[Assessment of perception about medication reconciliation among healthcare professionals at Saint-Justine hospital]

[Pharmaceutical cares as means of prevention against drug iatrogenic: Case of oral anticoagulant]

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.

Hospital staff perspectives: medication reconciliation responsibility and barriers at a tertiary teaching hospital in Jordan

Objectives

To explore hospital staff perspective on the responsibility and barriers to medicine reconciliation (MedRec) at a leading internationally renowned teaching hospital in Jordan.

Methods

A cross-sectional study using a self-completed questionnaire was conducted at Jordan University Hospital (JUH). The target sample was members of the health team caring for patients across various locations and settings. A convenient sample of physicians, pharmacists and nurses was targeted. Those were approached at various days, shifts, locations to scop various views and practices across JUH.

Key findings

Two hundred questionnaires were included in the analysis, of which 41 (20.5%) completed by physicians, 23 (11.5%) by pharmacists and 136 (68.0%) by nurses. For most steps, physicians were seen as the prim responsible health providers. Nurse perceived their role to come second. Whilst pharmacists perceived limited or no role of nurses in a number of steps. The main barriers reported are heavy workload 158 (79%), followed by lack of time 152 (76%) and communication between health care providers 140 (70%). Pharmacists highlighted lack of knowledge, clarity and training as leading barriers too.

Conclusions

Physicians are perceived as the leading provider responsible for all MedRec steps. MedRec as a process involve overlapping functions with various skill-based steps. A number of steps allocated potentially to nurses or pharmacists, particularly comparing different sources of information, constructing medication lists or written summaries upon discharge. Barriers to MedRec might be overcome by interdisciplinary discussions and mapping MedRec process clearly.