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Kashyap N, Jeffery S, Agresta T. From MedWreck to MedRec: A Call to Action to Improve Medication Reconciliation. Appl Clin Inform 2024; 15:230-233. [PMID: 37748724 PMCID: PMC10972679 DOI: 10.1055/a-2181-1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/24/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Nitu Kashyap
- Internal Medicine, Emory Healthcare, Emory University school of Medicine, Atlanta, Georgia, United States
| | - Sean Jeffery
- University of Connecticut School of Pharmacy, Storrs, Connecticut, United States
| | - Thomas Agresta
- Family Medicine, Center for Quantitative Medicine, University of Connecticut School of Medicine, Storrs, Connecticut, United States
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Liang MY, Feng L, Zhu W, Yang QQ. Effect of frailty on medication deviation during the hospital-family transition period in older patients with cardiovascular disease: An observational study. Medicine (Baltimore) 2024; 103:e36893. [PMID: 38215090 PMCID: PMC10783343 DOI: 10.1097/md.0000000000036893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
Studies have shown that frailty increases cardiovascular disease (CVD) incidence in older patients and is associated with poor patient prognosis. However, the relationship between medication deviation (MD) and frailty remains unclear. This study aimed to explore the influence of frailty on MD during the hospital-family transition period among older patients with CVD. Between February 2022 and February 2023, 231 older people CVD patients were selected from a class III hospital in Nantong City using a multi-stage sampling method. A general information questionnaire was used to collect the socio-demographic characteristics of the participants prior to discharge, the frailty assessment scale was used to assess the participants frailty, and a medication deviation instrument was used to assess the participants MD on the 10th day after discharge. Propensity score matching was used to examine the effect of frailty on MD in older patients with CVD during the hospital-family transition period. The incidences of frailty and MD were 32.9% (76/231) and 75.8% (175/231), respectively. After propensity score matching, the risk of MD in frail patients with CVD was 4.978 times higher than that in non-frail patients with CVD (95% CI: [1.616, 15.340]; P = .005). Incidences of frailty and MD during the hospital-family transition period are high in older patients with CVD, and frailty has an impact on MD. Medical staff in the ward should comprehensively examine older patients with CVD for frailty and actively promote quality medication management during the hospital-family transition period to reduce MD occurrence and delay disease progression.
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Affiliation(s)
- Meng-Yao Liang
- Department of Nursing, The Sixth People’s Hospital of Nantong, Jiangsu, China
| | - Li Feng
- Department of Nursing, The Sixth People’s Hospital of Nantong, Jiangsu, China
| | - Wuyang Zhu
- Department of Rehabilitation, Yi Jiangmen Community Health Service Center, Gulou District, Nanjing, China
| | - Qing-Qing Yang
- Department of Cardiology, The Sixth People’s Hospital of Nantong, Jiangsu, China
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Araya A, Thornton LR, Kwon D, Ferguson GM, Highfield LD, Hwang KO, Holmes HM, Bernstam EV. Medication Reconciliation during Transitions of Care Across Institutions: A Quantitative Analysis of Challenges and Opportunities. Appl Clin Inform 2023; 14:923-931. [PMID: 37726022 PMCID: PMC10665121 DOI: 10.1055/a-2178-0197] [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: 05/07/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Medication discrepancies between clinical systems may pose a patient safety hazard. In this paper, we identify challenges and quantify medication discrepancies across transitions of care. METHODS We used structured clinical data and free-text hospital discharge summaries to compare active medications' lists at four time points: preadmission (outpatient), at-admission (inpatient), at-discharge (inpatient), and postdischarge (outpatient). Medication lists were normalized to RxNorm. RxNorm identifiers were further processed using the RxNav API to identify the ingredient. The specific drugs and ingredients from inpatient and outpatient medication lists were compared. RESULTS Using RxNorm drugs, the median percentage intersection when comparing active medication lists within the same electronic health record system ranged between 94.1 and 100% indicating substantial overlap. Similarly, when using RxNorm ingredients the median percentage intersection was 94.1 to 100%. In contrast, the median percentage intersection when comparing active medication lists across EHR systems was significantly lower (RxNorm drugs: 6.1-7.1%; RxNorm ingredients: 29.4-35.0%) indicating that the active medication lists were significantly less similar (p < 0.05).Medication lists in the same EHR system are more similar to each other (fewer discrepancies) than medication lists in different EHR systems when comparing specific RxNorm drug and the more general RxNorm ingredients at transitions of care. Transitions of care that require interoperability between two EHR systems are associated with more discrepancies than transitions where medication changes are expected (e.g., at-admission vs. at-discharge). Challenges included lack of access to structured, standardized medication data across systems, and difficulty distinguishing medications from orderable supplies such as lancets and diabetic test strips. CONCLUSION Despite the challenges to medication normalization, there are opportunities to identify and assist with medication reconciliation across transitions of care between institutions.
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Affiliation(s)
- Alejandro Araya
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center (UTHealth), Houston, Texas, United States
| | - Logan R. Thornton
- Division of Population Health and Evidence-Based Practice, Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Deukwoo Kwon
- Division of Clinical and Translation Sciences, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Gayla M. Ferguson
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
| | - Linda D. Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Kevin O. Hwang
- Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Holly M. Holmes
- Division of Geriatrics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center (UTHealth), Houston, Texas, United States
- Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
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Lesselroth B, Church VL, Adams K, Mixon A, Richmond-Aylor A, Glasscock N, Wiedrick J. Interprofessional survey on medication reconciliation activities in the US Department of Veterans' Affairs: development and validation of an Implementation Readiness Questionnaire. BMJ Open Qual 2022; 11:bmjoq-2021-001750. [PMID: 36229073 PMCID: PMC9562315 DOI: 10.1136/bmjoq-2021-001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication reconciliation (MR) can detect medication history discrepancies at interfaces-in-care and help avoid downstream adverse drug events. However, organisations have struggled to implement high-quality MR programmes. The literature has identified systems barriers, including technology capabilities and data interoperability. However, organisational culture as a root cause has been underexplored. OBJECTIVES Our objectives were to develop an implementation readiness questionnaire and measure staff attitudes towards MR across a healthcare enterprise. METHODS We developed and distributed a questionnaire to 170 Veterans' Health Affairs (VHA) sites using Research Electronic Data Capture (REDCap) software. The questionnaire contained 21 Likert-scale items that measured three constructs, such as: (1) the extent that clinicians valued MR; (2) perceptions of workflow compatibility and (3) perceptions concerning organisational climate of implementation. RESULTS 8704 clinicians and staff responded to our questionnaire (142 of 170 VHA facilities). Most staff believed reconciling medications can improve medication safety (approximately 90% agreed it was 'important'). However, most (approximately 90%) also expressed concerns about changes to their workflow. One-third of respondents prioritised other duties over MR and reported barriers associated with implementation climate. Only 47% of respondents agreed they had enough resources to address discrepancies when identified. INTERPRETATION Our findings indicate that an MR readiness assessment can forecast challenges and inform development of a context-sensitive implementation bundle. Clinicians surveyed struggled with resources, technology challenges and implementation climate. A strong campaign should include clear leadership messaging, credible champions and resources to overcome technical challenges. CONCLUSIONS This manuscript provides a method to conduct a readiness assessment and highlights the importance of organisational culture in an MR campaign. The data can help assess site or network readiness for an MR change management programme.
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Affiliation(s)
- Blake Lesselroth
- Department of Medical Informatics, The University of Oklahoma-Tulsa, Tulsa, Oklahoma, USA,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Victoria Lee Church
- US Department of Veterans Affairs, Office of Nursing Services, Washington, DC, USA
| | - Kathleen Adams
- US Department of Veterans Affairs, Office of Human Factors Engineering, Washington, DC, USA
| | - Amanda Mixon
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy Richmond-Aylor
- Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Naomi Glasscock
- Specialty Care Services, Prescription Drug Monitoring Program, Veterans Health Administration, Washington, DC, USA
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon, USA
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Williams J, Malden S, Heeney C, Bouamrane M, Holder M, Perera U, Bates DW, Sheikh A. Optimizing Hospital Electronic Prescribing Systems: A Systematic Scoping Review. J Patient Saf 2022; 18:e547-e562. [PMID: 35188939 PMCID: PMC8855945 DOI: 10.1097/pts.0000000000000867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Considerable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospital ePrescribing systems to maximize the benefits and minimize the risks of these expensive digital health infrastructures. METHODS We undertook a systematic scoping review of the literature by searching MEDLINE, Embase, and CINAHL databases. We searched for primary studies reporting on ePrescribing optimization strategies and independently screened and abstracted data until saturation was achieved. Findings were theoretically and thematically synthesized taking a medicine life-cycle perspective, incorporating consultative phases with domain experts. RESULTS We identified 23,609 potentially eligible studies from which 1367 satisfied our inclusion criteria. Thematic synthesis was conducted on a data set of 76 studies, of which 48 were based in the United States. Key approaches to optimization included the following: stakeholder engagement, system or process redesign, technological innovations, and education and training packages. Single-component interventions (n = 26) described technological optimization strategies focusing on a single, specific step in the prescribing process. Multicomponent interventions (n = 50) used a combination of optimization strategies, typically targeting multiple steps in the medicines management process. DISCUSSION We identified numerous optimization strategies for enhancing the performance of ePrescribing systems. Key considerations for ePrescribing optimization include meaningful stakeholder engagement to reconceptualize the service delivery model and implementing technological innovations with supporting training packages to simultaneously impact on different facets of the medicines management process.
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Affiliation(s)
- Jac Williams
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Malden
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Heeney
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Matt Bouamrane
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Mike Holder
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Uditha Perera
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aziz Sheikh
- From the Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Gionfriddo M, Hu Y, Maddineni B, Kern M, Duboski V, Kaledas WR, Elder N, Border J, Frusciante K, Kobylinski M, Wright E. Evaluation of a web-based medication reconciliation application within a primary care setting: Results from a cluster randomized controlled trial. JMIR Form Res 2022; 6:e33488. [PMID: 35023836 PMCID: PMC8941436 DOI: 10.2196/33488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. Objective We aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT). Methods We conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews. Results Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement. Conclusions The use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.
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Affiliation(s)
- Michael Gionfriddo
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, US.,Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, US
| | - Bhumika Maddineni
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Melissa Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Nevan Elder
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Jeffrey Border
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Katie Frusciante
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
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Frament J, Hall RK, Manley HJ. Medication Reconciliation: The Foundation of Medication Safety for Patients Requiring Dialysis. Am J Kidney Dis 2020; 76:868-876. [PMID: 32920154 DOI: 10.1053/j.ajkd.2020.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/08/2020] [Indexed: 01/05/2023]
Abstract
Medication-related problems are a leading cause of morbidity and mortality. Patients requiring dialysis are at heightened risk for adverse drug reactions because of the prevalence of polypharmacy, multiple chronic conditions, and altered (but not well understood) medication pharmacokinetics and pharmacodynamics inherent to kidney failure. To minimize preventable medication-related problems, health care providers need to prioritize medication safety for this population. The cornerstone of medication safety is medication reconciliation. We present a case highlighting adverse outcomes when medication reconciliation is insufficient at care transitions. We review available literature on the prevalence of medication discrepancies worldwide. We also explain effective medication reconciliation and the practical considerations for implementation of effective medication reconciliation in dialysis units. In light of the addition of medication reconciliation requirements to the Centers for Medicare & Medicaid Services End-Stage Renal Disease Quality Incentive Program, this review also provides guidance to dialysis unit leadership for improving current medication reconciliation practices. Prioritization of medication reconciliation has the potential to positively affect rates of medication-related problems, as well as medication adherence, health care costs, and quality of life.
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Dolan JE, Lonsdale H, Ahumada LM, Patel A, Samuel J, Jalali A, Peck J, DeRosa JC, Rehman M, Varughese AM, Fernandez AM. Quality Initiative Using Theory of Change and Visual Analytics to Improve Controlled Substance Documentation Discrepancies in the Operating Room. Appl Clin Inform 2019; 10:543-551. [PMID: 31365940 DOI: 10.1055/s-0039-1693688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Discrepancies in controlled substance documentation are common and can lead to legal and regulatory repercussions. We introduced a visual analytics dashboard to assist in a quality improvement project to reduce the discrepancies in controlled substance documentation in the operating room (OR) of our free-standing pediatric hospital. METHODS Visual analytics were applied to collected documentation discrepancy audit data and were used to track progress of the project, to motivate the OR team, and in analyzing where further improvements could be made. This was part of a seven-step improvement plan based on the Theory of Change with a logic model framework approach. RESULTS The introduction of the visual analytics dashboard contributed a 24% improvement in controlled substance documentation discrepancy. The project overall reduced documentation errors by 71% over the studied period. CONCLUSION We used visual analytics to simultaneously analyze, monitor, and interpret vast amounts of data and present them in an appealing format. In conjunction with quality-improvement principles, this led to a significant improvement in controlled substance documentation discrepancies.
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Affiliation(s)
- Jenny E Dolan
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Hannah Lonsdale
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Luis M Ahumada
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Amish Patel
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Jibin Samuel
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Ali Jalali
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Jacquelin Peck
- Department of Anesthesiology, Mount Sinai Medical Center of Florida, Florida, United States
| | - JoAnn C DeRosa
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Mohamed Rehman
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Anna M Varughese
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
| | - Allison M Fernandez
- Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States
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Mixon AS, Kripalani S. The Challenges of Medication Reconciliation for the Medical Home. Jt Comm J Qual Patient Saf 2019; 45:531-533. [PMID: 31235407 DOI: 10.1016/j.jcjq.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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