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Francis M, Francis P, Makeham M, Baysari MT, Patanwala AE, Penm J. Using personal health records for medication continuity during transition of care: An observational study. HEALTH INF MANAG J 2024:18333583241270215. [PMID: 39183671 DOI: 10.1177/18333583241270215] [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: 08/27/2024]
Abstract
Background: National Personal Health Records (PHRs) have been proposed to improve the transfer of medication-related information during transition of care. Objective: To evaluate the concordance between the medications captured in the Australian national PHR, My Health Record (MyHR), and the pharmacist obtained best possible medication history (BPMH) for patients upon hospital admission. Method: This prospective observational study used a convenience sample of hospital patients. For newly admitted patients, the investigating pharmacist obtained a BPMH and then compared it to the medication list captured in MyHR. Upon comparison, the medications were categorised into either complete match, partial match or mismatch. Medications with a complete or partial match were grouped together. Medications with deviations were then assessed for risk based on their potential consequence, and reported descriptively. A multivariable logistic regression was conducted to assess the factors associated with a drug being mismatched. Results: A total of 82 patients were recruited, with a cumulative total of 1,207 medications documented. Of the 1,207 medications, 714 (59.2%) medications were documented as a complete/partial match. The remaining 493 (40.8%) medications were mismatched. Of the 493 mismatched medications, 442 (89.7%) were deemed low-risk deviations and 51 (10.3%) were deemed high-risk. A medication was more likely to be mismatched, rather than completely/partially matched, if it was a regular non-prescription medication, or "when-required" prescription medication, or "when required" non-prescription medication, or if it was administered parenterally. Conclusion: National PHRs may be a secondary source to either confirm a patient's medication history or be used as a starting point for a BPMH.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Francis
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Meredith Makeham
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Syyrilä T, Koskiniemi S, Manias E, Härkänen M. Taxonomy development methods regarding patient safety in health sciences - A systematic review. Int J Med Inform 2024; 187:105438. [PMID: 38579660 DOI: 10.1016/j.ijmedinf.2024.105438] [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: 11/23/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Taxonomies are needed for automated analysis of clinical data in healthcare. Few reviews of the taxonomy development methods used in health sciences are found. This systematic review aimed to describe the scope of the available taxonomies relative to patient safety, the methods used for taxonomy development, and the strengths and limitations of the methods. The purpose of this systematic review is to guide future taxonomy development projects. METHODS The CINAHL, PubMed, Scopus, and Web of Science databases were searched for studies from January 2012 to April 25, 2023. Two authors selected the studies using inclusion and exclusion criteria and critical appraisal checklists. The data were analysed inductively, and the results were reported narratively. RESULTS The studies (n = 13) across healthcare concerned mainly taxonomies of adverse events and medication safety but little for specialised fields and information technology. Critical appraisal indicated inadequate reporting of the used taxonomy development methods. Ten phases of taxonomy development were identified: (1) defining purpose and (2) the theory base for development, (3) relevant data sources' identification, (4) main terms' identification and definitions, (5) items' coding and pooling, (6) reliability and validity evaluation of coding and/or codes, (7) development of a hierarchical structure, (8) testing the structure, (9) piloting the taxonomy and (10) reporting application and validation of the final taxonomy. Seventeen statistical tests and seven software systems were utilised, but automated data extraction methods were used rarely. Multimethod and multi-stakeholder approach, code- and hierarchy testing and piloting were strengths and time consumption and small samples in testing limitations. CONCLUSION New taxonomies are needed on diverse specialities and information technology related to patient safety. Structured method is needed for taxonomy development, reporting and appraisal to strengthen taxonomies' quality. A new guide was proposed for taxonomy development, for which testing is required. Prospero registration number CRD42023411022.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, University of Eastern Finland, Finland.
| | - Saija Koskiniemi
- Department of Nursing Science, University of Eastern Finland, Finland
| | | | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Finland; Research Centre for Nursing Science and Social and Health Management, Kuopio University Hospital, Wellbeing Services County of North Savo, Finland
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3
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Al Musawi A, Hellström L, Axelsson M, Midlöv P, Rämgård M, Cheng Y, Eriksson T. Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions. Int J Clin Pharm 2024; 46:639-647. [PMID: 38340241 PMCID: PMC11133128 DOI: 10.1007/s11096-024-01702-4] [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: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home. AIM In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions. METHOD Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed. RESULTS Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores. CONCLUSION Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.
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Affiliation(s)
- Ahmed Al Musawi
- Department of Biomedical Science and Biofilm - Research Center for Biointerfaces, Faculty of Health and Society, Malmö University, Malmö, Sweden.
| | - Lina Hellström
- Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar, Sweden
- Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Yuanji Cheng
- Department of Materials Science and Applied Mathematics, Faculty of Technology and Society, Malmo University, Malmo, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science and Biofilm - Research Center for Biointerfaces, Faculty of Health and Society, Malmö University, Malmö, Sweden
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4
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Koot C, Rook M, Pols PAM, van den Bemt PMLA, Becker ML. A quality improvement study on the effect of electronic transmission of a basic discharge medication report on medication discrepancies in patients discharged from the hospital. Int J Clin Pharm 2024; 46:131-140. [PMID: 37934347 DOI: 10.1007/s11096-023-01650-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/08/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Medication discrepancies can occur in transitions of care because of a lack of communication between hospitals and community pharmacies. These discrepancies can lead to preventable adverse drug events (ADEs). AIM To investigate the effect of electronic transmission of the basic discharge medication report on unintentional medication discrepancies observed between this report and the 28-day post-discharge status in the community pharmacy. METHOD The study took place in a Dutch teaching hospital and 8 community pharmacies. A quality improvement study with a nonrandomized, historically controlled intervention design was performed. The intervention consisted of the electronic transmission of a basic discharge medication report to the community pharmacies. Unintentional medication discrepancies were identified by comparing the basic discharge medication report to the 28-day post-discharge medication record in community pharmacies. The main outcome measure was the proportion of drugs with one or more unintentional discrepancies compared between the historical control group and intervention group, using the chi-square test. Secondary outcome measure was the proportion of patients with one or more unintentional discrepancies. RESULTS The participants used a total of 1078 drugs in the control group and 862 in the intervention group. The intervention significantly reduced the proportion of drugs with an unintentional discrepancy from 230 out of 1078 in the control group (21.3%) to 149 out of 862 drugs in the intervention group (17.3%; p = 0.025). At patient level, a non-significant increase was seen (62.4-78.8%; p = 0.41). CONCLUSION The electronic transmission of the basic discharge medication report reduced the proportion of drugs with an unintentional discrepancy after discharge, but not the proportion of patients.
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Affiliation(s)
- Celine Koot
- Pharmacy Foundation of Haarlem Hospitals, Boerhaavelaan 24, 2035 RC, Haarlem, The Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem, The Netherlands
| | - Marion Rook
- Pharmacy Foundation of Haarlem Hospitals, Boerhaavelaan 24, 2035 RC, Haarlem, The Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem, The Netherlands
| | | | - Patricia M L A van den Bemt
- University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Matthijs L Becker
- Pharmacy Foundation of Haarlem Hospitals, Boerhaavelaan 24, 2035 RC, Haarlem, The Netherlands.
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem, The Netherlands.
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Corvaisier M, Sanchez-Rodriguez D, Sautret K, Riou J, Spiesser-Robelet L, Annweiler C. Identifying older inpatients at high risk of unintentional medication discrepancies: a classification tree analysis. Aging Clin Exp Res 2023; 35:3227-3232. [PMID: 37943406 DOI: 10.1007/s40520-023-02598-2] [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: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Unintentional medication discrepancies at admission are differences between the best possible medication history and the prescribed treatment at admission, and are associated with adverse outcomes, particularly in older people. This study aimed to identify the clinical profiles of geriatric inpatients with unintentional medication discrepancies at hospital admission. A classification tree Chi-square Automatic Interaction Detector (CHAID) analysis was conducted to assess those patients' profiles and characteristics that were associated with a higher risk of unintentional medication discrepancies. One-hundred and thirty consecutive older patients admitted to acute care (87 ± 5 years old; 61.8% women) were assessed. The CHAID analysis retrieved 5 clinical profiles of older inpatients with a risk of up to 94.4% for unintentional medication discrepancies. These profiles were determined based on combinations of three characteristics: use of eye drops, frequent falls (≥ 1/year), and admission due to urgent hospitalization. These easily measurable clinical characteristics may be helpful as a supportive measure to improve pharmacological care.
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Affiliation(s)
- Mathieu Corvaisier
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
- Department of Pharmacy, Angers University Hospital, Angers, France
- Health Faculty, University of Angers, Angers, France
| | - Dolores Sanchez-Rodriguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Liège, Belgium
- Rehabilitation Research Group, Geriatrics Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Kevin Sautret
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
| | - Jérémie Riou
- Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | | | - Cédric Annweiler
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France.
- Health Faculty, University of Angers, Angers, France.
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
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Chai D, Liu Z, Wang L, Duan H, Zhao C, Xu C, Zhang D, Zhao Q, Ma P. Effectiveness of Medication Reconciliation in a Chinese Hospital: A Pilot Randomized Controlled Trial. J Multidiscip Healthc 2023; 16:3641-3650. [PMID: 38034875 PMCID: PMC10683647 DOI: 10.2147/jmdh.s432522] [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: 08/22/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Implementing medication reconciliation (MR) was complex and challenging because of the variability in the guidance provided for conducting. The processes of MR adopted in China were different from that recommended by the World Health Organization. A pilot study to inform the design of a future randomized controlled trial to determine the effectiveness of these two workflows was undertaken. Methods Patients taking at least one home/regular medication for hypertension, diabetes, or coronary heart disease were recruited at admission, and then were randomized using a computer-generated random number in a closed envelope. In the study group, the pharmacist reviewed electronic medical record systems before communication with patients. In the control group, pharmacists communicated with patients at patient's admission. The time investment of pharmacists for MR process, the number of unintended medication discrepancies, and physician acceptance were tested as outcome measures. Results One hundred and forty adult patients were randomized, of which 66 patients in the intervention received MR within 24 hours, while 58 patients in control received MR at some point during admission. The most common condition in the study group was hypertension (coronary heart disease in the control group). The workflow of the study group can save an average 7 minutes per patient compared with the WHO recommended process [17.5 minutes (IQR 14.00, 28.25) vs 24.5 minutes (IQR17.75, 35.25), p = 0.004]. The number of unintended discrepancies was 42 in the study group and 34 in the control group (p = 0.33). Physicians' acceptance in the study and control groups were 87.5% and 92.3%, respectively (p = 0.87). Conclusion The results suggest that changes in outcome measures were in the appropriate direction and that the time limit for implementing MR can be set within 48 hours. A future multi-centre RCT study to determine the effectiveness of MR is feasible and warranted.
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Affiliation(s)
- Dongyan Chai
- Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, HenanPeople’s Republic of China
- International Medical Center of Henan Province, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Zhihui Liu
- Department of General Practice, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Liuyi Wang
- Department of General Practice, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Hongyan Duan
- International Medical Center of Henan Province, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of General Practice, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Chenglong Zhao
- Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, HenanPeople’s Republic of China
| | - Chengyang Xu
- International Medical Center of Henan Province, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Dongyan Zhang
- Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, HenanPeople’s Republic of China
| | - Qiongrui Zhao
- Department of Clinical Research Service Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Peizhi Ma
- Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, HenanPeople’s Republic of China
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Alqenae FA, Steinke D, Belither H, Robertson P, Bartlett J, Wilkinson J, Williams SD, Brad L, Jeffries M, Ashcroft DM, Keers RN. A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge. Drug Saf 2023; 46:1021-1037. [PMID: 37819463 PMCID: PMC10584716 DOI: 10.1007/s40264-023-01342-z] [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: 07/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems (MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. METHODS The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. RESULTS Most patient referrals (70%, 2126/3033) were marked as 'completed' by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event rates following TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44-1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57-2.45, p = 0.63]), although there remained considerable uncertainty. CONCLUSIONS The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety.
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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
| | - Hilary Belither
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | | | - Jennifer Bartlett
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Service Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Steven D Williams
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Westbourne Medical Centre, Bournemouth, UK
| | | | - Mark Jeffries
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Division of Population Health, Health Service Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, 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
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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8
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Bowers MT, Carter T. Heart Failure: Priorities for Transition to Home. Nurs Clin North Am 2023; 58:283-294. [PMID: 37536781 DOI: 10.1016/j.cnur.2023.05.001] [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: 08/05/2023]
Abstract
Nurses play a key role in promoting successful transitions of patients with heart failure (HF) from the hospital to the ambulatory setting. Engaging patients and caregivers in discharge teaching early in the hospitalization can enhance their understanding of HF as a clinical syndrome and identify precipitants of decompensation. Effective transitional care interventions for patient with HF include a phone call within 48 to 72 hours and a follow-up appointment within 7 days. Early symptom identification and treatment are key aspects of HF care to improve quality of life and minimize risk of hospitalization.
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Affiliation(s)
- Margaret T Bowers
- Department of Medicine, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
| | - Tonya Carter
- University of North Carolina Health, 160 Dental Circle Drive, CB# 7075, Chapel Hill, NC 27599, USA
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Linden-Lahti C, Takala A, Holmström AR, Airaksinen M. Applicability of drug-related problem (DRP) classification system for classifying severe medication errors. BMC Health Serv Res 2023; 23:743. [PMID: 37430249 DOI: 10.1186/s12913-023-09763-3] [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: 03/08/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Several classification systems for medication errors (MEs) have been established over time, but none of them apply optimally for classifying severe MEs. In severe MEs, recognizing the causes of the error is essential for error prevention and risk management. Therefore, this study focuses on exploring the applicability of a cause-based DRP classification system for classifying severe MEs and their causes. METHODS This was a retrospective document analysis study on medication-related complaints and authoritative statements investigated by the Finnish National Supervisory Authority for Welfare and Health (Valvira) in 2013-2017. The data was classified by applying a previously developed aggregated DRP classification system by Basger et al. Error setting and harm to the patient were identified using qualitative content analysis to describe the characteristics of the MEs in the data. The systems approach to human error, error prevention, and risk management was used as a theoretical framework. RESULTS Fifty-eight of the complaints and authoritative statements concerned MEs, which had occurred in a wide range of social and healthcare settings. More than half of the ME cases (52%, n = 30) had caused the patient's death or severe harm. In total, 100 MEs were identified from the ME case reports. In 53% (n = 31) of the cases, more than one ME was identified, and the mean number of MEs identified was 1.7 per case. It was possible to classify all MEs according to aggregated DRP system, and only a small proportion (8%, n = 8) were classified in the category "Other," indicating that the cause of the ME could not be classified to specific cause-based category. MEs in the "Other" category included dispensing errors, documenting errors, prescribing error, and a near miss. CONCLUSIONS Our study provides promising preliminary results for using DRP classification system for classifying and analyzing especially severe MEs. With Basger et al.'s aggregated DRP classification system, we were able to categorize both the ME and its cause. More research is encouraged with other ME incident data from different reporting systems to confirm our results.
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Affiliation(s)
- Carita Linden-Lahti
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, 00014, Helsinki, Finland.
- HUS Pharmacy, Helsinki University Hospital, Stenbäckinkatu 9B, 00029 HUS, Helsinki, Finland.
| | - Anna Takala
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, 00014, Helsinki, Finland
| | - Anna-Riia Holmström
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, 00014, Helsinki, Finland
| | - Marja Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, 00014, Helsinki, Finland
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10
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Francis M, Francis P, Patanwala AE, Penm J. Obtaining medication histories via telepharmacy: an observational study. J Pharm Policy Pract 2023; 16:69. [PMID: 37291672 DOI: 10.1186/s40545-023-00573-w] [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: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Medication reconciliation is an effective strategy to reduce medication errors upon hospital admission. The process involves obtaining a best possible medication history (BPMH), which can be both time-consuming and resource-intensive. During the COVID-19 pandemic, telepharmacy was used to reduce the risk of viral transmission. Telepharmacy is the remote provision of pharmacy-led clinical services, such as obtaining BPMHs, using telecommunications. However, the accuracy of telephone-obtained BPMHs has not yet been evaluated. Therefore, the primary aim of this study was to evaluate the proportion of patients who have an accurate BPMH from the telephone-obtained BPMH compared to an in-person obtained BPMH. METHODS This prospective, observational study took place in a large tertiary hospital. Recruited patients or carers had their BPMH obtained by a pharmacist over the telephone. The same patients or carers then had their BPMH conducted in-person to identify any deviations between the telephone-obtained and in-person obtained BPMH. All telephone-obtained BPMHs were timed with a stopwatch. Any deviations were categorised according to their potential consequence. An accurate BPMH was defined as having no deviations. Descriptive statistics were used to report all quantitative variables. A multivariable logistic regression was conducted to identify risk factors for patients and medications for having medication deviations. RESULTS In total, 116 patients were recruited to receive both a telephone-obtained and in-person obtained BPMH. Of these, 91 patients (78%) had an accurate BPMH with no deviations. Of the 1104 medications documented across all the BPMHs, 1064 (96%) had no deviation. Of the 40 (4%) medication deviations, 38 were deemed low-risk (3%) and 2 high-risk (1%). A patient was more likely to have a deviation if they are taking more medications (aOR: 1.11; 95% CI: 1.01-1.22; p < 0.05). A medication was more likely to have a deviation if it was regular non-prescription medication (aOR: 4.82; 95% CI: 2.14-10.82; p < 0.001) or 'when required' non-prescription medication (aOR: 3.12; 95% CI: 1.20-8.11; p = 0.02) or a topical medication (aOR: 12.53; 95% CI: 4.34-42.17; p < 0.001). CONCLUSIONS Telepharmacy represents a reliable and time-efficient alternative to in-person BPMHs.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Peter Francis
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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11
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Francis M, Deep L, Schneider CR, Moles RJ, Patanwala AE, Do LL, Levy R, Soo G, Burke R, Penm J. Accuracy of best possible medication histories by pharmacy students: an observational study. Int J Clin Pharm 2023; 45:414-420. [PMID: 36515780 PMCID: PMC9749631 DOI: 10.1007/s11096-022-01516-2] [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: 06/30/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication reconciliation is an effective strategy to prevent medication errors upon hospital admission and requires obtaining a patient's best possible mediation history (BPMH). However, obtaining a BPMH is time-consuming and pharmacy students may assist pharmacists in this task. AIM To evaluate the proportion of patients who have an accurate BPMH from the pharmacy student-obtained BPMH compared to the pharmacist-obtained BPMH. METHOD Twelve final-year pharmacy students were trained to obtain BPMHs upon admission at 2 tertiary hospitals and worked in pairs. Each student pair completed one 8-h shift each week for 8 weeks. Students obtained BPMHs for patients taking 5 or more medications. A pharmacist then independently obtained and checked the student BPMH from the same patient for accuracy. Deviations were determined between student-obtained and pharmacist-obtained BMPH. An accurate BPMH was defined as only having no-or-low risk medication deviations. RESULTS The pharmacy students took BPMHs for 91 patients. Of these, 65 patients (71.4%) had an accurate BPMH. Of the 1170 medications included in patients' BPMH, 1118 (95.6%) were deemed accurate. For the student-obtained BPMHs, they were more likely to be accurate for patients who were older (OR 1.04; 95% CI 1.03-1.06; p < 0.001), had fewer medications (OR 0.85; 95% CI 0.75-0.97; p = 0.02), and if students used two source types (administration and supplier) to obtain the BPMH (OR 1.65; 95% CI 1.09-2.50; p = 0.02). CONCLUSION It is suitable for final-year pharmacy students to be incorporated into the BPMHs process and for their BPMHs to be verified for accuracy by a pharmacist.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Louise Deep
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Rebekah J Moles
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Linda L Do
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Russell Levy
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Garry Soo
- Department of Pharmacy, Concord Repatriation Geriatric Hospital, Concord, NSW, Australia
| | - Rosemary Burke
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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12
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Animated video development COVID-19 prevention and management for anxiety among older adults in Indonesia. Geriatr Nurs 2023; 49:13-21. [PMID: 36401996 PMCID: PMC9637526 DOI: 10.1016/j.gerinurse.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rapid increase in information on coronavirus disease (COVID-19) has led to an infodemic that exposes older adults to a greater risk of anxiety. AIMS To develop an animated educational video for COVID-19 prevention and management and evaluate its feasibility and preliminary effectiveness in improving knowledge and anxiety levels among older adults. METHODS A pilot test of feasibility and preliminary effectiveness was conducted in three phases: expert agreement, content validation, and video creation. An intervention group received an animated educational video, whereas a control group received an educational leaflet. A total of 126 respondents were recruited from 15 community health centers in Indonesia. RESULTS Results showed that knowledge of intervention group respondents about COVID-19 misinformation improved, and anxiety levels significantly decreased after watching the video compared to the control group (p<0.001). CONCLUSIONS The animated educational video on COVID-19 prevention and management based on Indonesian preferences successfully improved knowledge and reduced anxiety levels among older adults.
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13
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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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14
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Brady JE, Simon SR, Yeksigian K, Zillich AJ, Moyer J, Linsky AM. Can nonclinicians classify medication discrepancies as accurately as clinical pharmacists? A validation study. Health Sci Rep 2022; 5:e824. [PMID: 36189414 PMCID: PMC9508616 DOI: 10.1002/hsr2.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Julianne E. Brady
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Steven R. Simon
- Center for the Study of Healthcare Innovation, Implementation and Policy VA Greater Los Angeles Healthcare System Los Angeles California USA
- Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles California USA
| | - Kate Yeksigian
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Alan J. Zillich
- Department of Pharmacy Practice, College of Pharmacy Purdue University West Lafayette Indiana USA
| | - Jonathan Moyer
- Office of Disease Prevention National Institutes of Health Bethesda Maryland USA
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine Boston University School of Medicine Boston Massachusetts USA
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15
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Assessment of medication discrepancies with point prevalence measurement: how accurate are the medication lists for Swedish patients? DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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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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17
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Alcântara TDS, Lima HF, Valença-Feitosa F, Aires-Moreno GT, Santos GAD, Araujo DC, Cavalcante-Santos LM, Cunha LC, Lyra DPD. Development and implementation of a medication reconciliation during pediatric transitions of care in a public hospital. J Am Pharm Assoc (2003) 2021; 62:1400-1406.e3. [PMID: 34998691 DOI: 10.1016/j.japh.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To generate effective changes in the work processes of an institution, such as hospitals, strategies are needed for the implementation of services. These should be based on the needs of the practice scenario and evidence that may develop programs applied to the routine of health care. This study aimed to implement medication reconciliation (MR) at the transition of care in the pediatric department of a public hospital located in Northeast Brazil. SETTING A step-by-step approach was adopted to implement MR in the studied hospital and conducted from March 2019 to December 2019. PRACTICE INNOVATION The implementation of MR used the "Model for Improvement" framework. The processes were built and tested in the Plan-Do-Study-Act (PDSA) cycles. Children admitted to the hospital's pediatrics department were included in the study. The objective of the PDSA cycles was to reach 75% of the patients included, with the service performed in at least one transition of care episode. EVALUATION This study used the following indicators: number of steps performed, number of discrepancies identified, and resolution of discrepancies. Descriptive statistical analysis was performed for all variables. RESULTS In the first cycle, all patients (n = 34) had the best possible medication history (BPMH) completed, and 26.4% went through all the MR stages. Seventy-two discrepancies were identified and 90.3% of them were resolved. In the second cycle, all patients (n = 35) had the BPMH completed, and 20% went through all the stages. A total of 32 discrepancies were identified and 96.8% of them were resolved. In the third cycle, all patients (n = 30) had the BPMH completed, and 56.6% of patients went through all the stages. Twenty-four discrepancies were identified and resolved. CONCLUSION The use of the "Model for Improvement" framework effectively contributed to the implementation of the service according to the characteristics of the studied hospital.
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18
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Deep L, Schneider CR, Moles R, Patanwala AE, Do LL, Burke R, Penm J. Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students. Pharm Pract (Granada) 2021; 19:2471. [PMID: 34621455 PMCID: PMC8456341 DOI: 10.18549/pharmpract.2021.3.2471] [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: 06/24/2021] [Accepted: 09/12/2021] [Indexed: 11/14/2022] Open
Abstract
Background Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution. Objective To evaluate the number and type of medication discrepancies identified by pharmacy students. Methods Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies. Results There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system. Conclusions Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.
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Affiliation(s)
- Louise Deep
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW (Australia).
| | - Carl R Schneider
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Linda L Do
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | | | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
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19
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Aires-Moreno GT, Alcântara TDS, Araújo DCSAD, Soares SDM, Gubert VT, Marcon de Oliveira V, Ferreira CM, Vasconcelos-Pereira EF, Lira ARP, Chemello C, Oliveira LMSD, Oliveira-Filho ADD, Lyra D. Medication discrepancies in transition of care of hospitalised children in Brazil: a multicentric study. Arch Dis Child 2021; 106:1018-1023. [PMID: 33958348 DOI: 10.1136/archdischild-2020-320225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the incidence of medication discrepancies in transition points of care of hospitalised children. DESIGN A prospective observational multicentre study was carried out between February and August 2019. Data collection consisted of the following steps: sociodemographic data collection, clinical interview with the patient's caregiver, review of patient prescriptions and evaluation of medical records. Medication discrepancies were classified as intentional (documented or undocumented) and unintentional. In addition, discrepancies identified were categorised according to the medication discrepancy taxonomy. Unintentional discrepancies were assessed for potential clinical harm to the patient. SETTING Paediatric clinics of four teaching hospitals in Brazil. PATIENTS Children aged 1 month-12 years. FINDINGS A total of 248 children were included, 77.0% (n=191) patients had at least one intentional discrepancy; 20.2% (n=50) patients had at least one unintended discrepancy and 15.3% (n=38) patients had at least one intentional discrepancy and an unintentional one. The reason for the intentional discrepancy was not documented in 49.6% (n=476) of the cases. The most frequent unintentional discrepancy was medication omission (54.1%; n=66). Low potential to cause discomfort was found in 53 (43.4%) unintentional discrepancies, while 55 (45.1%) had the potential to cause moderate discomfort and 14 (11.5%) could potentially cause severe discomfort. CONCLUSIONS Although most medication discrepancies were intentional, the majority of these were not documented by the healthcare professionals. Unintentional discrepancies were often related to medication omission and had a potential risk of causing harm to hospitalised children.
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Affiliation(s)
- Giulyane Targino Aires-Moreno
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
| | - Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
| | | | | | - Vanessa Terezinha Gubert
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Vanessa Marcon de Oliveira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Cristiane Munaretto Ferreira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Erica Freire Vasconcelos-Pereira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Ana Rafaela Pires Lira
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Clarice Chemello
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Divaldo Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
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20
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Schumacher PM, Griese-Mammen N, Schneider J, Laufs U, Schulz M. Interdisciplinary Physician-Pharmacist Medication Review for Outpatients With Heart Failure: A Subanalysis of the PHARM-CHF Randomized Controlled Trial. Front Pharmacol 2021; 12:712490. [PMID: 34557093 PMCID: PMC8453145 DOI: 10.3389/fphar.2021.712490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023] Open
Abstract
Aims: Patients with chronic heart failure (CHF) require polypharmacy and are at increased risk for drug-related problems. Interdisciplinary physician-pharmacist medication review may improve drug treatment. Our goal was to analyze the changes from the physician-documented medication plan (MP) and patient-stated medication to an interdisciplinary consolidated MP (CMP). Methods: This pre-specified subanalysis of the PHARM-CHF randomized controlled trial analyzed the medication review of CHF patients in the pharmacy care group. Community pharmacists compared the MP with the drug regimen stated by the patient and consulted with physicians on identified discrepancies and other medication-related problems resulting in a CMP. Results: We analyzed 93 patients (mean 74.0 ± 6.6 years, 37.6% female), taking a median of ten (IQR 8–13) drugs. 80.6% of patients had at least one change from MP to CMP. We identified changes in 32.7% (303/926) of drugs. The most common correction was the addition of a drug not documented in the MP to the CMP (43.2%). We also determined frequent modifications in the dosing regimens (37.6%). The omission of a drug documented in the MP but left out of the CMP accounted for 19.1%. Comparing patient-stated medication to CMP, the current drug regimen of patients was changed in 22.4% of drugs. Conclusion: The medication review resulted in changes of medication between MP and CMP in most of the patients and affected one-third of drugs. Structured physician-pharmacist interdisciplinary care is able to harmonize and optimize the drug treatment of CHF patients.
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Affiliation(s)
- Pia M Schumacher
- Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Juliana Schneider
- Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Ulrich Laufs
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
| | - Martin Schulz
- Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Berlin, Germany.,Drug Commission of German Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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21
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Tobiano G, Chaboyer W, Teasdale T, Cussen J, Raleigh R, Manias E. Older patient and family discharge medication communication: A mixed-methods study. J Eval Clin Pract 2021; 27:898-906. [PMID: 33084143 DOI: 10.1111/jep.13494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/02/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Medication discrepancies place patients discharged from hospital at risk of adverse medication events. Patient and family participation in medication communication may improve medication safety. This study aimed to examine older medical patient and family participation in discharge medication communication. METHODS Two-phased mixed-methods study. Data were collected from July 2018 to May 2019. Phase 1 comprised observations and a questionnaire of 30 patients pre-hospital discharge. Phase 2 involved telephone interviews with 11 patients and family members post-hospital discharge. Phase 1 analysis included descriptive statistics and deductive content analysis. Inductive content analysis was used in Phase 2. Phase 1 and 2 findings were integrated. RESULTS For Phase 1, observational data were deductively coded against the "continuum of patient participation"; information-giving was the most frequent level of participation observed on the continuum, followed by information-seeking, shared decision making, non-involved, and finally autonomous decision making. For descriptive statistics, written communication tools, noise, and interruptions were frequently observed during medication communication. In Phase 2, three categories were found about how patients and families participate, and the factors influencing their participation: (a) obtaining comprehensive medication information; (b) preferred approaches for receiving information; and (c) speaking about medications in hospital. Integrated findings showed that written communication tools and routine hospital tasks may promote, while lack of family presence and environmental factors may hinder medication communication. Patients' and families' role in medication communication ranged from asking questions to influencing decisions, and was enhanced by health care professionals' patient-centred communication. CONCLUSIONS More active patient and family participation could be achieved by encouraging them to identify medication-related problems. To create a climate for patient and family participation, health care professionals should use written communication tools, capitalize on participation opportunities during routine hospital tasks, and use patient-centred communication.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Trudy Teasdale
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Julie Cussen
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Rachael Raleigh
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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22
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King PK, Burkhardt C, Rafferty A, Wooster J, Walkerly A, Thurber K, Took R, Masterson J, St. Peter WL, Furuno JP, Williams E, Ferren J, Rascon K. Quality measures of clinical pharmacy services during transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Roxane Took
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Jon P. Furuno
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Evan Williams
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Janie Ferren
- American College of Clinical Pharmacy Lenexa Kansas USA
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Francis M, Wai A, Patanwala AE. Association between admission medication reconciliation by pharmacists on the accuracy of hospital discharge medication lists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Martina Francis
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown Australia
| | - Angela Wai
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown Australia
| | - Asad E. Patanwala
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown Australia
- School of Pharmacy University of Sydney, Pharmacy and Bank Building (A15) Sydney New South Wales Australia
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van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. A comparison between medication reconciliation by a pharmacy technician and the use of an online personal health record by patients for identifying medication discrepancies in patients' drug lists prior to elective admissions. Int J Med Inform 2020; 147:104370. [PMID: 33421688 DOI: 10.1016/j.ijmedinf.2020.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
AIM Medication discrepancies (MDs), defined as unexplained differences among medication regimens, cause important public health problems with clinical and economic consequences. Medication reconciliation (MR) reduces the risk of MDs, but is time consuming and its success relies on the quality of different information sources. Online personalized health records (PHRs) may overcome these drawbacks. Therefore, the aim of this study is to determine the level of agreement of identified MDs between traditional MR and an online PHR and the correctness of the identified MDs with a PHR. METHODS A prospective cohort study was conducted at the cardiology, neurology, internal medicine and pulmonary department of the Amphia Hospital, the Netherlands. Two weeks prior to a planned admission all patients received an invitation from a PHR to update their medication file derived from the Nationwide Medication Record System (NMRS). At admission MR was performed with all by a pharmacy technician, who created the best possible medication history (BPMH) based on the NMRS data and an interview. MDs were determined as discrepancies between the available information from the NMRS and the input and alterations patients or pharmacy technician made. The number, correctness of patients' alterations, type and severity of identified MDs were analysed. RESULTS Of 488 patients approached, 155 (31.8 %) patients who both used the PHR and had received MR were included. The mean number of MDs identified with MR and PHR was 6.2 (SD 4.3) and 4.7 (SD 3.7), respectively. 82.1 % of the drug information noted by the patient in the PHR was correct compared to the BPMH and 98.6 % had no clinically relevant differences between the lists. CONCLUSION Patients who used an online PHR can relatively accurately record a list of their medication. Further research is required to explore the level of agreement and the correctness of a PHR in other (larger) hospital(departments).
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Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Prevalence of medication discrepancies in pediatric patients transferred between hospital wards. Int J Clin Pharm 2020; 43:909-917. [PMID: 33175294 DOI: 10.1007/s11096-020-01196-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 01/24/2023]
Abstract
Background Children are more susceptible to harm from medication errors and adverse drug reactions when compared to adults. Such events may occur from medication discrepancies while transitioning patients throughout the healthcare system. Contributing factors include medication discontinuity and lack of information by the healthcare team. Objective To analyze the prevalence of medication discrepancies in transition points of care in a pediatric department. Setting Pediatric department of a public hospital in Northeast Brazil. Method A cross-sectional study was carried out from August 2017 to March 2018. Data collection consisted of the following steps: collection of sociodemographic data, clinical interview with the patient's caregiver, registration of patient prescriptions, and evaluation of medical records. Medication discrepancies were classified as intentional and unintentional. The unintentional medication discrepancies were classified as omission of medication, therapeutic duplicity, and differences in dose, frequency, or route of administration. Main outcomes measure Discrepancy profile identified at admission, internal transfer and hospital discharge. Results Among the 114 patients included in the study, 85 (74.5%) patients had at least one unintentional medication discrepancy, of which 16 (14.0%) patients presented medication discrepancies at hospital admission, 42 (36.8%) patients at internal transfer, and 52 (45.6%) patients during discharge. Omission of medication represented 20 (74.1%) errors at admission, 26 (37.7%) errors at internal transfer, and 80 (100.0%) errors at hospital discharge. Conclusions The main transition points of care where unintentional discrepancies occurred in the studied pediatric department were at internal transfer and hospital discharge, with omission being the most common type of unintentional discrepancy.
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Medication Discrepancies in Community Pharmacies in Switzerland: Identification, Classification, and Their Potential Clinical and Economic Impact. PHARMACY 2020; 8:pharmacy8010036. [PMID: 32182863 PMCID: PMC7151719 DOI: 10.3390/pharmacy8010036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Transitions of care are high-risk situations for the manifestation of medication discrepancies and, therefore, present threats for potential patient harm. Medication discrepancies can occur at any transition within the healthcare system. Methods: Fifth-year pharmacy students assessed a best possible medication list (BPML) during a medication review (based on medication history and patient interview) in community pharmacies. They documented all discrepancies between the BPML and the latest medication prescription. Discrepancies were classified using the medication discrepancy taxonomy (MedTax) classification system and were assessed for their potential clinical and economic impact. Results: Overall, 116 patients with a mean age and medication prescription of 74 (± 10.3) years and 10.2 (± 4.2), respectively, were analyzed. Of the 317 discrepancies identified, the most frequent type was related to strength and/or frequency and/or number of units of dosage form and/or the total daily dose. Although, the majority of discrepancies were rated as inconsequential (55.2%) on health conditions, the remainder posed a potential moderate (43.2%) or severe impact (1.6%). In 49.5% of the discrepancies, the current patients’ medication cost less than the prescribed. Conclusion: Community pharmacies are at a favorable place to identify discrepancies and to counsel patients. To improve patient care, they should systematically perform medication reconciliation whenever prescriptions are renewed or added.
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Slight SP, Tolley CL, Bates DW, Fraser R, Bigirumurame T, Kasim A, Balaskonis K, Narrie S, Heed A, Orav EJ, Watson NW. Medication errors and adverse drug events in a UK hospital during the optimisation of electronic prescriptions: a prospective observational study. LANCET DIGITAL HEALTH 2019; 1:e403-e412. [PMID: 33323222 DOI: 10.1016/s2589-7500(19)30158-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND WHO's Third Global Patient Safety Challenge, Medication Without Harm, focused on reducing the substantial burden of iatrogenic harm associated with medications by 50% in the next 5 years. We aimed to assess whether the number and type of medication errors changed as an electronic prescribing system was optimised over time in a UK hospital. METHODS We did a prospective observational study at a tertiary-care teaching hospital. Eight senior clinical pharmacists reviewed patients' records and collected data across four adult wards (renal, cardiology, general medical, and orthopaedic surgical) over a 2-year period (from Sept 29, 2014, to June 9, 2016). All medication errors and potential and actual adverse drug events were documented and the number of medication errors measured over the course of four time periods 7-10 weeks long. Pharmacists also recorded instances where the electronic prescribing system contributed to an error (system-related errors). A negative-binomial model and a Poisson model were used to identify factors related to medication error rates. FINDINGS 5796 primary errors were recorded over the four time periods (period 1, 47 days [Sep 29-Dec 2, 2014]; period 2, 38 days [April 20-June 12, 2015, for the renal, medical, and surgical wards and April 20-June 15, 2015, for the cardiology ward]; period 3, 35 days [Sep 28-Nov 27, 2015] for the renal ward, 37 days [Sep 28-Nov 23, 2015] for the medical ward, and 40 days [Sep 28-Nov 20, 2015] for the cardiology and surgical wards; and period 4, 37 days [Feb 22-April 15, 2015] for the renal and medical wards and 39 days for the cardiology [April 13-June 7, 2015] and surgery [April 18-June 9, 2015] wards; unanticipated organisational factors prevented data collection on some days during each time period). There was no change in the rate of primary medication errors per admission over the observation periods: 1·53 medication errors in period 1, 1·44 medication errors in period 2, 1·70 medication errors in period 3, and 1·43 medication errors in period 4, per admission. By contrast, the overall rate of different types of medication errors decreased over the four periods. The most common types of error were medicine-reconciliation, dose, and avoidable delay-of-treatment errors. Some types of errors appeared to reduce over time (eg, dose errors [from 52 errors in period 1 to 19 errors in period 4, per 100 admissions]), whereas others increased (eg, inadequate follow-up of therapy [from 12 errors in period 1 to 24 errors in period 4, per 100 admissions]). We also found a reduction in the rates of potential adverse drug events between the first three periods and period 4. 436 system-related errors were recorded over the study period. INTERPRETATION Although the overall rates of primary medication errors per admission did not change, we found a reduction in some error types and a significant decrease in the rates of potential adverse drug events over a 2-year period, during which system optimisation occurred. Targeting some error types could have the added benefit of reducing others, which suggests that system optimisation could ultimately help improve patient safety and outcomes. FUNDING No funding.
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Affiliation(s)
- Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK; The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK; The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Clare L Tolley
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David W Bates
- The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Health and Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA; Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rachel Fraser
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | | | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Stockton on Tees, UK
| | | | - Steven Narrie
- Northumbria Healthcare National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Heed
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - E John Orav
- The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Neil W Watson
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
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