important priority for all hospitals and health systems. Hospital discharge can be complicated by discrepancies in the medication reconciliation and/or prescribing processes. Clinical pharmacist involvement in the medication reconciliation process at discharge can help prevent these discrepancies and possibly reduce unplanned hospital readmissions. Methods We report the results of our quality improvement intervention at Duke University Hospital, in which pharmacists were involved in the discharge medication reconciliation process on select high-risk general medicine patients over 2 years (2018–2020). Pharmacists performed traditional discharge medication reconciliation which included a review of medications for clinical appropriateness and affordability. A total of 1569 patients were identified as high risk for hospital readmission using the Epic readmission risk model and had a clinical pharmacist review the discharge medication reconciliation. Results This intervention was associated with a significantly lower 7-day readmission rate in patients who scored high risk for readmission and received pharmacist support in discharge medication reconciliation versus those patients who did not receive pharmacist support (5.8% vs 7.6%). There was no effect on readmission rates of 14 or 30 days. The clinical pharmacists had at least one intervention on 67% of patients reviewed and averaged 1.75 interventions per patient. Conclusion This quality improvement study showed that having clinical pharmacists intervene in the discharge medication reconciliation process in patients identified as high risk for readmission is associated with lower unplanned readmission rates at 7 days. The interventions by pharmacists were significant and well received by ordering providers. This study highlights the important role of a clinical pharmacist in the discharge medication reconciliation process.
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Affiliation(s)
- David Gallagher
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Lisa Sadolf
- Pharmacy, Duke University Hospital, Durham, North Carolina, USA
| | - Casey Scully
- Performance Services, Duke University Health System, Durham, North Carolina, USA
| | - Kristian Knutsen
- Performance Services, Duke University Health System, Durham, North Carolina, USA
| | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Lindsey Burgess
- Pharmacy, Duke University Hospital, Durham, North Carolina, USA
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Mahomedradja RF, van den Beukel TO, van den Bos M, Wang S, Kalverda KA, Lissenberg-Witte BI, Kuijvenhoven MA, Nossent EJ, Muller M, Sigaloff KCE, Tichelaar J, van Agtmael MA. Prescribing errors in post - COVID-19 patients: prevalence, severity, and risk factors in patients visiting a post - COVID-19 outpatient clinic. BMC Emerg Med 2022; 22:35. [PMID: 35247982 PMCID: PMC8897739 DOI: 10.1186/s12873-022-00588-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has challenged healthcare globally. An acute increase in the number of hospitalized patients has necessitated a rigorous reorganization of hospital care, thereby creating circumstances that previously have been identified as facilitating prescribing errors (PEs), e.g. a demanding work environment, a high turnover of doctors, and prescribing beyond expertise. Hospitalized COVID-19 patients may be at risk of PEs, potentially resulting in patient harm. We determined the prevalence, severity, and risk factors for PEs in post–COVID-19 patients, hospitalized during the first wave of COVID-19 in the Netherlands, 3 months after discharge. Methods This prospective observational cohort study recruited patients who visited a post-COVID-19 outpatient clinic of an academic hospital in the Netherlands, 3 months after COVID-19 hospitalization, between June 1 and October 1 2020. All patients with appointments were eligible for inclusion. The prevalence and severity of PEs were assessed in a multidisciplinary consensus meeting. Odds ratios (ORs) were calculated by univariate and multivariate analysis to identify independent risk factors for PEs. Results Ninety-eight patients were included, of whom 92% had ≥1 PE and 8% experienced medication-related harm requiring an immediate change in medication therapy to prevent detoriation. Overall, 68% of all identified PEs were made during or after the COVID-19 related hospitalization. Multivariate analyses identified ICU admission (OR 6.08, 95% CI 2.16–17.09) and a medical history of COPD / asthma (OR 5.36, 95% CI 1.34–21.5) as independent risk factors for PEs. Conclusions PEs occurred frequently during the SARS-CoV-2 pandemic. Patients admitted to an ICU during COVID-19 hospitalization or who had a medical history of COPD / asthma were at risk of PEs. These risk factors can be used to identify high-risk patients and to implement targeted interventions. Awareness of prescribing safely is crucial to prevent harm in this new patient population. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00588-7.
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33
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Ziaie S, Mehralian G, Talebi Z. Evaluation of medication reconciliation process in internal medicine wards of an academic medical center by a pharmacist: errors and risk factors. Intern Emerg Med 2022; 17:377-386. [PMID: 34342787 DOI: 10.1007/s11739-021-02811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient's insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients' gender, physicians' gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs' potential interactions and harmful errors can improve this process and prevent such errors in the future.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, 500 12th 13 avenue, Columbus, OH, 43210, USA.
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Murry LT, Keller MS, Pevnick JM, Schnipper JL, Kennelty KA, Nguyen AT, Henreid A, Wisniewski J, Amer K, Armbruster C, Conti N, Guan J, Wu S, Leang DW, Llamas-Sandoval R, Phung E, Rosen O, Rosen SL, Salandanan A, Shane R, Ko EJM, Moriarty D, Muske AM, Matta L, Fanikos J. A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework. BMC Health Serv Res 2022; 22:186. [PMID: 35151310 PMCID: PMC8840769 DOI: 10.1186/s12913-022-07583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention.
Methods
Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding.
Results
In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention.
Conclusion
The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability.
Trial registration
NCT04071951.
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35
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Andersen TS, Gemmer MN, Sejberg HRC, Jørgensen LM, Kallemose T, Andersen O, Iversen E, Houlind MB. Medicines Reconciliation in the Emergency Department: Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication. Pharmaceuticals (Basel) 2022; 15:ph15020142. [PMID: 35215255 PMCID: PMC8877185 DOI: 10.3390/ph15020142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.
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Affiliation(s)
- Tanja Stenholdt Andersen
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Mia Nimb Gemmer
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Hayley Rose Constance Sejberg
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Lillian Mørch Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Ove Andersen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-28-83-85-63
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36
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van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. Risk factors for clinically relevant deviations in patients' medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting. Int J Clin Pharm 2022; 44:539-547. [PMID: 35032251 PMCID: PMC9007785 DOI: 10.1007/s11096-022-01376-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Background Personal health records have the potential to identify medication discrepancies. Although they facilitate patient empowerment and broad implementation of medication reconciliation, more medication discrepancies are identified through medication reconciliation performed by healthcare professionals. Aim We aimed to identify the factors associated with the occurrence of a clinically relevant deviation in a patient’s medication list based on a personal health record (used by patients) compared to medication reconciliation performed by a healthcare professional. Method Three- to 14 days prior to a planned admission to the Cardiology-, Internal Medicine- or Neurology Departments, at Amphia Hospital, Breda, the Netherlands, patients were invited to update their medication file in their personal health records. At admission, medication reconciliation was performed by a pharmacy technician. Deviations were determined as differences between these medication lists. Associations between patient-, setting-, and medication-related factors, and the occurrence of a clinically relevant deviation (National Coordinating Council for Medication Error Reporting and Prevention class \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ E) were analysed. Results Of the 488 patients approached, 155 patients were included. Twenty-four clinically relevant deviations were observed. Younger patients (adjusted odds ratio (aOR) 0.94; 95%CI:0.91–0.98), patients who used individual multi-dose packaging (aOR 14.87; 95%CI:2.02–110), and patients who used \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 8 different medications, were at highest risk for the occurrence of a clinically relevant deviation (sensitivity 0.71; specificity 0.62; area under the curve 0.64 95%CI:0.52–0.76). Conclusion Medication reconciliation is the preferred method to identify medication discrepancies for patients with individual multi-dose packaging, and patients who used eight or more different medications.
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Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Breda, The Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
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37
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Veyrier M, Brun C, Diaby O, Bloch V, Ducasse V. [Continuity of medication after hospitalisation in geriatric follow-up and rehabilitation care]. SOINS. GERONTOLOGIE 2022; 27:39-45. [PMID: 35120721 DOI: 10.1016/j.sger.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
After one year of practice, the medication reconciliation approach in follow-up and rehabilitation care was evaluated. The aim of the activity was to identify changes in treatment (CT). Three hundred and two patients benefited from the process. Some 82.2% of drug lines had voluntary TCs at discharge and all of patients had at least one TC at discharge. What are the consequences of so many TCs and what are the levers to limit these effects?
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Affiliation(s)
| | - Charlotte Brun
- Service de soins de suite et de réadaptation gériatrique, hôpital Fernand-Widal, Assistance publique-Hôpitaux de Paris, groupe hospitalier universitaire Saint-Louis-Lariboisière-Fernand Widal, 2 rue Ambroise-Paré, 75010 Paris, France
| | | | | | - Valérie Ducasse
- Service de soins de suite et de réadaptation gériatrique, hôpital Fernand-Widal, Assistance publique-Hôpitaux de Paris, groupe hospitalier universitaire Saint-Louis-Lariboisière-Fernand Widal, 2 rue Ambroise-Paré, 75010 Paris, France
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38
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van Dijk LM, Meulman MD, van Eikenhorst L, Merten H, Schutijser BCFM, Wagner C. Can using the functional resonance analysis method, as an intervention, improve patient safety in hospitals?: a stepped wedge design protocol. BMC Health Serv Res 2021; 21:1228. [PMID: 34774048 PMCID: PMC8590349 DOI: 10.1186/s12913-021-07244-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Healthcare professionals are sometimes forced to adjust their work to varying conditions leading to discrepancies between hospital protocols and daily practice. We will examine the discrepancies between protocols, 'Work As Imagined' (WAI), and daily practice 'Work As Done' (WAD) to determine whether these adjustments are deliberate or accidental. The discrepancies between WAI and WAD can be visualised using the Functional Resonance Analysis Method (FRAM). FRAM will be applied to three patient safety themes: risk screening of the frail older patients; the administration of high-risk medication; and performing medication reconciliation at discharge. METHODS A stepped wedge design will be used to collect data over 16 months. The FRAM intervention consists of constructing WAI and WAD models by analysing hospital protocols and interviewing healthcare professionals, and a meeting with healthcare professionals in each ward to discuss the discrepancies between WAI and WAD. Safety indicators will be collected to monitor compliance rates. Additionally, the potential differences in resilience levels among nurses before and after the FRAM intervention will be measured using the Employee Resilience Scale (EmpRes) questionnaire. Lastly, we will monitor whether gaining insight into differences between WAI and WAD has led to behavioural and organisational change. DISCUSSION This article will assess whether using FRAM to reveal possible discrepancies between hospital protocols (WAI) and daily practice (WAD) will improve compliance with safety indicators and employee resilience, and whether these insights will lead to behavioural and organisational change. TRIAL REGISTRATION Netherlands Trial Register NL8778; https://www.trialregister.nl/trial/8778 . Registered 16 July 2020. Retrospectively registered.
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Affiliation(s)
- Liselotte M van Dijk
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.
| | - Meggie D Meulman
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.
| | - Linda van Eikenhorst
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Bernadette C F M Schutijser
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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39
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Masse M, Yelnik C, Labreuche J, André L, Bakhache E, Décaudin B, Drumez E, Odou P, Dambrine M, Lambert M. Risk factors associated with unintentional medication discrepancies at admission in an internal medicine department. Intern Emerg Med 2021; 16:2213-2220. [PMID: 34148179 DOI: 10.1007/s11739-021-02782-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
At admission, unintentional medication discrepancies (UMDs) can occur and may led to severe adverse events. Some of them are preventable through medication reconciliation (MR). As MR is a time-consuming activity, a better identification of high-risk patients of UMDs is mandatory. The objective was to identify risk factors associated with UMDs at admission in an internal medicine department. This prospective observational study was conducted from April 2017 to June 2019. At admission, inpatients had MR to obtain a complete list of home medications. This list was compared to prescriptions made at admission. All discrepancies were classified as intentional or UMDs. Univariate and multivariate analyses to identify the risk factors associated with UMDs were performed. MR was performed on 1157 patients (70.1 ± 16.8 years old); 550 MR (47.5%) contained at least one UMD. More than half of the UMDs (n = 892, 65.6%) corresponded to drug omission. The univariate analysis showed that age (> 60 years old), "living at home", medication preparation not performed by patient, medication-intake difficulties, number of sources consulted, MR duration, presence of a high-risk drug and the number of home medications were associated with UMDs. In the multivariate analysis, adjusted on the number of sources consulted, independent risk factors were "living at home" and the number of home medications. At admission to an internal medicine department, UMDs were frequent and associated with "living at home" and poly-medication. Our findings might help physicians to identify high-risk patients of UMDs since their admission.
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Affiliation(s)
- Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France.
| | - Cécile Yelnik
- Univ. Lille, Inserm, CHU Lille, U1167, 59000, Lille, France
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, 59000, Lille, France
| | - Loïc André
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Edgar Bakhache
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France
| | - Elodie Drumez
- Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, 59000, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France
| | | | - Marc Lambert
- Univ. Lille, Inserm, CHU Lille, U1167, 59000, Lille, France
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
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Dias Fernandes B, Coutinho Ribeiro L, Pereira Dos Santos JC, Rocha Ayres L, Chemello C. Medication Reconciliation at hospital admission and discharge: Evaluation of fidelity and process outcomes in a real-world setting. Int J Clin Pract 2021; 75:e14656. [PMID: 34324769 DOI: 10.1111/ijcp.14656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The study aimed to assess the fidelity of Medication Reconciliation (MR) delivered by the pharmacist at hospital admission and discharge, and the process outcomes. METHODS Prospective study conducted in cardiology and cardiovascular surgery unit of a university hospital between September 2019 and January 2020. Independent observers collected data to measure MR fidelity, related to coverage, sources of information used to collect medication history and presence of outstanding and resolved Undocumented Discrepancies (UD). Process outcomes included medication errors and their potential to cause harm, identified by the pharmacist during the formal MR process. RESULTS Of the eligible patients, 122 (69.7%) had their medications reconciled in a timely manner at hospital admission and 50 (43.8%) at discharge. The pharmacist consulted 2.76 (±0.8) sources of information to build the medication history, on average. At least one outstanding UD was found in 101 (82.8%) patients at admission and in 41 (82.0%), at discharge. The average number of outstanding UD per patient at admission and discharge was 3.0 (±2.6) and 2.4 (±1.9), respectively. The UD communicated to the physician by the pharmacist during the formal MR process, involved mainly omission errors and were classified as requiring monitoring or potentially necessary intervention. In the univariate analysis, the number of drugs pre-admission and admission, the reason for admission and non-elective readmission in 30 days were associated with the presence of medication errors at admission. CONCLUSIONS This study found a high number of UD, suggesting flaws in the implementation of MR and highlight the importance of quality measurement.
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Affiliation(s)
- Brígida Dias Fernandes
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo Coutinho Ribeiro
- Cassiano Antonio Moraes University Hospital, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | | | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Health Science Center, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Clarice Chemello
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Breuker C, Macioce V, Mura T, Castet-Nicolas A, Audurier Y, Boegner C, Jalabert A, Villiet M, Avignon A, Sultan A. Medication Errors at Hospital Admission and Discharge: Risk Factors and Impact of Medication Reconciliation Process to Improve Healthcare. J Patient Saf 2021; 17:e645-e652. [PMID: 28877049 DOI: 10.1097/pts.0000000000000420] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE First, the aim of the study was to assess the prevalence, characteristics, and severity of unintended medication discrepancies (UMDs) and medication errors (MEs) at admission and discharge of hospitalization. Second, the aim of the study was to identify clinical and hospitalization factors associated with risk of UMDs as well as characteristics of the medication reconciliation process associated with UMDs detection. METHODS This prospective observational study included all adult patients admitted from 2013 to 2015 in the Endocrinology-Diabetology-Nutrition Department of Montpellier Hospital, France. Clinical pharmacists conducted medication reconciliation by collecting the best possible medication history from different sources and comparing it with admission and discharge prescriptions to identify discrepancies. Unintended medication discrepancies corrected by the physician were considered as MEs. Risk factors of UMDs were identified with logistic regression. RESULTS Of 904 patients included, 266 (29.4%) had at least one UMD, at admission or at discharge. In total, 378 (98.2%) of 385 UMDs were considered to be MEs. Most MEs were omissions (59.3%). Medication errors were serious or very serious in 36% of patients and had potentially moderate severity in almost 40% of patients. The risk of UMDs increased constantly with the number of treatments (P < 0.001). Thyroid (adjusted odds ratio [OR] = 1.79, 95% CI = 1.12-2.86) and infectious diseases (adjusted OR = 1.80, 95% CI = 1.17-2.78) were associated with UMDs risk at admission. The best type of source for the detection of UMDs was the general practitioner or nurse (OR = 2.64, 95% CI = 1.51-4.63). CONCLUSIONS Unintended medication discrepancies are frequent at hospital and depend on intrinsic clinical parameters but also on practice of medication reconciliation process, such as number and type of sources used.
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Affiliation(s)
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | | | - Yohan Audurier
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Catherine Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Maxime Villiet
- From the Clinical Pharmacy Department, University Hospital of Montpellier
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[Pharmaceutical cares as means of prevention against drug iatrogenic: Case of oral anticoagulant]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:494-506. [PMID: 34481783 DOI: 10.1016/j.pharma.2021.08.009] [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: 02/13/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
Oral anticoagulant can have a significant risk of adverse events, particularly when it is initiated, modified or interrupted. Pharmaceutical care through medication reconciliation could improve the benefit-to-risk ratio of these drugs. A prospective and interventional single center study was conducted from March through August 2018 in medicine and surgical units. Patients with an oral anticoagulant prescribed and coming from outpatient sector were included. These patients received a medication reconciliation at admission and discharge. Frequency and type of discrepancies were studied. Their gravity rating was assessed using the Cornish et al. scale. This study included 162 patients. The medication reconciliation at the admission allowed the detection of 133 unintentional discrepancies which 16 of them represented a high risk for the patient included nine errors about oral anticoagulant prescribing. Concerning the reconciliation at discharge, 51 unintentional discrepancies had been detected: 12 of them represented a high risk for the patient included eight errors about oral anticoagulant prescription. The acceptance rate of the discrepancies was 86% and reflected discrepancies severity. This result reached 96.4% if we took into account discrepancies with a severe clinical impact. This study highlighted oral anticoagulant represented relevant prioritization criteria to the long-lasting implementation of pharmaceutical care. This secures the management of the patient since the admission until the hospital discharge. The last step of our approach would be to study the needs about data transmission to the community caregivers.
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43
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Schnipper JL. Medication Reconciliation-Too Much or Not Enough? JAMA Netw Open 2021; 4:e2125272. [PMID: 34529070 DOI: 10.1001/jamanetworkopen.2021.25272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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44
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Abdul Halim Zaki I, Razali RM, Gnanasan S, Alias R, Karuppannan M. Medication discrepancies among elderly patients discharged from a tertiary hospital: prevalence and risk factors. Singapore Med J 2021; 62:362-365. [PMID: 34409484 DOI: 10.11622/smedj.2021093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Izzati Abdul Halim Zaki
- Pharmacy Department, Hospital Queen Elizabeth II, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.,Faculty of Pharmacy, Puncak Alam Campus, Universiti Teknologi MARA, Selangor, Malaysia
| | | | - Shubashini Gnanasan
- Faculty of Pharmacy, Puncak Alam Campus, Universiti Teknologi MARA, Selangor, Malaysia
| | - Rosmaliah Alias
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Mahmathi Karuppannan
- Faculty of Pharmacy, Puncak Alam Campus, Universiti Teknologi MARA, Selangor, Malaysia
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45
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Alqenae FA, Steinke D, Keers RN. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Saf 2021; 43:517-537. [PMID: 32125666 PMCID: PMC7235049 DOI: 10.1007/s40264-020-00918-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Little is known about the epidemiology of medication errors and medication-related harm following transition from secondary to primary care. This systematic review aims to identify and critically evaluate the available evidence on the prevalence and nature of medication errors and medication-related harm following hospital discharge. Methods Studies published between January 1990 and March 2019 were searched across ten electronic databases and the grey literature. No restrictions were applied with publication language or patient population studied. Studies were included if they contained data concerning the rate of medication errors, unintentional medication discrepancies, or adverse drug events. Two authors independently extracted study data. Results Fifty-four studies were included, most of which were rated as moderate (39/54) or high (7/54) quality. For adult patients, the median rate of medication errors and unintentional medication discrepancies following discharge was 53% [interquartile range 33–60.5] (n = 5 studies) and 50% [interquartile range 39–76] (n = 11), respectively. Five studies reported adverse drug reaction rates with a median of 27% [interquartile range 18–40.5] and seven studies reported adverse drug event rates with a median of 19% [interquartile range 16–24]. For paediatric patients, one study reported a medication error rate of 66.3% and another an adverse drug event rate of 9%. Almost a quarter of studies (13/54, 24%) utilised a follow-up period post-discharge of 1 month (range 2–180 days). Drug classes most commonly implicated with adverse drug events were antibiotics, antidiabetics, analgesics and cardiovascular drugs. Conclusions This is the first systematic review to explore the prevalence and nature of medication errors and adverse drug events following hospital discharge. Targets for future work have been identified. Electronic supplementary material The online version of this article (10.1007/s40264-020-00918-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fatema A Alqenae
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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46
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Bülow C, Noergaard JDSV, Faerch KU, Pontoppidan C, Unkerskov J, Johansson KS, Kornholt J, Christensen MB. Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications. Basic Clin Pharmacol Toxicol 2021; 129:221-231. [PMID: 34137181 DOI: 10.1111/bcpt.13626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non-adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9-15] medications listed and 3 [IQR 1-5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non-adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Josefine D S V Noergaard
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Ullitz Faerch
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Pontoppidan
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Unkerskov
- Quality in General Practice in the Capital Region of Denmark (KAP-H), Hillerød, Denmark
| | - Karl Sebastian Johansson
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonatan Kornholt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Marinović I, Bačić Vrca V, Samardžić I, Marušić S, Grgurević I, Papić I, Grgurević D, Brkić M, Jambrek N, Mesarić J. Impact of an integrated medication reconciliation model led by a hospital clinical pharmacist on the reduction of post-discharge unintentional discrepancies. J Clin Pharm Ther 2021; 46:1326-1333. [PMID: 33969511 DOI: 10.1111/jcpt.13431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is no optimal standardized model in the transfer of care between hospitals and primary healthcare facilities. Transfer of care is a critical point during which unintentional discrepancies, that can jeopardize pharmacotherapy outcomes, can occur. The objective was to determine the effect that an integrated medication reconciliation model has on the reduction of the number of post-discharge unintentional discrepancies. METHODS A randomized controlled study was conducted on an elderly patient population. The intervention group of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care in collaboration with a primary care physician and a community pharmacist). Unintentional discrepancies were identified by comparing the medications listed on the discharge summary with the first list of medications prescribed and issued at primary care level, immediately after discharge. The main outcome measures were incidence, type and potential severity of post-discharge unintentional discrepancies. RESULTS AND DISCUSSION A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced the number of patients with unintentional discrepancies by 57.1% (p < 0.001). The intervention reduced the number of patients with unintentional discrepancies associated with a potential moderate harm by 58.6% (p < 0.001) and those associated with a potential severe harm by 68.6% (p = 0.039). The most common discrepancies were incorrect dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in unintentional discrepancies. WHAT IS NEW AND CONCLUSION The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.
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Affiliation(s)
- Ivana Marinović
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Vesna Bačić Vrca
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivana Samardžić
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Srećko Marušić
- Department of Endocrinology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivica Grgurević
- Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Papić
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Dijana Grgurević
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Brkić
- Community Health Center Zagreb-East, Zagreb, Croatia
| | | | - Jasna Mesarić
- Faculty of Health Sciences, Libertas International University, Zagreb, Croatia
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Dixit D, Barbarello Andrews L, Radparvar S, Adams C, Kumar ST, Cardinale M. Descriptive analysis of the unwarranted continuation of antipsychotics for the management of ICU delirium during transitions of care: A multicenter evaluation across New Jersey. Am J Health Syst Pharm 2021; 78:1385-1394. [PMID: 33895793 DOI: 10.1093/ajhp/zxab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Nearly half of intensive care unit (ICU) patients will develop delirium. Antipsychotics are used routinely for the management of ICU delirium despite limited reliable data supporting this approach. The unwarranted continuation of antipsychotics initiated for ICU delirium is an emerging transitions of care concern, especially considering the adverse event profile of these agents. We sought to evaluate the magnitude of this issue across 6 centers in New Jersey and describe risk factors for continuation. METHODS This multicenter, retrospective study examined adult ICU patients who developed ICU delirium from June 2016 to June 2018. Patients were included in the study if they received at least 3 doses of antipsychotics while in the ICU with presence of either a clinical diagnosis of delirium or a positive Confusion Assessment Method score. Patients were excluded if they were on an antipsychotic before ICU admission. RESULTS Of the 300 patients included and initiated on antipsychotics for ICU delirium, 157 (52.3%) were continued on therapy upon transfer from the ICU to another level of inpatient care. The number of patients continued on newly initiated antipsychotics further increased to 183 (61%) upon discharge from the hospital. CONCLUSION The continuation of antipsychotics for the management of delirium during transitions of care was a common practice across ICUs in New Jersey. Several risk factors for continuation of antipsychotics were identified. Efforts to reduce unnecessary continuation of antipsychotics at transitions of care are warranted.
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Affiliation(s)
- Deepali Dixit
- Ernest Mario School of Pharmacy, Rutgers,The State University of New Jersey, Piscataway, NJ,USA
| | - Liza Barbarello Andrews
- Ernest Mario School of Pharmacy, Rutgers,The State University of New Jersey, Piscataway, NJ,USA
| | | | - Christopher Adams
- Ernest Mario School of Pharmacy, Rutgers,The State University of New Jersey, Piscataway, NJ,USA
| | | | - Maria Cardinale
- Ernest Mario School of Pharmacy, Rutgers,The State University of New Jersey, Piscataway, NJ,USA
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Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. Res Social Adm Pharm 2021; 17:677-684. [DOI: 10.1016/j.sapharm.2020.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/10/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023]
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50
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Harper A, Kukielka E, Jones R. Patient Harm Resulting From Medication Reconciliation Process Failures: A Study of Serious Events Reported by Pennsylvania Hospitals. PATIENT SAFETY 2021. [DOI: 10.33940/data/2021.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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