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Liu AK, Possin KL, Cook KM, Lynch S, Dulaney S, Merrilees JJ, Braley T, Kiekhofer RE, Bonasera SJ, Allen IE, Chiong W, Clark AM, Feuer J, Ewalt J, Guterman EL, Gearhart R, Miller BL, Lee KP. Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial. Alzheimers Dement 2023; 19:1865-1875. [PMID: 36331050 PMCID: PMC10156873 DOI: 10.1002/alz.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community-dwelling persons living with dementia (PLWD). METHODS Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti-dementia medications. RESULTS Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (-0.35; 95% CI, -0.49 to -0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS-active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti-dementia medication regimens were modified more frequently. CONCLUSION The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD. HIGHLIGHTS Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti-dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.
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Affiliation(s)
- Amy K. Liu
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
| | - Kristen M. Cook
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shalini Lynch
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer J. Merrilees
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Tamara Braley
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rachel E. Kiekhofer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Stephen J. Bonasera
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Amy M. Clark
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Julie Feuer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joan Ewalt
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elan L. Guterman
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Rosalie Gearhart
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kirby P. Lee
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
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2
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Brady JE, Simon SR, Yeksigian K, Zillich AJ, Moyer J, Linsky AM. Can nonclinicians classify medication discrepancies as accurately as clinical pharmacists? A validation study. Health Sci Rep 2022; 5:e824. [PMID: 36189414 PMCID: PMC9508616 DOI: 10.1002/hsr2.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Julianne E. Brady
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Steven R. Simon
- Center for the Study of Healthcare Innovation, Implementation and Policy VA Greater Los Angeles Healthcare System Los Angeles California USA
- Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles California USA
| | - Kate Yeksigian
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Alan J. Zillich
- Department of Pharmacy Practice, College of Pharmacy Purdue University West Lafayette Indiana USA
| | - Jonathan Moyer
- Office of Disease Prevention National Institutes of Health Bethesda Maryland USA
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine Boston University School of Medicine Boston Massachusetts USA
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Gala P, Moshokgo V, Seth B, Ramasuana K, Kazadi E, M'buse R, Pharithi S, Gobotsamang K, Szymanowski P, Kerobale RO, Balekile K, Tshimbalanga J, Tieng'o J, Tapela N, Barak T. Medication Errors and Blood Pressure Control Among Patients Managed for Hypertension in Public Ambulatory Care Clinics in Botswana. J Am Heart Assoc 2020; 9:e013766. [PMID: 31955639 PMCID: PMC7033820 DOI: 10.1161/jaha.119.013766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The prevalence of hypertension in low‐ and middle‐income countries is rapidly increasing, with most cases undiagnosed and many poorly controlled among those diagnosed. Medication reconciliation studies from high‐income countries have demonstrated a high occurrence of antihypertensive medication errors and a strong association between medication errors and inadequate blood pressure control, but data from low‐ and middle‐income countries are lacking. Methods and Results We conducted a cross‐sectional study from April to October 2018 of adult patients on pharmacologic management for known hypertension at 7 public health facilities in Kweneng East District, Botswana. Our aims included to evaluate the frequency of uncontrolled hypertension, the frequency and type of medication errors causing discrepancies between patient‐reported and prescribed antihypertensive medications, and the association between medication errors and uncontrolled hypertension. Descriptive analyses and multivariable logistic regression were used. The prevalence of uncontrolled hypertension was 55% among 280 enrolled adult patients, and 95 (34%) had ≥1 medication error. The most common errors included patients taking medications incorrectly (11.1%; 31/280), patients omitting medications (7.9%; 22/280), and unfilled prescriptions caused by pharmacy stock outs (7.5%%; 21/280). Uncontrolled hypertension was significantly associated with having ≥1 medication error compared with no errors (adjusted odds ratio, 3.26; 95% CI, 1.75–6.06; P<0.001). Conclusions Medication errors are strongly associated with poor blood pressure control in this setting. Further research is warranted to assess whether medication reconciliation and other low‐cost interventions addressing root causes of medication errors can improve the control of hypertension and other chronic conditions in low‐ and middle‐income countries.
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Affiliation(s)
- Pooja Gala
- Section of Hospital Medicine Department of General Medicine University of Chicago IL
| | | | - Bhavna Seth
- Department of Medicine Beth Israel Deaconess Hospital Boston MA
| | - Kegomoditswe Ramasuana
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Emmanuel Kazadi
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Rudy M'buse
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Solomon Pharithi
- Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | | | | | - Ruth Olyn Kerobale
- Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | | | - Jacques Tshimbalanga
- Department of Medicine Kweneng East District Management Team Molepolole Botswana.,Department of Medicine Thamaga Hospital Thamaga Botswana
| | - Jane Tieng'o
- Department of Medicine Scottish Livingstone Hospital Molepolole Botswana.,Department of Medicine Kweneng East District Management Team Molepolole Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership Gaborone Botswana.,University of Oxford United Kingdom
| | - Tomer Barak
- Department of Medicine Beth Israel Deaconess Hospital Boston MA.,Botswana Harvard AIDS Institute Partnership Gaborone Botswana.,Department of Medicine Scottish Livingstone Hospital Molepolole Botswana
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Lai FW, Kant JA, Dombagolla MH, Hendarto A, Ugoni A, Taylor DM. Variables associated with completeness of medical record documentation in the emergency department. Emerg Med Australas 2019; 31:632-638. [PMID: 30690885 DOI: 10.1111/1742-6723.13229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The completeness of ED medical record documentation is often suboptimal. We aimed to determine the variables associated with documentation completeness in a large, tertiary referral ED. METHODS We audited 1200 randomly selected medical records of patients who presented with either abdominal pain, cardiac chest pain, shortness of breath or headache between May-July 2013 and May-July 2016. Data were collected on patient and treating doctor variables. Documentation completeness was assessed using a 0-10 point scoring tool designed for the study. A maximum score was achieved if each of 10 pre-determined important items, specific to the presenting complaint, were documented (five medical history items, five physical examination items). Data were analysed using multivariate regression. RESULTS The presenting year, day and time, patient age and gender, preferred language, interpreter requirement, discharge destination and doctor gender were not associated with documentation completeness (P > 0.05). Patients with triage category 3 or pain score of 6-7 had higher documentation scores (P < 0.05). Compared to interns, registrars (effect size -0.72, 95% CI -1.02 to -0.42, P < 0.01) and consultants (-1.62, 95% CI -1.95 to -1.29, P < 0.01) scored significantly less. The headache patient subgroup scored significantly less than the other patient subgroups (-0.35, 95% CI -0.63 to -0.08, P = 0.01). For all presenting complaint subgroups, examination findings were less well documented than history items (P < 0.001). CONCLUSION Documentation completeness is less among senior doctors, headache patients and for examination findings. Research should determine if the supervision responsibilities of senior doctors affects documentation and if medico-legal and patient care implications exist.
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Affiliation(s)
- Fiona Wy Lai
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Andreas Hendarto
- Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia
| | - Antony Ugoni
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - David McD Taylor
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Caleres G, Bondesson Å, Midlöv P, Modig S. Elderly at risk in care transitions When discharge summaries are poorly transferred and used -a descriptive study. BMC Health Serv Res 2018; 18:770. [PMID: 30305104 PMCID: PMC6180642 DOI: 10.1186/s12913-018-3581-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Discharge summary with medication report effectively counteracts drug-related problems among elderly patients due to insufficient information transfer in care transitions. However, this requires optimal transfer and use of the discharge summaries. This study aimed to examine information transfer with discharge summaries from hospital to primary care. Methods A descriptive study with data consisting of discharge summaries of 115 patients, 75 years or older, using five or more drugs, collected during one week from 28 different hospital wards in Skåne county, Sweden. Two weeks after discharge, information transfer was examined via review of primary care medical records. It was noted whether the discharge summary was received (i.e. scanned to the primary care medical records), if the medication list was updated with drug changes and if a patient chart entry regarding medication or its follow-up was made in the primary care medical records. An electronic survey, which was sent to 151 primary care units in Skåne county, was used to examine experiences of the information transfer. Results Out of 115 discharge summaries, 47 (41%) were found in the primary care medical records. Patient chart entries regarding medication or its follow-up were seen in 53 (46%) cases. Drug changes during hospitalisation were seen in 51 out of 76 patients without multidose drug dispensing. In 16 (31%) out of these cases, medication lists were updated in primary care medical records. In the electronic survey, 22 (21%) out of the 107 responding primary care units reported the discharge summary was often received on the day of discharge, while 71 (66%) respondents indicated the discharge summary was always/often received but later. Medication list updates and patient chart entries in the primary care medical records were always/often done upon receipt of the discharge summary according to 61 (57%) respondents. Conclusion The transfer of information was often deficient and the discharge summaries were insufficiently used. Many discharge summaries were lost, an insufficient proportion of medication lists were updated and patient chart entries were often lacking. These findings may increase the risk of medication errors and drug-related problems for elderly in care transitions.
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Affiliation(s)
- Gabriella Caleres
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden
| | - Sara Modig
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Malmö, Sweden
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6
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Mead T, Schauner S. Pharmacy student engagement in the evaluation of medication documentation within an ambulatory care electronic medical record. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:415-420. [PMID: 29233279 DOI: 10.1016/j.cptl.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 10/03/2016] [Accepted: 12/25/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE An abundance of literature supports the benefits of electronic medical records (EMR) for improving overall healthcare quality. Identifying preventative care opportunities, reducing medical and medication related errors and incorporating clinical practice guidelines are just a few attributes of EMR implementation. The goals of this study were to engage experiential pharmacy students in the assessment of medication related documentation discrepancies in a newly implemented EMR system and to provide exposure to various aspects of conducting research. EDUCATIONAL ACTIVITY AND SETTING Pharmacy students screened patient charts over a three-month period to identify documentation discrepancies, including omissions of medications and medical problems and duplication of medications. Students conducted medication reconciliation for a total of one-hundred thirty-four patients. FINDINGS Medication omissions were identified for 46% of patients, medical problem omissions were identified for 38% of patients, and thirty-two duplicate medications were identified. SUMMARY Engaging pharmacy students in the quality improvement project afforded an interactive learning experience, highlighting firsthand the challenges associated with electronic documentation and the associated potential negative implications to patient care. Additionally, students gained exposure to various components of research including data collection, assessment, entry, analysis and future implications.
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Affiliation(s)
- Tatum Mead
- Goppert-Trinity Family Care, Kansas City, MO 64131, USA; University of Missouri-Kansas City School of Pharmacy, Kansas City, MO 64108, USA.
| | - Stephanie Schauner
- Goppert-Trinity Family Care, Kansas City, MO 64131, USA; University of Missouri-Kansas City School of Pharmacy, Kansas City, MO 64108, USA.
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7
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Franco JVA, Terrasa SA, Kopitowski KS. Medication discrepancies and potentially inadequate prescriptions in elderly adults with polypharmacy in ambulatory care. J Family Med Prim Care 2017; 6:78-82. [PMID: 29026754 PMCID: PMC5629905 DOI: 10.4103/2249-4863.214962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: The objective of this study is to describe the frequency and type of medication discrepancies (MD) through medication reconciliation and to describe the frequency of potentially inadequate prescription (PIP) medications using screening tool of older persons’ prescriptions criteria. Design: Cross-sectional comparison of electronic medical record (EMR) medication lists and patient's self-report of their comprehensive medication histories obtained through telephone interviews. Inclusion criteria: Elderly individuals (>65 years old) with more than ten medications recorded in their EMR, who had not been hospitalized in the past year and were not under domiciliary care, affiliated to a private community hospital. Outcome Measures: The primary outcomes were the proportion of patients with MD and PIP. Secondary outcomes were the proportion of types of discrepancies and PIP. We analyzed possible associations between these variables and other demographic and clinical variables. Results: Out of 214 randomly selected individuals, 150 accepted to participate (70%). The mean number of medications referred to be consumed by patients was 9.1 (95% confidence interval [CI] =8.6–9.6), and the mean number of prescribed medications in their EMR was 13.9 (95% CI = 13.3–14.5). Ninety-nine percent had at least one discrepancy (total 1252 discrepancies); 46% consumed at least one prescription not documented in their EMR and 93% did not consume at least one of the prescriptions documented in their EMR. In 77% of the patients, a PIP was detected (total 186), 87% of them were at least within one of the following categories: Prolonged used of benzodiazepines or proton pump inhibitors and the use of aspirin for the primary prevention of cardiovascular disease. Conclusions: There was a high prevalence of MD and PIP within the community of elderly adults affiliated to a Private University Hospital. Future interventions should be aimed at reducing the number of PIP to prevent adverse drug events and improve EMR accuracy by lowering medications discrepancies.
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Affiliation(s)
- Juan Víctor Ariel Franco
- Research Area, Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Public Health, Instituto Universitario Hospital Italiano and Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Research, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.,Department of Toxicology and Pharmacology, Universidad de, Buenos Aires, Argentina
| | - Sergio Adrián Terrasa
- Research Area, Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Public Health, Instituto Universitario Hospital Italiano and Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Karin Silvana Kopitowski
- Research Area, Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Research, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
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8
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Almanasreh E, Moles R, Chen TF. The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol 2016; 82:645-58. [PMID: 27198753 PMCID: PMC5338112 DOI: 10.1111/bcp.13017] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified. METHODS We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors. RESULTS Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n = 35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n = 57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists. CONCLUSIONS We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice.
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Affiliation(s)
- Enas Almanasreh
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Rebekah Moles
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
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9
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Waltering I, Schwalbe O, Hempel G. Discrepancies on Medication Plans detected in German Community Pharmacies. J Eval Clin Pract 2015; 21:886-92. [PMID: 26139566 DOI: 10.1111/jep.12395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES A current medication plan was identified as important patient safety factor. Information is needed on how many patients possess such a plan and what problems can be identified with its use. This study tried to define factors that influence accuracy of medication plans and to detect discrepancies from planned and actually administered medication in polypharmacy patients. METHODS Participants of the 'Apo-AMTS' course in Germany evaluated medication plans from their patients during performing medication reviews in community pharmacies. Discrepancies were defined as additional or missing drugs and deviations in dosage and drug names for Rx drugs and missing or additional self-medication. RESULTS Eighty per cent of the patients possessed a medication plan mainly written by general practitioners. Only 6.5% of the plans showed no discrepancies. Most discrepancies were seen on medication plans written by medical specialists and general practitioners, mainly name aberrations (41%) followed by additional drugs taken (30%) and prescribed drugs no longer taken (18%). Dosage variance was seen in 11% of all discrepancies. Deviations from the plan were observed frequently with antihypertensives (31.4%), analgesics (11.3%) and antidepressants/hypnotics as well as lipid-lowering drugs (6.7%). Four hundred thirty-three OTC drugs were not listed, mainly analgesics, mineral supplements and laxatives. CONCLUSION Many patients possess a medication plan but most of these plans showed discrepancies which limits the use as patient safety indicator. Community pharmacies offering medication reviews have an essential position to use the medication plan as a central link between patients and their prescribers, and therefore improve patient safety.
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Affiliation(s)
| | | | - Georg Hempel
- Department of Pharmaceutical and Medicinal Chemistry - Clinical Pharmacy, Westfälische Wilhelms-Universität, Muenster, Germany
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10
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Sarzynski EM, Luz CC, Zhou S, Rios-Bedoya CF. Medication Reconciliation in an Outpatient Geriatrics Clinic: Does Accuracy Improve If Patients “Brown Bag” Their Medications for Appointments? J Am Geriatr Soc 2014; 62:567-9. [DOI: 10.1111/jgs.12706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Erin M. Sarzynski
- College of Human Medicine; Michigan State University; East Lansing Michigan
| | - Clare C. Luz
- College of Human Medicine; Michigan State University; East Lansing Michigan
| | - Shiwei Zhou
- College of Human Medicine; Michigan State University; East Lansing Michigan
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11
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Benson JM, Snow G. Impact of Medication Reconciliation on Medication Error Rates in Community Hospital Cardiac Care Units. Hosp Pharm 2012. [DOI: 10.1310/hpj4712-927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Objective Medication reconciliation has become a practice standard across the country. We conducted a prospective study to measure the impact of medication reconciliation on the rates of medication error in cardiac care units. Methods We used 2 cardiac care units of similar size and case mix index (a measure of patient acuity) at separate hospitals to measure the difference in changes in medication error rates when medication reconciliation was implemented in the study unit, but not the control unit. A total of 457 patients were enrolled. Medication histories were recorded and compared with medication orders at admission to the units and upon transfer or discharge from the units. Errors were categorized as omission, incorrect drug order details, therapeutic duplication, missing information, medication allergy, drug interaction, incorrect therapeutic substitution, or contraindication. Adjudication of errors was done by a 3-pharmacist panel that was blinded to study group. A Poisson regression model was used to determine the significance of the difference in error rate changes between the study and control units. Results Errors were found in 325 of 7,203 orders reviewed (4.5%). Medication error rates decreased from 7.2% to 3.4% in the study group (3.8% absolute error reduction) and from 4.3% to 3.3% in the control group (1% absolute error reduction). The difference in changes in error rates between groups was statistically significant ( P < .0001). Conclusion Medication reconciliation has been one of the most costly and difficult health care quality improvement initiatives in recent history. Based on our findings, it appears that significant reductions in medication errors, the primary purpose for its implementation, can be achieved.
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Affiliation(s)
- John M. Benson
- Promise Hospital of Salt Lake, and University of Utah, Salt Lake City, Utah
| | - Greg Snow
- Statistical Data Center, Intermountain Healthcare, Salt Lake City, Utah. Intermountain Medical Center, Intermountain Healthcare, Murray, Utah
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12
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BURKE-BEBEE SUZIE, WILSON MARISA, BUCKLEY KATHLEENM. Building Health Information Technology Capacity. Comput Inform Nurs 2012; 30:547-53. [DOI: 10.1097/nxn.0b013e318261fc3a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Andrus MR. Student pharmacist initiated medication reconciliation in the outpatient setting. Pharm Pract (Granada) 2012; 10:78-82. [PMID: 24155821 PMCID: PMC3780482 DOI: 10.4321/s1886-36552012000200003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/27/2012] [Indexed: 11/21/2022] Open
Abstract
The Joint Commission continues to emphasize the importance of medication
reconciliation in all practice settings. Pharmacists and student pharmacists
are uniquely trained in this aspect of patient care, and can assist with
keeping accurate and complete medication records through patient interview
in the outpatient setting. Objective The objective of this study was to quantify and describe medication
reconciliation efforts by student pharmacists in an outpatient family
medicine center. Methods A retrospective review was conducted of all standard medication
reconciliation forms completed by student pharmacists during patient
interviews from April 2010 to July 2010. The number of reviews conducted was
recorded, along with the frequency of each type of discrepancy. A
discrepancy was defined as any lack of agreement between the medication list
in the electronic health record (EHR) and the patient-reported regimen and
included any differences in dose or frequency of a medication, duplication
of the same medication, medication no longer taken or omission of any
medication. Results A total of 213 standard medication forms from the 4 month period were
reviewed. A total of 555 discrepancies were found, including medications no
longer taken, prescription medications that needed to be added to the EHR,
over-the-counter(OTC) and herbal medications that needed to be added to the
EHR, medications taken differently than recorded in the EHR, and medication
allergies which needed to be updated. An average of 2.6 discrepancies was
found per patient interviewed. Conclusions Student pharmacist-initiated medication reconciliation in an outpatient
family medicine center resulted in the resolution of numerous discrepancies
in the medication lists of individual patients. Pharmacists and student
pharmacists are uniquely trained in medication history taking and play a
vital role in medication reconciliation in the outpatient setting.
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Affiliation(s)
- Miranda R Andrus
- Harrison School of Pharmacy, Auburn University . Huntsville, AL ( United States )
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14
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Ekedahl A, Brosius H, Jönsson J, Karlsson H, Yngvesson M. Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients. Pharmacoepidemiol Drug Saf 2011; 20:1177-83. [PMID: 21858899 DOI: 10.1002/pds.2226] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/10/2011] [Accepted: 07/08/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE To study discrepancies between (i) the prescribed current treatment stated by patients with congestive heart failure (CHF) compared with patients with other chronic diseases, (ii) the data in the medication list (ML) in the electronic medical record and (iii) the data in the prescription list (PL) on the prescriptions stored in the national prescription repository in Sweden, to determine current, noncurrent, duplicate and missing prescriptions. METHODS At one healthcare centre, a random sample of patients 18 years and older with a diagnosis of CHF, diabetes mellitus (DM) or osteoarthritis (OA) provided written informed consent to participate. Participants were interviewed by telephone on the prescribed current treatment. RESULTS Of 161 invited patients (61 CHF, 50 DM and 50 OA), 66 patients were included. More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%. Patients with CHF had overall more discrepancies and patients with DM fewer discrepancies in the ML. CONCLUSIONS Prescriptions for noncurrent treatment, duplicates and missing prescriptions are common in both the ML in the electronic medical record and the list on prescriptions stored in the Swedish National Prescription Repository. Patients with CHF had more discrepancies in the ML. The risk for medication errors in primary care due to incorrect information on prescribed treatment may be substantial.
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15
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Rytter L, Jakobsen HN, Rønholt F, Hammer AV, Andreasen AH, Nissen A, Kjellberg J. Comprehensive discharge follow-up in patients' homes by GPs and district nurses of elderly patients. A randomized controlled trial. Scand J Prim Health Care 2010; 28:146-53. [PMID: 20429738 PMCID: PMC3442329 DOI: 10.3109/02813431003764466] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical treatment and reduce the risk of readmission of elderly newly discharged patients. DESIGN AND SETTING The patients were randomized to either an intervention group receiving a structured home visit by the GP and the district nurse one week after discharge followed by two contacts after three and eight weeks, or to a control group receiving the usual care. PATIENTS A total of 331 patients aged 78+ years discharged from Glostrup Hospital, Denmark, were included. MAIN OUTCOME MEASURES Readmission rate within 26 weeks after discharge among all randomized patients. Control of medication, evaluated 12 weeks after discharge on 293 (89%) of the patients by an interview at home and by a questionnaire to the GP. RESULTS Control-group patients were more likely to be readmitted than intervention-group patients (52% v 40%; p = 0.03). In the intervention group, the proportions of patients who used prescribed medication of which the GP was unaware (48% vs. 34%; p = 0.02) and who did not take the medication prescribed by the GP (39% vs. 28%; p = 0.05) were smaller than in the control group. CONCLUSION The intervention shows a possible framework securing the follow-up on elderly patients after discharge by reducing the readmission risk and improving medication control.
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Affiliation(s)
- Lars Rytter
- General Practice, Albertslund, Glostrup University Hospital, Denmark.
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16
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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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17
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Marmura MJ, Hopkins M, Andrel J, Young WB, Biondi DM, Rupnow MF, Armstrong RB. Electronic Medical Records as a Research Tool: Evaluating Topiramate Use at a Headache Center. Headache 2010; 50:769-78. [DOI: 10.1111/j.1526-4610.2010.01624.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Neuspiel DR, Hyman D, Lane M. Quality improvement and patient safety in the pediatric ambulatory setting: current knowledge and implications for residency training. Pediatr Clin North Am 2009; 56:935-51. [PMID: 19660636 DOI: 10.1016/j.pcl.2009.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The outpatient environment has been the leading edge of improvement work in pediatrics and it has similarly served as an effective locale for the training of pediatric residents in the science of improvement. This review summarizes what is known about the measurement of quality and patient safety in pediatric ambulatory settings. The current Accreditation Council for Graduate Medical Education (ACGME) requirements for resident training in improvement and their application in these settings are discussed. Some approaches and challenges to meeting these requirements are reviewed. Finally, some future directions that this work may follow are presented; the goal is to strengthen the effectiveness of improvement methods and their linkage to professional education.
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Affiliation(s)
- Daniel R Neuspiel
- Division of General Pediatrics, Levine Children's Hospital of Carolinas Medical Center, PO BOX 32861, Charlotte, NC 28232-2861, USA.
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Dean BB, Lam J, Natoli JL, Butler Q, Aguilar D, Nordyke RJ. Review: use of electronic medical records for health outcomes research: a literature review. Med Care Res Rev 2009; 66:611-38. [PMID: 19279318 DOI: 10.1177/1077558709332440] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs' flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR's ability to achieve similar results previously achieved using other data sources. Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias.
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Wood DL, Brennan MD, Chaudhry R, Chihak AA, Feyereisn WL, Woychick NL, Hagen PT, Curtright JW, Naessens JM, Spurrier BR, Larusso NF. Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine, Mayo Clinic. Health Serv Manage Res 2009; 21:276-80. [PMID: 18957404 DOI: 10.1258/hsmr.2008.008009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There are opportunities to improve quality and safety of care provided to adult patients. The Plummer Project of the Department of Medicine at the Mayo Clinic (Rochester, MN, USA) is an initiative to redesign outpatient practice. We used multidisciplinary teams to standardize the tasks essential to improve patient care. With the initiative to standardize the rooming process, patient care and safety improved with greater accuracy of the medication list. The standardization also improved physician efficiency because trained clinical assistants helped address the needs of the patient. Physicians were satisfied by the new process and the technology enhancements. Clinical assistants were also highly satisfied by the training process. The quality and safety of patient care can be significantly improved by practice redesign. This practice redesign was satisfying for all, especially the patients, physicians and support team in our practice.
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Affiliation(s)
- Douglas L Wood
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
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Weingart SN, Cleary A, Seger A, Eng TK, Saadeh M, Gross A, Shulman LN. Medication Reconciliation in Ambulatory Oncology. Jt Comm J Qual Patient Saf 2007; 33:750-7. [DOI: 10.1016/s1553-7250(07)33090-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Robinson CA, Cocohoba J, MacDougall C, John MDV, Guglielmo BJ. Discordance between ambulatory care clinic and community pharmacy medication databases for HIV-positive patients. J Am Pharm Assoc (2003) 2007; 47:613-5. [PMID: 17848351 DOI: 10.1331/japha.2007.06131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Christie A Robinson
- Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, CA, USA.
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Nassaralla CL, Naessens JM, Chaudhry R, Hansen MA, Scheitel SM. Implementation of a medication reconciliation process in an ambulatory internal medicine clinic. Qual Saf Health Care 2007; 16:90-4. [PMID: 17403752 PMCID: PMC2653166 DOI: 10.1136/qshc.2006.021113] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the causes of medication list inaccuracy, implement intervention to enhance overall accuracy of medication lists and measure the sustainability of the intervention. METHODS A prospective study of patients seen in an academic, ambulatory primary care internal medicine clinic. Before the intervention, baseline data were analysed, assessing completeness of medication documentation in the electronic medical record. The intervention consisted of standardising the entire visit process from scheduling of the appointment to signing of the final clinical note by the physician. Each healthcare team member was instructed in her role to enhance accuracy of the documented medication list. Immediately after the intervention, a second data collection was undertaken to assess the effectiveness of the intervention on the accuracy of individual medications and medication lists. Finally, a year later, a third data collection was undertaken to assess the sustainability of the intervention. RESULTS Completeness of individual medications improved from 9.7% to 70.7% (p<0.001). However, completeness of the entire medication lists improved only from 7.7% to 18.5%. The incomplete documentation of medication lists was mostly due to lack of route (85.8%) and frequency (22.3%) for individual medications within a medication list. Also, documentation of over-the-counter and "as needed" medications was often incomplete. The incorrectness in a medication list was mostly due to misreporting of medications by patients or failure of clinicians to update the medication list when changes were made. CONCLUSION To improve the accuracy of medication lists, active participation of all members of the healthcare team and the patient is needed.
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Affiliation(s)
- Claudia L Nassaralla
- The Division of Primary Care Internal Medicine, Medicine Clinic, Rochester, Minnesota, USA
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Brown CA, Bailey JH, Lee J, Garrett PK, Rudman WJ. The Pharmacist-Physician Relationship in the Detection of Ambulatory Medication Errors. Am J Med Sci 2006; 331:22-4. [PMID: 16415659 DOI: 10.1097/00000441-200601000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expenditures on outpatient prescription drugs have increased enormously in the last decade. Despite this growth in expenditures, prescription medication safety in the ambulatory setting is lacking. Prior research in outpatient care has centered around the physician-patient encounter. What remains unexamined in the ambulatory care literature is the pharmacist's role as interceptor, detector, and reporter of medication errors to the physician. METHODS Data about the role, responsibilities, and expectations to inform physicians about this subject were collected from pharmacist (N = 30) and patient (N = 31) focus groups conducted between July 2002 and July 2003. Pharmacists in outpatient practices and patients were randomly selected from the state licensure database and the Jackson Metropolitan phonebook, respectively. ANALYSIS Grounded theory provided the perspective on which data were interpreted. Data patterns were linked using key words and phrases for theme analysis. Arbitration between coders resulted in an inter-rater reliability of 0.85. RESULTS : Three complementary patterns were identified from the data: 1) patients likely see multiple physicians and only one pharmacist; 2) patients are more likely to report medication errors to the pharmacist than to the physician; and 3) pharmacists are the final interceptors, detecting medication errors before they reach patients. CONCLUSIONS Ambulatory pharmacists are in a privileged position to gather data regarding adverse responses to prescribed medication or incidents of medication mishaps. The failure of pharmacists to report information back to physicians is a missed opportunity to improve patient safety.
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Affiliation(s)
- C Andrew Brown
- School of Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
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25
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Affiliation(s)
- Kathy Ketchum
- Southern Illinois University at Edwardsville, School of Nursing, USA.
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Manley HJ, Drayer DK, McClaran M, Bender W, Muther RS. Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center. Pharmacotherapy 2003; 23:231-9. [PMID: 12596688 DOI: 10.1592/phco.23.2.231.32079] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients who require hemodialysis take many drugs. Electronic drug records may be discrepant with what patients are actually taking. Record discrepancies are a potential source of drug-related problems. We sought to determine the extent to which drug record discrepancies occur in a hemodialysis population. METHODS This was a prospective observational study of patients enrolled in a pharmacist clinic at an outpatient hemodialysis center from August-December 2001. Patients participated in monthly drug interviews conducted by a pharmacist, during which patient drug use was determined. Data collected consisted of patient demographics, drug type, and number of drugs. Drug record discrepancies were classified and assigned a potential drug-related problem. Results were compared with the electronic drug record. Patients with documented drug record discrepancies were compared with those patients for whom no discrepancy was identified. RESULTS Over the 5-month period, 215 drug interviews were conducted in 63 patients. One hundred thirteen drug record discrepancies were identified in 38 patients (60%). Discrepancies (mean +/- SD 1.7 +/- 1.3, range 1-7) were identified during 65 drug interviews (30.2%). Electronic drug records were discrepant by one drug record, two drug records, and more than two drug records 60.0%, 26.2%, and 13.8% of the time, respectively. Drug record discrepancies placed patients at risk for adverse drug events and dosing errors in 49.6% and 34.5%, respectively, of 113 discrepancies. Patient age negatively correlated with the number of drug record discrepancies identified (r = -0.27, p = 0.04). CONCLUSIONS Drug record discrepancies occur frequently among patients undergoing hemodialysis. Incorporation of a pharmacist into the patient care team may increase the accuracy of the electronic drug record and avert unnecessary drug-related problems.
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Affiliation(s)
- Harold J Manley
- Department of Pharmacy Practice, University of Missouri-Kansas City, MO 64102, USA.
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