Medication reconciliation service in Tan Tock Seng Hospital

Impact of pharmacist-initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam

WHAT IS KNOWN AND OBJECTIVE

Unintentional medication discrepancies (UMDs) are common in geriatric patients during care transitions, resulting in frequent undesirable consequences. Medication reconciliation could be a useful practice to prevent or ameliorate UMD. However, this practice in Vietnamese hospitals has not been well established or standardized. This study aims to determine the effect of pharmacist-initiated educational interventions on improving medication reconciliation practice.

METHODS

This prospective 6-month pre-and post-study was conducted in two internal medicine wards in a Vietnamese 800-bed public hospital. Pharmacists provided training and short-term support to physicians on medication reconciliation. Primary outcome measures were the proportions of patients with at least one UMD at admission. Secondary outcome measures were the proportions of patients with preventable adverse drug events (pADEs) score ≥0.1 due to these UMDs. Odds ratio and 95% confidence intervals were assessed based on a multivariate logistic regression model.

RESULTS AND DISCUSSION

One hundred fifty-two patients were recruited in the pre-intervention phase, and 146 in the post-intervention phase. Following the intervention, the proportion of geriatric patients with ≥1 UMD at admission significantly decreased from 55.3 to 25.3 % (ORadj 0.255, 95% CI: 0.151-0.431). Similarly, the proportion of patients with a pADE ≥0.1 at admission reduced from 44.1 to 11.6% [ORadj 0.188, 95% CI: 0.105-0.340] post-intervention.

WHAT IS NEW AND CONCLUSION

Our pharmacist-initiated educational interventions have demonstrated the ability to produce substantial improvement in medication reconciliation practice, reducing UMDs and potential harm. Our approach may provide an alternate option to implement medication reconciliation for jurisdictions with limited healthcare resources.

Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia

BACKGROUND

Medication use process in the emergency department (ED) can be challenging and the risk for medication error (ME) to occur is high. In Malaysia, several studies on ME have been conducted in various hospital settings. However, little is known about the prevalence of ME in emergency department (ED) in these hospitals. The objective of this study was to determine the prevalence and characteristics of ME at an ED of a teaching hospital in Malaysia.

METHODS

A cross-sectional study was conducted over the period of 9 weeks in patients who visited the ED of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Data on patient medication orders and demographic information was collected from the doctor's clerking sheet. Observations were made on nursing activities and these were documented in the data collection form. Other information related to the administration of medications were obtained from the nursing care records.

RESULTS

Observations and data collections were made for 547 patients who fulfilled the study criteria. From these, 311 patient data were randomly selected for analysis. Ninety-five patients had at least one ME. The prevalence of ME was calculated to be 30.5%. The most common types of ME were wrong time error (46.9%), unauthorized drug error (25.4%), omission error (18.5%) and dose error (9.2%). The most frequently drug associated with ME was analgesics. No adverse event was observed.

CONCLUSIONS

The prevalence of ME in our ED setting was moderately high. However, the majority of them did not result in any adverse event. Intervention measures are needed to prevent further occurrence.

Medication Errors in the Southeast Asian Countries: A Systematic Review

BACKGROUND

Medication error (ME) is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region.

METHODS

The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages) that investigated the incidence and the contributing factors of ME in patients of all ages.

RESULTS

The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional.

DISCUSSION

The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed.

Characterizing medication discrepancies among older adults during transitions of care: a systematic review focusing on discrepancy synonyms, data sources and classification terms

Medication reconciliation is a Joint Commission National Patient Safety Goal prioritized at transitions of care. Medication discrepancies are the reason for, and result of, medication reconciliation. However, their characterization in the literature has not been systematically studied. Older adults are at particularly high risk for medication discrepancies given the prevalence of polypharmacy in this population. The aim was to determine how medication discrepancies among older adults are defined during transitions of care by analyzing synonyms, medication data sources and classification terms. A systematic search of PubMed and EMBASE for primary literature involving medication discrepancies among adults aged ≥50 years during hospital care transitions was carried out. Reviewers consolidated data into like categories and used descriptive statistics to summarize findings. Out of 746 records retrieved, 35 studies were included in this review. In total, 19 studies (54%) were exclusive to adults over 65 years of age. Study settings included hospital discharge (n = 16; 46%), admission (n = 13; 37%) and mixed or multiple transitions (n = 6; 17%). Synonyms for discrepancies included inconsistencies, incongruences, inaccuracies and disagreements, among others. Common data sources included inpatient medication records and medication histories. A comprehensive, best possible medication history utilizing all available medication data sources was recorded in 51% of studies (n = 18), most consistently at admission. Most studies (n = 32; 91%) classified discrepancies; common classification terms included drug dose (n = 28; 88%), omission (n = 26; 80%) and commission (n = 16; 50%). In this first systematic review of medication discrepancy definitions, we found inconsistency across studies. Standardization and common discrepancy nomenclature is necessary for medication reconciliation outcomes to be compared, and to identify best practices to enhance safety. Safety implications are most salient in older adults given the number of medications and transitions of care to which they are exposed, as well as their sensitivity to adverse consequences of medication discrepancies.