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Darcis E, Germeys J, Stragier M, Cortoos P. The impact of medication reconciliation and review in patients using oral chemotherapy. J Oncol Pharm Pract 2023; 29:270-275. [PMID: 36729465 DOI: 10.1177/10781552211066959] [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
BACKGROUND AND AIM Verifying and reviewing a patients medication list can detect and reduce drug related problems (DRPs). However little is known about its effects in patients using oral chemotherapy. The aim of this study was to evaluate the impact of these interventions and the adapted Medication Appropriateness Index (aMAI) as a tool to carry out a medication review. METHODS A case-control study was carried out. The hospital pharmacist performed a medication reconciliation and medication review, using the aMAI tool, in 54 patients starting oral chemotherapy. Discrepancies, DRP's and associated pharmaceutical interventions were reported via the electronic patient record (EPR). After one month, the acceptance rate was measured and the aMAI score recalculated. Kappa statistics were used to test intra- and interrater reliability. RESULTS The medication list in the EPR was incomplete in 74,1% of patients with an average of 2.4 errors per patient. After medication review, the aMAI score decreased significantly from 7.2 to 5.4 (SD = 4,7; p <0.001), indicating an improvement in the appropriateness of the drugs patients were taking. Acceptance rates were 41,4% and 53,2% for advices resulting from medication reconciliation and medication review respectively. Kappa values of 0.90 and 0.70 respectively indicate good intra- and interrater reliability. DISCUSSION AND CONCLUSION The study shows that medication reconciliation can identify and address discrepancies. Furthermore, medication review seems to ensure that drug treatment better meets patient needs. The aMAI was a reliable tool. Future research will have to determine the clinical relevance of these interventions.
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Affiliation(s)
| | - Jana Germeys
- Pharmacy, 82214Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Pieterjan Cortoos
- 60201Academisch Ziekenhuis van de Vrije Universiteit Brussel, Brussel, Belgium
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2
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Elbeddini A, To A, Tayefehchamani Y, Wen CX. Importance of medication reconciliation in cancer patients. J Pharm Policy Pract 2021; 14:98. [PMID: 34844645 PMCID: PMC8628436 DOI: 10.1186/s40545-021-00379-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022] Open
Abstract
Cancer patients are a complex and vulnerable population whose medication history is often extensive. Medication reconciliations in this population are especially essential, since medication discrepancies can lead to dire outcomes. This commentary aims to describe the significance of conducting medication reconciliations in this often-forgotten patient population. We discuss additional clinical interventions that can arise during this process as well. Medication reconciliations provide the opportunity to identify and prevent drug-drug and herb-drug interactions. They also provide an opportunity to appropriately adjust chemotherapy dosing according to renal and hepatic function. Finally, reconciling medications can also provide an opportunity to identify and deprescribe inappropriate medications. While clinical impact appears evident in this landscape, evidence of economic impact is lacking. As more cancer patients are prescribed a combination of oral chemotherapies, intravenous chemotherapies and non-anticancer medications, future studies should evaluate the advantages of conducting medication reconciliations in these patient populations across multiple care settings.
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Affiliation(s)
- Ali Elbeddini
- Chairman of the Pharmacy Department, Winchester District Memorial Hospital, 566 Louise Street, Winchester, ON KK0C2K0 Canada
| | - Anthony To
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 college st, Toronto, M5S 3M2 Canada
| | - Yasamin Tayefehchamani
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 college st, Toronto, M5S 3M2 Canada
| | - Cindy Xin Wen
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 college st, Toronto, M5S 3M2 Canada
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3
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Yacobucci MJ, Lombardi CL, Briceland LL. Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations. J Oncol Pharm Pract 2021; 28:109-118. [PMID: 33470177 DOI: 10.1177/1078155220985579] [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: 11/16/2022]
Abstract
INTRODUCTION Student pharmacists contribute meaningfully to patient care during Advanced Practice Pharmacy Experiences (APPEs) in varied settings. We aimed to characterize and evaluate the impact of student participation in hematology-oncology (hem-onc) APPEs on the practice site, and on student professionalization. METHODS For students completing hem-onc APPEs during 2016-2019, rotation activities and post-APPE self-reflections describing meaningful impact were reviewed; activities were categorized into direct and indirect patient care, and up to three reflection themes of professionalization impact were extracted from each self-reflection. Hem-onc preceptor cohort was surveyed to assess impact of student contributions on the practice site. RESULTS 171 students completed hem-onc APPEs in ambulatory care (133) and/or inpatient (38) settings. Of 932 student-reported activities, the most common were: evaluating patient pharmacotherapy (209), providing education to medical staff (132), patient counseling [non-chemotherapy (99); chemotherapy (82)], and providing drug information (96); 89% involved direct patient care/education. Survey results from 16 of 33 preceptors identified the most impactful student activities as evaluating pharmacotherapy, medication education/adherence resources, and in-service presentations. Of 392 student self-reflections, themes of impact focused on professionalization/self-awareness (39.3%), counseling/communication skills (27.8%), practice skills development (20.4%) and collaborative teamwork (12.5%). CONCLUSION Pharmacy students make significant direct patient care contributions to hem-onc practice settings by evaluating pharmacotherapy and providing education to patients and healthcare personnel. Participation in hem-onc APPEs is highly influential to the professionalization of students, particularly in developing skills in oncology practice, patient interactions/communications, and developing self-awareness.
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Affiliation(s)
- Matthew J Yacobucci
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.,Albany Medical Center Hospital, Albany, NY, USA
| | | | - Laurie L Briceland
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
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4
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Weingart SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. Lancet Oncol 2019; 19:e191-e199. [PMID: 29611527 DOI: 10.1016/s1470-2045(18)30094-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Although chemotherapy is a well established treatment modality, chemotherapy errors represent a potentially serious risk of patient harm. We reviewed published research from 1980 to 2017 to understand the extent and nature of medication errors in cancer chemotherapy, and to identify effective interventions to help prevent mistakes. Chemotherapy errors occur at a rate of about one to four per 1000 orders, affect at least 1-3% of adult and paediatric oncology patients, and occur at all stages of the medication use process. Oral chemotherapy use is a particular area of growing risk. Our knowledge of chemotherapy errors is drawn primarily from single-institution studies at university hospitals and referral centres, with a particular focus on prescription orders and pharmacy practices. Although the heterogeneity of research methods and measures used in these studies limits our understanding of this issue, the rate of chemotherapy error-related injuries is generally lower than those seen in comparable studies of general medical patients. Although many interventions show promise in reducing chemotherapy errors, most have little empirical support. Additional research is needed to understand and to mitigate the risk of chemotherapy medication errors.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Lulu Zhang
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Megan Sweeney
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hassett
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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5
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Phan H, Williams M, McElroy K, Burton B, Fu D, Khandoobhai A. Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center. J Oncol Pharm Pract 2019; 25:1419-1424. [PMID: 30808276 DOI: 10.1177/1078155219831066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. METHODS A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. RESULTS Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. CONCLUSION The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.
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Affiliation(s)
- Ha Phan
- 1 Johns Hopkins Home Care Group, Pharmacy Services, Baltimore, Maryland
| | - Macey Williams
- 2 Beaumont Hospital Grosse Pointe, Department of Pharmacy, Grosse, Michigan
| | - Kelly McElroy
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
| | - Bradley Burton
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
| | - Denise Fu
- 1 Johns Hopkins Home Care Group, Pharmacy Services, Baltimore, Maryland
| | - Anand Khandoobhai
- 3 The Johns Hopkins Hospital, Department of Pharmacy, Division of Oncology, Baltimore, Maryland
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6
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Aljabri D, Dumitrascu A, Burton MC, White L, Khan M, Xirasagar S, Horner R, Naessens J. Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction. BMC Med Inform Decis Mak 2018; 18:70. [PMID: 30053809 PMCID: PMC6062873 DOI: 10.1186/s12911-018-0644-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures. METHODS A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis. RESULTS Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05). CONCLUSIONS Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.
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Affiliation(s)
- Duaa Aljabri
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL USA
| | - Adrian Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - Launia White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL USA
| | - Mahmud Khan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - James Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
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Lesselroth BJ, Adams K, Church VL, Tallett S, Russ Y, Wiedrick J, Forsberg C, Dorr DA. Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection. Appl Clin Inform 2018; 9:285-301. [PMID: 29719884 DOI: 10.1055/s-0038-1645889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Veterans Affairs Portland Healthcare System developed a medication history collection software that displays prescription names and medication images. OBJECTIVE This article measures the frequency of medication discrepancy reporting using the medication history collection software and compares with the frequency of reporting using a paper-based process. This article also determines the accuracy of each method by comparing both strategies to a best possible medication history. STUDY DESIGN Randomized, controlled, single-blind trial. SETTING Three community-based primary care clinics associated with the Veterans Affairs Portland Healthcare System: a 300-bed teaching facility and ambulatory care network serving Veteran soldiers in the Pacific Northwest United States. PARTICIPANTS Of 212 patients with primary care appointments, 209 patients fulfilled the study requirements. INTERVENTION Patients randomized to a software-directed medication history or a paper-based medication history. Randomization and allocation to treatment groups were performed using a computer-based random number generator. Assignments were placed in a sealed envelope and opened after participant consent. The research coordinator did not know or have access to the treatment assignment until the time of presentation. MAIN OUTCOME MEASURES The primary analysis compared the discrepancy detection rates between groups with respect to the health record and a best possible medication history. RESULTS Of 3,500 medications reviewed, we detected 1,435 discrepancies. Forty-six percent of those discrepancies were potentially high risk for causing an adverse drug event. There was no difference in detection rates between treatment arms. Software sensitivity was 83% and specificity was 91%; paper sensitivity was 81% and specificity was 94%. No participants were lost to follow-up. CONCLUSION The medication history collection software is an efficient and scalable method for gathering a medication history and detecting high-risk discrepancies. Although it included medication images, the technology did not improve accuracy over a paper list when compared with a best possible medication history. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02135731.
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Affiliation(s)
- Blake J Lesselroth
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Kathleen Adams
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Victoria L Church
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Stephanie Tallett
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Yelizaveta Russ
- Division of Primary Care, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Jack Wiedrick
- Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Christopher Forsberg
- Center of Innovation, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
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8
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Tamblyn R, Winslade N, Lee TC, Motulsky A, Meguerditchian A, Bustillo M, Elsayed S, Buckeridge DL, Couture I, Qian CJ, Moraga T, Huang A. Improving patient safety and efficiency of medication reconciliation through the development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project. J Am Med Inform Assoc 2018; 25:482-495. [PMID: 29040609 PMCID: PMC6018649 DOI: 10.1093/jamia/ocx107] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Many countries require hospitals to implement medication reconciliation for accreditation, but the process is resource-intensive, thus adherence is poor. We report on the impact of prepopulating and aligning community and hospital drug lists with data from population-based and hospital-based drug information systems to reduce workload and enhance adoption and use of an e-medication reconciliation application, RightRx. Methods The prototype e-medical reconciliation web-based software was developed for a cluster-randomized trial at the McGill University Health Centre. User-centered design and agile development processes were used to develop features intended to enhance adoption, safety, and efficiency. RightRx was implemented in medical and surgical wards, with support and training provided by unit champions and field staff. The time spent per professional using RightRx was measured, as well as the medication reconciliation completion rates in the intervention and control units during the first 20 months of the trial. Results Users identified required modifications to the application, including the need for dose-based prescribing, the role of the discharge physician in prescribing community-based medication, and access to the rationale for medication decisions made during hospitalization. In the intervention units, both physicians and pharmacists were involved in discharge reconciliation, for 96.1% and 71.9% of patients, respectively. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in the intervention units, and 0.7% (surgery) to 82.7% of patients in the control units. The odds of completing medication reconciliation were 9 times greater in the intervention compared to control units (odds ratio: 9.0, 95% confidence interval, 7.4-10.9, P < .0001) after adjusting for differences in patient characteristics. Conclusion High rates of medication reconciliation completion were achieved with automated prepopulation and alignment of community and hospital medication lists.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
- Department of Medicine, McGill University, Montréal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
| | - Nancy Winslade
- Department of Medicine, McGill University, Montréal, Canada
| | - Todd C Lee
- Department of Medicine, McGill University, Montréal, Canada
- McGill University Health Centre, Montréal, Canada
| | - Aude Motulsky
- Department of Medicine, McGill University, Montréal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, School of Public Health, University of Montréal, Montréal, Canada
| | - Ari Meguerditchian
- Department of Medicine, McGill University, Montréal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
- McGill University Health Centre, Montréal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sarah Elsayed
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
| | - Isabelle Couture
- McGill University Health Centre, Montréal, Canada
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Christina J Qian
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
| | - Teresa Moraga
- Clinical and Health Informatics Research Group, McGill University, Montréal, Canada
| | - Allen Huang
- Division of Geriatric Medicine, University of Ottawa, Ottawa, Canada
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9
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Tezcan S, İzzettin FV, Sancar M, Turhal NS, Yumuk PF. Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer. Eur J Hosp Pharm 2018; 25:e17-e20. [PMID: 31157061 PMCID: PMC6457159 DOI: 10.1136/ejhpharm-2016-001188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer. METHODS 36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the study. The patients were followed up during 3 courses of chemotherapy and individual pharmaceutical care plans were developed. The quality of life of patients was evaluated before and after the third course of chemotherapy. RESULTS The incidence of drug-related problems (DRPs) in chemotherapy-treated patients was reduced in the 3rd course as compared with 1st course (63.9% vs 75%, respectively; n=36; p>0.05). The clinical oncology pharmacist gave 147 recommendations to patients, which were followed in 98% (n=144) of cases. 91.7% (n=132) of the recommendations of clinical oncology pharmacists solved the drug-related problems; however, the remaining 8.3% (n=12) did not solve the problems and the patients were referred to a doctor for further investigations. The symptom-related quality of life of patients related to anaemia, diarrhoea and neurotoxicity was reduced after the third course of chemotherapy (p<0.05). CONCLUSIONS The pharmaceutical care provided by the clinical oncology pharmacist has an important role in the identification and resolution of DRPs. Evaluation of symptom-related quality of life is important for the monitoring of patients receiving chemotherapy.
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Affiliation(s)
- Songül Tezcan
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Fikret Vehbi İzzettin
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Mesut Sancar
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Nazım Serdar Turhal
- Department of Internal Medicine, Division of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Perran Fulden Yumuk
- Department of Internal Medicine, Division of Medical Oncology, Marmara University Medical School, Istanbul, Turkey
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10
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Panchal R. Systemic anticancer therapy (SACT) for lung cancer and its potential for interactions with other medicines. Ecancermedicalscience 2017; 11:764. [PMID: 28955400 PMCID: PMC5606292 DOI: 10.3332/ecancer.2017.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background Systemic anticancer therapy, comprising chemotherapy agents alongside targeted therapies and immunotherapy, is clinically indicated for late-stage lung cancer. It is delivered in regimens often containing multiple anticancer agents as well as supportive care medicines to reduce side effects, raising potential for polypharmacy and therefore the possibility of drug–drug interactions with medicines taken for comorbidities. A pharmacy-led process commonly performed to assist safe prescribing in secondary care is medicines reconciliation; its benefit in minimising interactions involving systemic anticancer therapy medicines has not been assessed previously. Objectives The objectives were to characterise the potential drug–drug interactions between systemic anticancer therapy medicines for lung cancer and other medicines and to evaluate the rate of medicines reconciliation being performed and the extent of documentation of potential interactions (clinical audit). Methodology This retrospective case series study involved recording the medicines being taken by lung cancer patients undergoing systemic anticancer therapy elicited in consultations at Chelsea and Westminster Hospital, United Kingdom. Potential interactions were identified and characterised in terms of severity using the British National Formulary and other sources. Patient consultation records were also searched for documentation of medicines reconciliation and acknowledgement of potential drug–drug interactions. Results Twenty-three patients were included in this study. Eighty-eight potential drug–drug interactions were identified across 21 patients, 39% (34/88) of which involved the supportive care medicine dexamethasone. 3.0% of consultations included a documented medicines reconciliation, and 15.9% of potential interactions were documented in the notes, with no correlation between the two. Potentially serious interactions were significantly more likely to be documented (p < 0.05). Conclusions Many potential drug–drug interactions involving anticancer agents and supportive care medicines exist; particular attention should be paid to dexamethasone. Documentation of interactions and medicines reconciliation occur much less often than expected, suggesting there is scope for implementing methods of safe prescribing to prevent adverse drug effects.
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Affiliation(s)
- Ryan Panchal
- Imperial College London, Exhibition Road, London SW7 2AZ, UK
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11
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Albano ME, Bostwick JR, Ward KM, Fluent T, Choe HM. Discrepancies Identified Through a Telephone-Based, Student-Led Initiative for Medication Reconciliation in Ambulatory Psychiatry. J Pharm Pract 2017. [PMID: 28629301 DOI: 10.1177/0897190017715391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify the number of medication discrepancies following establishment of a telephone-based, introductory pharmacy practice experience student-driven, medication reconciliation service for new patients in an ambulatory psychiatry clinic. Secondarily, to identify factors impacting medication discrepancies to better target medication profiles to reconcile and to evaluate whether the implementation of a call schedule effected clinic no-show rates. METHODS This was a retrospective analysis of a telephone-based medication reconciliation service from June 2014 to January 2016. RESULTS At least 1 medication discrepancy was identified among 84.7% of medication profiles (N = 438), with a total of 1416 medication discrepancies reconciled (3.2 discrepancies per patient). Of the 1416 discrepancies, 38.6% were deletions, 38.9% were additions, and 22.5% were changes in dosage strength or frequency. Discrepancies pertaining to prescription medications totaled 57.8%. Student pharmacists were critical team members in the service. Patient's age, number of medications on the patient's list, and number of days since the last medication reconciliation were not clinically significant determinants for targeting medication profiles. There was a statistically significant reduction in the clinic no-show rates following implementation of a call schedule compared with no-show rates prior to call schedule implementation. CONCLUSION This student pharmacist-led telephone medication reconciliation service demonstrated the importance of medication reconciliation in ambulatory psychiatry by identifying numerous discrepancies within this population. Further, we demonstrated pharmacy students across various levels of education can assist in this process under the supervision of a pharmacist.
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Affiliation(s)
- Marie E Albano
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Kristen M Ward
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Thomas Fluent
- 2 Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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12
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McCarthy L, Su X(W, Crown N, Turple J, Brown TER, Walsh K, John J, Rochon P. Medication reconciliation interventions in ambulatory care: A scoping review. Am J Health Syst Pharm 2016; 73:1845-1857. [DOI: 10.2146/ajhp150916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - Jennifer Turple
- Institute for Safe Medication Practices Canada, Toronto, Canada
| | | | - Kate Walsh
- Toronto Central Community Care Access Centre, Toronto, Canada
| | - Jessica John
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Paula Rochon
- Women’s College Research Institute, Toronto, Canada
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13
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Ashjian E, Salamin LB, Eschenburg K, Kraft S, Mackler E. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center. J Am Pharm Assoc (2003) 2016; 55:540-5. [PMID: 26359964 DOI: 10.1331/japha.2015.14214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the number of discrepancies and medication-related problems found as a result of pharmacy-led medication reconciliation involving introductory pharmacy practice experience (IPPE) students at a comprehensive cancer center. SETTING Outpatient infusion center of a National Cancer Institute (NCI)-designated and National Comprehensive Cancer Network (NCCN) cancer center. PRACTICE DESCRIPTION AND INNOVATION Third-year IPPE students contacted and completed medication reconciliation for 510 hematology/oncology patients scheduled for infusion center appointments without a coupled provider visit. IPPE students discussed the findings of the medication reconciliations with their pharmacist preceptors, who updated the medication histories in the electronic medical record (EMR) and communicated with prescribers directly about identified medication-related problems. All medication reconciliation was documented using a standardized note template in the EMR. MAIN OUTCOME MEASURES Number of medication discrepancies found, including medication additions, medication deletions, dose changes, and herbal product additions; medication-related problems-including drug-drug interactions, untreated indications (e.g., nausea, vomiting, pain, need for prophylactic medications), failure of patients to receive prescribed medications, and adverse drug reactions-were also documented. RESULTS Medication reconciliation was completed for 510 patients through the student pharmacist/pharmacist preceptor-led intervention during a 1-year period between January 1, 2013, and December 31, 2013. A total of 88% of patients had at least one discrepancy identified in their medication history and corrected in the EMR. In addition, 11.4% of patients had a medication-related problem identified. CONCLUSIONS Pharmacy-led medication reconciliation identified a large number of discrepancies among our hematology/oncology patients. This intervention allowed for correction of discrepancies in the EMR leading to improved accuracy of patient medication lists. In addition, it provided a valuable learning experience for student pharmacists.
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Dullabh PM, Sondheimer NK, Katsh E, Evans MA. How patients can improve the accuracy of their medical records. EGEMS 2014; 2:1080. [PMID: 25848614 PMCID: PMC4371478 DOI: 10.13063/2327-9214.1080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy. BACKGROUND Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. METHODS The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs. FINDINGS/DISCUSSION (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for medication list changes. (3) Processing patient feedback will requires both software algorithms and human interpretation. For the 107 forms subsample, pharmacists accepted patient input in 51 percent of cases where they could not contact the patient. Where the patient was contacted, they accepted feedback from 68 percent. This suggests there may be opportunities to automate feedback filtering and processing for more efficient (and larger scale) medication-list optimization. (4) A supportive overall e-health environment makes acceptance of an online patient feedback system more likely. Review of Geisinger usage data showed patients who completed the medication feedback form had previously accessed MyGeisinger 2.3 times as often as the average patient and initiated secure messages with a clinician 1.35 times as often as patients not involved in the pilot. CONCLUSIONS Patient feedback, placed in a useful workflow, can improve medical record accuracy. Electronic health record (EHR) vendors and developers need to build appropriate capabilities into applications. Continued research and development is needed for enabling health care organizations to elicit and process patient information most effectively.
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Lazure P, St-Germain F, Gryfe R, Trudeau M, Hayes SM. Communication – the foundation for collaborative relationships amongst providers, and between providers and patients: A case in breast and colorectal cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1179/1753807614y.0000000047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Eckardt R, Steinhagen-Thiessen E, Kämpfe S, Buchmann N. Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Z Gerontol Geriatr 2013; 47:293-301. [DOI: 10.1007/s00391-013-0562-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Huynh C, Wong ICK, Tomlin S, Terry D, Sinclair A, Wilson K, Jani Y. Medication discrepancies at transitions in pediatrics: a review of the literature. Paediatr Drugs 2013; 15:203-15. [PMID: 23670796 DOI: 10.1007/s40272-013-0030-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm.
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Affiliation(s)
- Chi Huynh
- Centre for Paediatric Pharmacy Research, University College London School of Pharmacy, BMA/Tavistock House Entrance, Mezzanine Floor, London, WC1H 9JP, UK
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Liekweg A, Westfeld M, Braun M, Zivanovic O, Schink T, Kuhn W, Jaehde U. Pharmaceutical care for patients with breast and ovarian cancer. Support Care Cancer 2013; 20:2669-77. [PMID: 22298194 PMCID: PMC3461211 DOI: 10.1007/s00520-012-1385-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 01/08/2012] [Indexed: 12/18/2022]
Abstract
Purpose Individualized patient care may help reduce the incidence of adverse drug events in systemic cancer therapy. This study was conducted to explore the feasibility and potential of additional pharmaceutical care for breast and ovarian cancer patients. Methods The study was designed as a prospective, multicentered cohort study with a control group. Ninety-eight breast or ovarian cancer patients were recruited from outpatient oncology clinics and primary care oncologists: initially into the control group receiving standard care and after implementation of pharmaceutical care into the intervention group consisting of additional patient counseling on the management of treatment-associated adverse events and optimization of supportive medication. Primary outcome was the complete response to the antiemetic prophylaxis. Secondary endpoints were the severity of nausea, frequency of emesis, health-related quality of life, and patient satisfaction with information on cancer treatment education. Results Forty-eight patients were included in the control group and 50 in the intervention group. Of the patients, 35.4% in the control group and 76.0% in the intervention group (p < 0.001) had a complete response to the antiemetic prophylaxis. The severity of acute and delayed nausea was not reduced. The global health scale and two symptom scales (nausea and vomiting, appetite loss) of the EORTC QLQ-C30 questionnaire were positively affected by pharmaceutical care. Patient satisfaction with information was significantly higher in the intervention group. Conclusions Patients with breast and ovarian cancer seem to benefit from pharmaceutical care, as suggested by improved patient-reported outcomes such as emetic episodes, quality of life, and patient satisfaction after implementation. Electronic supplementary material The online version of this article (doi:10.1007/s00520-012-1385-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Liekweg
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany
| | - Martina Westfeld
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany
| | - Michael Braun
- Center for Integrated Oncology (CIO), Department of Obstetrics and Gynaecology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Oliver Zivanovic
- Center for Integrated Oncology (CIO), Department of Obstetrics and Gynaecology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Achterstr. 30, 28359 Bremen, Germany
| | - Walther Kuhn
- Center for Integrated Oncology (CIO), Department of Obstetrics and Gynaecology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany
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Weiskopf NG, Weng C. Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research. J Am Med Inform Assoc 2013; 20:144-51. [PMID: 22733976 PMCID: PMC3555312 DOI: 10.1136/amiajnl-2011-000681] [Citation(s) in RCA: 589] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/03/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To review the methods and dimensions of data quality assessment in the context of electronic health record (EHR) data reuse for research. MATERIALS AND METHODS A review of the clinical research literature discussing data quality assessment methodology for EHR data was performed. Using an iterative process, the aspects of data quality being measured were abstracted and categorized, as well as the methods of assessment used. RESULTS Five dimensions of data quality were identified, which are completeness, correctness, concordance, plausibility, and currency, and seven broad categories of data quality assessment methods: comparison with gold standards, data element agreement, data source agreement, distribution comparison, validity checks, log review, and element presence. DISCUSSION Examination of the methods by which clinical researchers have investigated the quality and suitability of EHR data for research shows that there are fundamental features of data quality, which may be difficult to measure, as well as proxy dimensions. Researchers interested in the reuse of EHR data for clinical research are recommended to consider the adoption of a consistent taxonomy of EHR data quality, to remain aware of the task-dependence of data quality, to integrate work on data quality assessment from other fields, and to adopt systematic, empirically driven, statistically based methods of data quality assessment. CONCLUSION There is currently little consistency or potential generalizability in the methods used to assess EHR data quality. If the reuse of EHR data for clinical research is to become accepted, researchers should adopt validated, systematic methods of EHR data quality assessment.
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Affiliation(s)
- Nicole Gray Weiskopf
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA.
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Tamblyn R, Huang AR, Meguerditchian AN, Winslade NE, Rochefort C, Forster A, Eguale T, Buckeridge D, Jacques A, Naicker K, Reidel KE. Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial. Trials 2012; 13:150. [PMID: 22920446 PMCID: PMC3502593 DOI: 10.1186/1745-6215-13-150] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 08/07/2012] [Indexed: 12/05/2022] Open
Abstract
Background Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem. Methods/Design Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units. Discussion The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors. Trial registration NCT01179867
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada.
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Sharma AN, Dvorkin R, Tucker V, Margulies J, Yens D, Rosalia A. Medical Reconciliation in Patients Discharged from the Emergency Department. J Emerg Med 2012; 43:366-73. [DOI: 10.1016/j.jemermed.2011.05.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/02/2010] [Accepted: 05/20/2011] [Indexed: 10/14/2022]
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Abstract
More and more elderly people with cancer are treated in oncology clinics worldwide every year, many of whom have comorbid disorders treated with one or more drugs. Moreover, these patients might also take self-prescribed over-the-counter drugs or complementary and alternative medicines, which they might not tell their doctor about. Initiation of chemotherapy with one or more cytotoxic or targeted agents and drugs for treatment of cancer symptoms or toxic effects related to treatment can result in polypharmacy. We examine the clinical implications of polypharmacy. Challenges for the medical teams who treat elderly patients with cancer include identification of what drugs are actually being taken by the patient, avoidance or management of any adverse effects or drug interactions, and reassessing the patient's overall treatment. We address these issues and propose practical recommendations for management of treatment for elderly patients with cancer.
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Weingart SN, Zhu J, Chiappetta L, Stuver SO, Schneider EC, Epstein AM, David-Kasdan JA, Annas CL, Fowler FJ, Weissman JS. Hospitalized patients' participation and its impact on quality of care and patient safety. Int J Qual Health Care 2011; 23:269-77. [PMID: 21307118 DOI: 10.1093/intqhc/mzr002] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety. DESIGN Random sample telephone survey and medical record review. SETTING US acute care hospitals in 2003. PARTICIPANTS A total of 2025 recently hospitalized adults. MAIN OUTCOME MEASURES Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. RESULTS Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of >4 activities) was strongly associated with patients' favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15-7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31-0.78). CONCLUSIONS Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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Maßnahmen zur Verbesserung der Patientensicherheit. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:171-5. [DOI: 10.1007/s00103-010-1201-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weeks DL, Corbett CF, Stream G. Beliefs of ambulatory care physicians about accuracy of patient medication records and technology-enhanced solutions to improve accuracy. J Healthc Qual 2010; 32:12-21. [PMID: 20854355 DOI: 10.1111/j.1945-1474.2010.00097.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The continuing problem of inaccurate medication records and resultant harm from medication errors has prompted the Institute of Medicine and others to encourage information technology (IT) solutions to improve medication list accuracy. There are few studies on how ambulatory care documentation contributes to medication list inaccuracies and medication reconciliation failures. To address medication reconciliation issues in ambulatory care, office-based physicians in a region with a high adoption rate for electronic medical records (EMRs) were surveyed about current reconciliation practices, the need for redesigning reconciliation processes, and acceptable IT solutions for improving availability of medication information. Physicians selected from a list of potential IT platforms that would create a single reconciled record of prescription medications, nonprescription medications, and supplements accessible wherever patients go. The two most popular platforms were either an aggregated list within existing EMRs accessible by inpatient and outpatient providers regardless of their EMR system, or a web-based repository that was not integrated into an EMR. Respondents felt that implementation of such platforms would not require major changes to clinical workflow, perhaps due to the region's existing familiarity with health IT. Leveraging community acceptance of health IT could result in rapid implementation of universally accessible medication list platforms.
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Bassi J, Lau F, Bardal S. Use of information technology in medication reconciliation: a scoping review. Ann Pharmacother 2010; 44:885-97. [PMID: 20371752 DOI: 10.1345/aph.1m699] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify studies involving information technology (IT) in medication reconciliation (MedRec) and determine how IT is used to facilitate the MedRec process. DATA SOURCES The search strategy included a database search of MEDLINE and Cumulative Index of Nursing and Allied Health Literature (CINAHL), hand-searching of collected material, and references from articles retrieved. The database search was limited to English-language papers. MEDLINE includes publications dating back to 1950 and CINAHL includes those dating back to 1982. The search included articles in both databases up to March 2009. Boolean queries were constructed using combinations of search terms for medication reconciliation, IT, and electronic records. STUDY SELECTION AND DATA EXTRACTION Three inclusion criteria were used. The study had to (1) involve the MedRec process, (2) be a primary study, and (3) involve the use of IT. Selection was performed by 2 reviewers through consensus. Data related to study characteristics, focus, and IT use were extracted. DATA SYNTHESIS The included studies described a range of IT used throughout the MedRec process, from basic email and databases to specialized MedRec tools. A generic MedRec workflow was created and types of IT found in the studies were mapped to the workflow activities as well as to a set of functionalities based on the Institute of Medicine's Key Capabilities of an Electronic Health Record System. In the studies reviewed, IT was mainly used to obtain medication information. Although there were only a few MedRec tools in the studies, those that did exist supported the central activities for MedRec: comparison of medications and clarification of discrepancies. CONCLUSIONS MedRec is an important process to ensure patient medication safety. Evidence was found that IT can and has been used to facilitate some MedRec activities and new applications are being developed to support the entire MedRec process.
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Affiliation(s)
- Jesdeep Bassi
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
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Hoffmann B, Rohe J. Patient safety and error management: what causes adverse events and how can they be prevented? DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:92-9. [PMID: 20204120 DOI: 10.3238/arztebl.2010.0092] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 06/15/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Even in industrialized countries, health care is not as safe as it should be. The term "patient safety" denotes the non-occurrence of adverse events and the presence of measures to prevent them. METHODS The literature was selectively reviewed to obtain information on the epidemiology and causes of preventable adverse events (PAE), as well as on measures that can increase patient safety. RESULTS Preventable adverse events occur in Germany both in the hospital and in outpatient settings, although their precise frequency is currently a disputed matter. PAE should be analyzed systematically. They are caused both by active errors and by latent failures that are inherent in components of the health care system. CONCLUSION Three main strategies should be pursued to improve patient safety. A safety management system involving error reporting, learning from errors, and the fair exchange of information should be established in hospitals and in doctors' outpatient practices. An error management system should be implemented in which critical incidents are identified, reported, and analyzed so that similar events can be prevented, and measures for the prevention of critical incidents and errors should also be implemented and evaluated. Finally, whenever preventable adverse events do occur, the persons involved should take action to prevent further harm to the patient and other involved individuals.
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Affiliation(s)
- Barbara Hoffmann
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt am Main, Germany.
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Chan KS, Fowles JB, Weiner JP. Review: electronic health records and the reliability and validity of quality measures: a review of the literature. Med Care Res Rev 2010; 67:503-27. [PMID: 20150441 DOI: 10.1177/1077558709359007] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous reviews of research on electronic health record (EHR) data quality have not focused on the needs of quality measurement. The authors reviewed empirical studies of EHR data quality, published from January 2004, with an emphasis on data attributes relevant to quality measurement. Many of the 35 studies reviewed examined multiple aspects of data quality. Sixty-six percent evaluated data accuracy, 57% data completeness, and 23% data comparability. The diversity in data element, study setting, population, health condition, and EHR system studied within this body of literature made drawing specific conclusions regarding EHR data quality challenging. Future research should focus on the quality of data from specific EHR components and important data attributes for quality measurement such as granularity, timeliness, and comparability. Finally, factors associated with poor or variability in data quality need to be better understood and effective interventions developed.
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Affiliation(s)
- Kitty S Chan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Persell SD, Bailey SC, Tang J, Davis TC, Wolf MS. Medication reconciliation and hypertension control. Am J Med 2010; 123:182.e9-182.e15. [PMID: 20103029 DOI: 10.1016/j.amjmed.2009.06.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 06/13/2009] [Accepted: 06/18/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Discrepancies between the medical record and patient medication list are common. The relationship of discrepancies to chronic disease control has not been established. METHODS To determine the frequency and type of antihypertensive medication discrepancies between patient-named antihypertensive medications and the medical record, we performed a cross-sectional study of 315 adults with medically treated hypertension from 6 safety-net clinics in 3 states. We determined the association between medication discrepancies and uncontrolled blood pressure (> or =140/90 mm Hg or > or =130/80 mm Hg if diabetes) using multivariate logistic regression models. RESULTS Discrepancies were present for 75.2% of patients; 25.7% of patients could not provide the name of any antihypertensive medication they took; 49.5% could name 1 or more antihypertensive medications but had discrepancies between patient-reported antihypertensive medications and those listed in the medical record. Both patients who were unable to name any of their antihypertensive medications and patients with discrepancies between patient-named medications and the medical record were significantly more likely to have uncontrolled blood pressure than patients who named the same medications as the medical record in adjusted analyses, adjusted risk ratios 1.66 (95% confidence interval, 1.31-2.10) and 1.51 (95% confidence interval, 1.11-2.07), respectively. Twelve percent of patients reporting medications took antihypertensive medication that altered potassium metabolism that was not in their medical record. CONCLUSIONS Among patients at safety-net clinics, inability to name one's antihypertensive medications and discrepancies between patient-reported medications and the medical record were very common. Both were strongly associated with inadequate hypertension control. Performing medication reconciliation at the point of care may be an important way to identify patients at high risk for inadequate disease control or safety problems.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Ill, USA.
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Karapinar-Carkit F, Borgsteede SD, Zoer J, Smit HJ, Egberts ACG, van den Bemt PMLA. Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. Ann Pharmacother 2009; 43:1001-10. [PMID: 19491320 DOI: 10.1345/aph.1l597] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hospital admissions are a risk factor for the occurrence of unintended medication discrepancies between drugs used before admission and after discharge. To diminish such discrepancies and improve quality of care, medication reconciliation has been developed. The exact contribution of patient counseling to the medication reconciliation process is unknown, especially not when compared with community pharmacy medication records, which are considered reliable in the Netherlands. OBJECTIVE To examine the effect of medication reconciliation with and without patient counseling among patients at the time of hospital discharge on the number and type of interventions aimed at preventing drug-related problems. METHODS A prospective observational study in a general teaching hospital was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed the interventions with and without patient counseling on discharge medications for each patient. RESULTS Two hundred sixty-two patients were included. Medication reconciliation without patient counseling was responsible for at least one intervention in 87% of patients (mean 2.7 interventions/patient). After patient counseling, at least one intervention (mean 5.3 interventions/patient) was performed in 97% of patients. After patient counseling, discharge prescriptions were frequently adjusted due to discrepancies in use or need of drug therapy. Most interventions led to the start of medication due to omission and dose changes due to incorrect dosages being prescribed. Patients also addressed their problems/concerns with use of the drug, which were discussed before discharge. CONCLUSIONS Significantly more interventions were identified after patient counseling. Therefore, patient information is essential in medication reconciliation.
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