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Ataei S, Makki B, Ayubi E, Emami S. Medication discrepancies identified by medication reconciliation among patients with acute coronary syndrome. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:7649-7657. [PMID: 38695910 DOI: 10.1007/s00210-024-03114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 10/04/2024]
Abstract
Medication errors such as medication discrepancies are known as one of the leading cause of death. Medication discrepancies mostly occur during admission and at time transfer of care and discharge. Medication reconciliation process has pivotal role to avert medication discrepancies and improve patient safety and quality. Patients with acute coronary syndrome (ACS) are prone to medication discrepancies due to acute manifestations, simultaneous use of different medicines and having different co-morbidities. This study aimed to determine medication discrepancies identified by medication reconciliation among patients with ACS. In an observational study, patients with ACS admitted to a specialized Hospital in Baneh County, Kurdistan province during September 2023 and January 2024 were included. Medication reconciliation process was done when the patient was admitted. The history of medicine use was collected through interviews with the patient, their caregivers, as well as observing the medicines that were accompany with the patients. Number and type of unintentional medication discrepancies and related factors were evaluated. A total of 280 ACS patients (mean age: 63.8 ± 14.2, male gender: 59.3%) were included in the study. About 68% had at least 2 underlying diseases. The mean daily medicines taken by the patients during admission were 8.5 ± 1.54. The number (percentage) of unintentional inconsistency was observed in 78 (27.3%), and omission (39.7%) and changes in dosage (20.5%) had the highest frequency of unintentional medication discrepancies, respectively. Cardiovascular agents such as anti-dyslipidemia and antiplatelet had the highest frequency of unintentional medication discrepancies. The number of underlying diseases and daily medications before hospitalization increase the odds of discrepancies by 2.15 and 1.49 times, respectively (p-value < 0.05). Medication discrepancies identified by medication reconciliation among patients is relatively common. Unintentional medication discrepancies that have the potential to harm the ACS patients should be given more attention, especially in patients with multiple comorbidities and polypharmacy.
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Affiliation(s)
- Sara Ataei
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behrouz Makki
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahaboddin Emami
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran.
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Kruik-Kollöffel WJ, Moltman GAW, Wu MD, Braaksma A, Karapinar F, Boucherie RJ. Optimisation of medication reconciliation using queueing theory: a computer experiment. Int J Clin Pharm 2024; 46:881-888. [PMID: 38727777 DOI: 10.1007/s11096-024-01722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Medication reconciliation (MedRec) in hospitals is an important tool to enhance the continuity of care, but completing MedRec is challenging. AIM The aim of this study was to investigate whether queueing theory could be used to compare various interventions to optimise the MedRec process to ultimately reduce the number of patients discharged prior to MedRec being completed. Queueing theory, the mathematical study of waiting lines or queues, has not been previously applied in hospital pharmacies but enables comparisons without interfering with the baseline workflow. METHOD Possible interventions to enhance the MedRec process (replacing in-person conversations with telephone conversations, reallocating pharmacy technicians (PTs) or adjusting their working schedule) were compared in a computer experiment. The primary outcome was the percentage of patients with an incomplete discharge MedRec. Due to the COVID-19 pandemic, it was possible to add a real-life post hoc intervention (PTs starting their shift later) to the theoretical interventions. Descriptive analysis was performed. RESULTS The queueing model showed that the number of patients with an incomplete discharge MedRec decreased from 37.2% in the original scenario to approximately 16% when the PTs started their shift 2 h earlier and 1 PT was reassigned to prepare the discharge MedRec. The number increased with the real-life post hoc intervention (PTs starting later), which matches a decrease in the computer experiment when started earlier. CONCLUSION Using queueing theory in a computer experiment could identify the most promising theoretical intervention to decrease the percentage of patients discharged prior to MedRec being completed.
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Affiliation(s)
- W J Kruik-Kollöffel
- Department of Clinical Pharmacy, Ziekenhuisgroep Twente (Hospital Group Twente), Postbus 7600, Almelo and Hengelo, 7600 SZ, The Netherlands.
| | - G A W Moltman
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
| | - M D Wu
- Department of Clinical Pharmacy, Ziekenhuisgroep Twente (Hospital Group Twente), Postbus 7600, Almelo and Hengelo, 7600 SZ, The Netherlands
- Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands
| | - A Braaksma
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
| | - F Karapinar
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
| | - R J Boucherie
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
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Barat E, Soubieux A, Brevet P, Gerard B, Vittecoq O, Lequerre T, Chenailler C, Varin R, Lattard C. Impact of the Clinical Pharmacist in Rheumatology Practice: A Systematic Review. Healthcare (Basel) 2024; 12:1463. [PMID: 39120166 PMCID: PMC11312274 DOI: 10.3390/healthcare12151463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
This is a systematic literature review on the impact of pharmacists in rheumatology, conducted using the PubMed®, CINAHL®, Cochrane Library®, and Web of science® databases and using the PRISMA 2020 checklist. This review was conducted from 2000 to June 2024. A quality analysis was performed. The selection of articles, as well as all analyses, including quality analyses, were conducted by a pair of pharmacists with experience in rheumatology, and included 24 articles. This study highlights the growth of clinical pharmacy activities in rheumatology and the positive influence of clinical pharmacists on patient care. The implementation of such initiatives has the potential to improve medication adherence, reduce medication-related risks, and optimize associated healthcare costs. All these pharmaceutical interventions aim to make the patient care journey smoother and safer. Additionally, the diversity of available pharmaceutical services caters to the varied needs of rheumatology. Furthermore, outpatient clinical pharmacy is also explored in this field and garners interest from patients. The vast majority of studies demonstrate significant improvement in patient care with promising performance outcomes when pharmacists are involved. This review highlights the diverse range of interventions by clinical pharmacists in rheumatology, which is very promising. However, to better assess the benefits of clinical pharmacists, this activity needs further development and evaluation through controlled and randomized clinical research programs.
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Affiliation(s)
- Eric Barat
- Department of Pharmacy, Rouen University Hospital, F-76000 Rouen, France
- Department of Public Health, Normandie University, UNICAEN, Inserm U1086, F-14000 Caen, France
| | - Annaelle Soubieux
- Department of Pharmacy, Rouen University Hospital, F-76000 Rouen, France
| | - Pauline Brevet
- Department of Rheumatology & CIC-CRB 1404, CHU Rouen, University Rouen Normandie, UNIROUEN, F-76000 Rouen, France
| | - Baptiste Gerard
- Department of Rheumatology, Rouen University Hospital, F-76000 Rouen, France
| | - Olivier Vittecoq
- Department of Rheumatology & CIC-CRB 1404, CHU Rouen, University Rouen Normandie, UNIROUEN, F-76000 Rouen, France
| | - Thierry Lequerre
- Department of Rheumatology & CIC-CRB 1404, CHU Rouen, University Rouen Normandie, UNIROUEN, F-76000 Rouen, France
| | | | - Rémi Varin
- Department of Pharmacy, Rouen University Hospital, F-76000 Rouen, France
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Stoll JT, Weidmann AE. Development of hospital pharmacy services at transition of care points: a scoping review. Eur J Hosp Pharm 2024:ejhpharm-2023-003836. [PMID: 38418197 DOI: 10.1136/ejhpharm-2023-003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/30/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Several hospital pharmacy services exist, which take place at different interfaces of patient care. Although they are an important tool for improving medication safety, they are not yet sufficiently implemented in hospitals around the world. OBJECTIVE This scoping review aims to summarise different hospital pharmacy services at transition of care (TOC) points in order to identify development trends and practice patterns in high-income countries over the past decade. METHODS A literature search of four databases (PubMed, PubPharm, Cochrane Library (Ovid) and ScienceDirect) since 2011 was conducted. A detailed search strategy was developed and refined with the help of a research librarian. Title, abstract and full-text selection was carried out by two researchers independently. The study was reported in accordance with the PRISMA-ScR items to ensure quality standard reporting. Only studies originating from developed countries and published in the English language were included. The data obtained were extracted and summarised using a data extraction form developed to meet the research aims of the study. RESULTS Of the 5456 search results, 65 studies met the inclusion criteria. These originated from Europe (n=29), North America/Canada (n=28), Australia (n=7) and Asia (n=1). Individual TOC services such as medication reconciliation and medication review on admission and at discharge were the main focus of published literature practice patterns between 2011 and 2016, after which a more holistic TOC service started to emerge that follows patients across all TOC points during their hospital stay. Facilitators and barriers were consistently dependent on resources and infrastructure. Clinical and economic outcomes show a mixed picture. CONCLUSION During the past decade pharmaceutical services have developed more holistic TOC services. Large-scale high-quality studies are needed to reliably determine clinical and economic benefit.
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Rhoten B, Jones AC, Maxwell C, Stolldorf DP. Hospital Adaptions to Mitigate the COVID-19 Pandemic Effects on MARQUIS Toolkit Implementation and Sustainability. J Healthc Qual 2024; 46:1-11. [PMID: 37788425 PMCID: PMC10840884 DOI: 10.1097/jhq.0000000000000406] [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] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To explore the perceived effects of COVID-19 on MARQUIS toolkit implementation and sustainability, challenges faced by hospitals in sustaining medication reconciliation efforts, and the strategies used to mitigate the negative effects of the pandemic. DATA SOURCES AND STUDY SETTINGS Primary qualitative data were extracted from a Web-based survey. Data were collected from hospitals that participated in MARQUIS2 ( n = 18) and the MARQUIS Collaborative ( n = 5). STUDY DESIGN A qualitative, cross-sectional study was conducted. DATA COLLECTION/DATA EXTRACTION Qualitative data were extracted from a Research Electronic Data Capture survey databased and uploaded into an Excel data analysis template. Two coders independently coded the data with a third coder resolving discrepancies. PRINCIPAL FINDINGS Thirty-one team members participated, including pharmacists ( n = 20; 65%), physicians ( n = 9; 29%), or quality-improvement (QI) specialists ( n = 2; 6%) with expertise in medication reconciliation (MedRec) (14; 45%) or QI (10; 32%). Organizational resources were limited, including funding, staffing, and access to pharmacy students. To support program continuation, hospitals reallocated staff and used new MedRec order sets. Telemedicine, workflow adaptations, leadership support, QI team involvement, and ongoing audits and feedback promoted toolkit sustainability. CONCLUSIONS COVID-19 affected the capacity of hospitals to sustain the MARQUIS toolkit. However, hospitals adapted various strategies to sustain the toolkit.
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Stolldorf DP, Jones AB, Miller KF, Paz HH, Mumma BE, Danesh VC, Collins SP, Dietrich MS, Storrow AB. Medication Discussions With Patients With Cardiovascular Disease in the Emergency Department: An Opportunity for Emergency Nurses to Engage Patients to Support Medication Reconciliation. J Emerg Nurs 2023; 49:275-286. [PMID: 36623969 PMCID: PMC9992264 DOI: 10.1016/j.jen.2022.12.002] [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: 07/02/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study aimed to investigate the level of patient involvement in medication reconciliation processes and factors associated with that involvement in patients with cardiovascular disease presenting to the emergency department. METHODS An observational and cross-sectional design was used. Patients with cardiovascular disease presenting to the adult emergency department of an academic medical center completed a structured survey inclusive of patient demographics and measures related to the study concepts. Data abstracted from the electronic health record included the patient's medical history and emergency department visit data. Our multivariable model adjusted for age, gender, education, difficulty paying bills, health status, numeracy, health literacy, and medication knowledge and evaluated patient involvement in medication discussions as an outcome. RESULTS Participants' (N = 93) median age was 59 years (interquartile range 51-67), 80.6% were white, 96.8% were not Hispanic, and 49.5% were married or living with a partner. Approximately 41% reported being employed and 36.9% reported an annual household income of <$25,000. Almost half (n = 44, 47.3%) reported difficulty paying monthly bills. Patients reported moderate medication knowledge (median 3.8, interquartile range 3.4-4.2) and perceived involvement in their care (41.8 [SD = 9.1]). After controlling for patient characteristics, only difficulty paying monthly bills (b = 0.36, P = .005) and medication knowledge (b = 0.30, P = .009) were associated with involvement in medication discussions. DISCUSSION Some patients presenting to the emergency department demonstrated moderate medication knowledge and involvement in medication discussions, but more work is needed to engage patients.
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Kabir R, Liaw S, Cerise J, Yi J, Mulvany C, Qiu M, Beizer JL, Sinvani LD. Obtaining the Best Possible Medication History at Hospital Admission: Description of a Pharmacy Technician-Driven Program to Identify Medication Discrepancies. J Pharm Pract 2023; 36:19-26. [PMID: 34080461 DOI: 10.1177/08971900211021254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Describe the process of obtaining the best possible medication history (BPMH) by Certified Pharmacy Technicians (CPhTs) on hospital admission to identify medication discrepancies. METHODS Cross-sectional, descriptive study conducted between December 2016 and June 2017 at a quaternary center in New York, including all patients 18 years and older admitted to the medicine service through the Emergency Department (ED) and seen by a CPhT. CPhTs obtained the BPMH using a systematic approach involving a standardized interview, checking medications with secondary sources and updating the electronic health record (EHR). Medication discrepancies were identified and categorized by type and risk. Summary statistics were provided as average and standard deviation (SD) for continuous variables, and as frequencies and percentages for categorical variables. Multivariable regression was used to test for associations between patient factors and presence of a medication discrepancy. RESULTS Of the 3,087 patient visits, the average age was 69 (SD 17.8), 54% were female (n = 1652) and 65% white (n = 2017); comorbidity score breakdown was: 0 (25%, n = 757), 1-2 (33%, n = 1023), 3-4 (23%, n = 699), > 4 (20%, n = 608). The average number of home and discharge medications were 10 (SD 6.1) and 10 (SD 5.4), respectively. The average time spent obtaining the BPMH was 30.6 minutes (SD 12.9). 69% of patients (n = 2130) had at least 1 discrepancy with an average of 4.2 (SD 4.6), of which 43% (n = 920) included high-risk medications. Having a medication discrepancy was associated with a higher number of home medications (p < 0.0001) comorbidities (p < 0.0001), and source of information (p < 0.04). CONCLUSION Obtaining the BPMH by CPhTs on hospital admission frequently identifies medication discrepancies. Further studies are needed to evaluate the association between obtaining the BPMH and clinical outcomes.
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Affiliation(s)
- Rubiya Kabir
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Samantha Liaw
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jane Cerise
- Feinstein Institute for Medical Research-Biostatistics Unit, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jungen Yi
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Colm Mulvany
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Judith L Beizer
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Liron D Sinvani
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Medicine, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
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Dong PTX, Pham VTT, Nguyen LT, Le AV, Nguyen TT, Vu HD, Nguyen HTL, Nguyen HT, Hua S, Li SC. Impact of pharmacist-initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam. J Clin Pharm Ther 2022; 47:2107-2114. [PMID: 36543256 PMCID: PMC10086993 DOI: 10.1111/jcpt.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Linh Thi Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Thao Thi Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Hoa Dinh Vu
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Hoa Thi Nguyen
- Department of Musculoskeletal System, Friendship Hospital, Hanoi, Vietnam
| | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
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Moges TA, Akalu TY, Sema FD. Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation. BMC Health Serv Res 2022; 22:1251. [PMID: 36243696 PMCID: PMC9571466 DOI: 10.1186/s12913-022-08628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Medication reconciliation (MedRec) is a widely accepted tool for the identification and resolution of unintended medication discrepancies (UMD). Objective This study aimed at assessing the magnitude and associated factors of UMD identified through medication reconciliation upon patient admission to the internal medicine wards. Methods Prospective cross-sectional study was conducted at the internal medicine wards of Felege Hiwot and Tibebe Ghion comprehensive specialized hospitals in Bahir Dar city, Northwest Ethiopia, from May 01 to July 30, 2021. Data were collected by using a data abstraction format prepared based on standard MedRec tools and previous studies on medication discrepancy. Pharmacists-led MedRec was made by following the WHO High5s “retroactive medication reconciliation model”. SPSS® (IBM Corporation) version 25.0 was used to analyze the data with descriptive and inferential statistics. A binary logistic regression analysis was used to identify factors associated with UMD. A statistical significance was declared at a p-value < 0.05. Results Among 635 adult patients, 248 (39.1%) of them had at least one UMD. The most frequent types of UMDs were omission (41.75%) and wrong dose (21.9%). The majority (75.3%) of pharmacists’ interventions were accepted. Polypharmacy at admission (p-value < 0.001), age ≥ 65 (p-value = 0.001), a unit increase on the number of comorbidities (p-value = 0.008) and information sources used for MedRec (p-value < 0.001), and medium (p-value = 0.019) and low adherence (p-value < 0.001) were significantly associated with UMD. Conclusion The magnitude of UMD upon patient admission to the internal medicine wards was considerably high. Omission and the wrong dose of medication were common. Older age, polypharmacy, low and medium adherence, and an increase in the number of comorbidities and information sources used for MedRec are significantly associated with UMDs. Pharmacists' interventions were mostly acceptable. Thus, the implementation of pharmacists-led MedRec in the two hospitals is indispensable for patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08628-5.
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Affiliation(s)
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Faisel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Zheng F, Wang D, Zhang X. The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China. BMC Health Serv Res 2022; 22:1157. [PMID: 36104805 PMCID: PMC9472438 DOI: 10.1186/s12913-022-08505-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs. METHODS A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication. RESULTS The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001). CONCLUSION The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur. TRIAL REGISTRATION This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020-087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn , number ChiCTR2000035321 date: 08/08/2020).
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Affiliation(s)
- Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Huangjiahu West Road No.16, Hongshan District, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Dong PTX, Pham VTT, Dinh CT, Le AV, Tran HTH, Nguyen HTL, Hua S, Li SC. Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting. Clin Interv Aging 2022; 17:1127-1138. [PMID: 35903286 PMCID: PMC9314755 DOI: 10.2147/cia.s368871] [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: 04/05/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Geriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission. Patients and Methods The study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system. Results A total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians. Conclusion Improving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Chi Thi Dinh
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Ha Thi Hai Tran
- Department of Internal Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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12
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‘Everyone should know what they’re on’: a qualitative study of attitudes towards and use of patient held lists of medicines among patients, carers and healthcare professionals in primary and secondary care settings in Ireland. BMJ Open 2022. [PMCID: PMC9301806 DOI: 10.1136/bmjopen-2022-064484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesManaging multiple medicines can be challenging for patients with multimorbidity, who are at high risk of adverse outcomes, for example, hospitalisation. Patient-held medication lists (PHMLs) can contribute to patient safety and potentially reduce medication errors. The aims of this study are to investigate attitudes towards and use of PHMLs among healthcare professionals (HCPs), patients and carers.DesignQualitative study based on 39 semistructured telephone interviews.SettingPrimary and secondary care settings in Ireland.ParticipantsTwenty-one HCPs and 18 people taking medicines and caregivers.MethodsTelephone interviews were conducted with HCPs, people taking multiple medicines (5+ medicines) and carers of people taking medicines who were purposively sampled via social media, patient groups and research collaborators. Interviews were transcribed and thematically analysed based on the Framework approach, with the Consolidated Framework for Implementation Research and Theoretical Domains Framework.ResultsThree core themes emerged: (1) attitudes to PHML, (2) function and preferred features of PHML and (3) barriers and facilitators to future use of PHML. All participating (patients/carers and HCP) groups considered PHML beneficial for patients and HCPs (eg, empowering for patients and improved adherence). While PHML were used in a variety of situations such as emergencies, concerns about their accuracy were shared across all groups. HCPs and patients differed on the level of detail that should be included in PHML. HCPs’ time constraints, patients’ multiple medicines and cognitive impairments were reported barriers. Key facilitators included access to digital/compact lists and promotion of lists by appropriate HCPs.ConclusionsOur findings provide insight into the factors that influence use of PHML. Lists were used in a variety of settings, but there were concerns about their accuracy. A range of list formats and encouragement from key HCPs could increase the use of PHML.
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13
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Assessment of medication discrepancies with point prevalence measurement: how accurate are the medication lists for Swedish patients? DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Ziaie S, Mehralian G, Talebi Z. Evaluation of medication reconciliation process in internal medicine wards of an academic medical center by a pharmacist: errors and risk factors. Intern Emerg Med 2022; 17:377-386. [PMID: 34342787 DOI: 10.1007/s11739-021-02811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient's insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients' gender, physicians' gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs' potential interactions and harmful errors can improve this process and prevent such errors in the future.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, 500 12th 13 avenue, Columbus, OH, 43210, USA.
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15
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Henriksen BT, Andersson Y, Davies MN, Mathiesen L, Krogseth M, Andersen RD. Development and initial validation of MedHipPro-Q: a questionnaire assessing medication management of hip fracture patients in different care settings. BMC Health Serv Res 2022; 22:240. [PMID: 35193572 PMCID: PMC8862359 DOI: 10.1186/s12913-022-07524-2] [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: 06/11/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background A validated questionnaire to assess medication management of hip fracture patients within and outside the hospital setting was lacking. The study aims were to describe the hip fracture patient pathway, and develop a valid and feasible questionnaire to assess clinicians’ experience with medication management of hip fracture patients in different care settings throughout the patient pathway. Methods This qualitative, descriptive methodological study used strategic and snowball sampling. The questionnaire was developed, and face and content validity explored through interviews with stakeholders. Phase I described the hip fracture patient pathway, and identified questionnaire dimensions in semi-structured interviews with management and clinicians (n = 37). The patient pathway was also discussed in six meetings (n = 70). Phase II refined a first draft of the questionnaire through cognitive interviews with future respondents (n = 23). The draft was modified after each interview. Post hoc, cognitive interview data were analysed using matrix analysis to condense problems and solutions into themes and subthemes. Phase III, converted the final version to a digital format, and tested its feasibility with a subset of the cognitive interview participants (n = 21) who completed the questionnaire and provided feedback. Results Phase I: Hip fracture patients were cared for in at least three different care settings, and went through at least four handovers between and within primary and secondary care. Three questionnaire dimensions were identified: 1) Medication reconciliation and review, 2) Communication of key information, and 3) Profession and setting. Phase II: The MedHipPro-Q was representative of how the different professions experienced medication management in all settings, and hence showed face and content validity. Post hoc analysis: Problem themes (with sub-themes) were Representativeness (-of patient pathway and -of respondent reality) and Presentation (Language and Appearance). Solution themes (with sub-themes) were: Content (added or deleted) and Presentation (modified appearance or corrected language). Phase III: Participants did not identify technical, linguistic or content flaws in the questionnaire, and the digital version was considered feasible for use. Conclusion The novel MedHipPro-Q showed good face and content validity, and was feasible for use throughout the hip fracture patient pathway. The rigorous development process supports its construct validity and reliability. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07524-2.
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Affiliation(s)
- Ben Tore Henriksen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Tonsberg, Norway. .,Vestfold Hospital Trust, Tonsberg, Norway. .,Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Yvonne Andersson
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Maren Nordsveen Davies
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Tonsberg, Norway
| | - Liv Mathiesen
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maria Krogseth
- Department of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, Tonsberg, Norway.,University of South-Eastern Norway, Drammen, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway.,Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), The Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Andersen TS, Gemmer MN, Sejberg HRC, Jørgensen LM, Kallemose T, Andersen O, Iversen E, Houlind MB. Medicines Reconciliation in the Emergency Department: Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication. Pharmaceuticals (Basel) 2022; 15:ph15020142. [PMID: 35215255 PMCID: PMC8877185 DOI: 10.3390/ph15020142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.
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Affiliation(s)
- Tanja Stenholdt Andersen
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Mia Nimb Gemmer
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Hayley Rose Constance Sejberg
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Lillian Mørch Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Ove Andersen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-28-83-85-63
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17
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Abu Farha R, Yousef A, Gharaibeh L, Alkhalaileh W, Mukattash T, Alefishat E. Medication discrepancies among hospitalized patients with hypertension: assessment of prevalence and risk factors. BMC Health Serv Res 2021; 21:1338. [PMID: 34903221 PMCID: PMC8670213 DOI: 10.1186/s12913-021-07349-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Medication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients. Methods This was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized. Results A high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition. Conclusions Unintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.
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Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Alaa Yousef
- Faculty of Medicine, Al Balqa' Applied University, Salt, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Waed Alkhalaileh
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman Alefishat
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan. .,Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates. .,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
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18
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Masse M, Yelnik C, Labreuche J, André L, Bakhache E, Décaudin B, Drumez E, Odou P, Dambrine M, Lambert M. Risk factors associated with unintentional medication discrepancies at admission in an internal medicine department. Intern Emerg Med 2021; 16:2213-2220. [PMID: 34148179 DOI: 10.1007/s11739-021-02782-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
At admission, unintentional medication discrepancies (UMDs) can occur and may led to severe adverse events. Some of them are preventable through medication reconciliation (MR). As MR is a time-consuming activity, a better identification of high-risk patients of UMDs is mandatory. The objective was to identify risk factors associated with UMDs at admission in an internal medicine department. This prospective observational study was conducted from April 2017 to June 2019. At admission, inpatients had MR to obtain a complete list of home medications. This list was compared to prescriptions made at admission. All discrepancies were classified as intentional or UMDs. Univariate and multivariate analyses to identify the risk factors associated with UMDs were performed. MR was performed on 1157 patients (70.1 ± 16.8 years old); 550 MR (47.5%) contained at least one UMD. More than half of the UMDs (n = 892, 65.6%) corresponded to drug omission. The univariate analysis showed that age (> 60 years old), "living at home", medication preparation not performed by patient, medication-intake difficulties, number of sources consulted, MR duration, presence of a high-risk drug and the number of home medications were associated with UMDs. In the multivariate analysis, adjusted on the number of sources consulted, independent risk factors were "living at home" and the number of home medications. At admission to an internal medicine department, UMDs were frequent and associated with "living at home" and poly-medication. Our findings might help physicians to identify high-risk patients of UMDs since their admission.
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Affiliation(s)
- Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France.
| | - Cécile Yelnik
- Univ. Lille, Inserm, CHU Lille, U1167, 59000, Lille, France
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, 59000, Lille, France
| | - Loïc André
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Edgar Bakhache
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France
| | - Elodie Drumez
- Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, 59000, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000, Lille, France
| | | | - Marc Lambert
- Univ. Lille, Inserm, CHU Lille, U1167, 59000, Lille, France
- CHU Lille, Service de Médecine Polyvalente-Post-Urgence, 59000, Lille, France
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19
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Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol 2021; 78:159-170. [PMID: 34611721 PMCID: PMC8748358 DOI: 10.1007/s00228-021-03213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.
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Affiliation(s)
- O Laatikainen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland. .,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.
| | - S Sneck
- Oulu University Hospital, Oulu, Finland
| | - M Turpeinen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland.,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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20
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Dias Fernandes B, Coutinho Ribeiro L, Pereira Dos Santos JC, Rocha Ayres L, Chemello C. Medication Reconciliation at hospital admission and discharge: Evaluation of fidelity and process outcomes in a real-world setting. Int J Clin Pract 2021; 75:e14656. [PMID: 34324769 DOI: 10.1111/ijcp.14656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The study aimed to assess the fidelity of Medication Reconciliation (MR) delivered by the pharmacist at hospital admission and discharge, and the process outcomes. METHODS Prospective study conducted in cardiology and cardiovascular surgery unit of a university hospital between September 2019 and January 2020. Independent observers collected data to measure MR fidelity, related to coverage, sources of information used to collect medication history and presence of outstanding and resolved Undocumented Discrepancies (UD). Process outcomes included medication errors and their potential to cause harm, identified by the pharmacist during the formal MR process. RESULTS Of the eligible patients, 122 (69.7%) had their medications reconciled in a timely manner at hospital admission and 50 (43.8%) at discharge. The pharmacist consulted 2.76 (±0.8) sources of information to build the medication history, on average. At least one outstanding UD was found in 101 (82.8%) patients at admission and in 41 (82.0%), at discharge. The average number of outstanding UD per patient at admission and discharge was 3.0 (±2.6) and 2.4 (±1.9), respectively. The UD communicated to the physician by the pharmacist during the formal MR process, involved mainly omission errors and were classified as requiring monitoring or potentially necessary intervention. In the univariate analysis, the number of drugs pre-admission and admission, the reason for admission and non-elective readmission in 30 days were associated with the presence of medication errors at admission. CONCLUSIONS This study found a high number of UD, suggesting flaws in the implementation of MR and highlight the importance of quality measurement.
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Affiliation(s)
- Brígida Dias Fernandes
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo Coutinho Ribeiro
- Cassiano Antonio Moraes University Hospital, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | | | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Health Science Center, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Clarice Chemello
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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21
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Breuker C, Macioce V, Mura T, Castet-Nicolas A, Audurier Y, Boegner C, Jalabert A, Villiet M, Avignon A, Sultan A. Medication Errors at Hospital Admission and Discharge: Risk Factors and Impact of Medication Reconciliation Process to Improve Healthcare. J Patient Saf 2021; 17:e645-e652. [PMID: 28877049 DOI: 10.1097/pts.0000000000000420] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE First, the aim of the study was to assess the prevalence, characteristics, and severity of unintended medication discrepancies (UMDs) and medication errors (MEs) at admission and discharge of hospitalization. Second, the aim of the study was to identify clinical and hospitalization factors associated with risk of UMDs as well as characteristics of the medication reconciliation process associated with UMDs detection. METHODS This prospective observational study included all adult patients admitted from 2013 to 2015 in the Endocrinology-Diabetology-Nutrition Department of Montpellier Hospital, France. Clinical pharmacists conducted medication reconciliation by collecting the best possible medication history from different sources and comparing it with admission and discharge prescriptions to identify discrepancies. Unintended medication discrepancies corrected by the physician were considered as MEs. Risk factors of UMDs were identified with logistic regression. RESULTS Of 904 patients included, 266 (29.4%) had at least one UMD, at admission or at discharge. In total, 378 (98.2%) of 385 UMDs were considered to be MEs. Most MEs were omissions (59.3%). Medication errors were serious or very serious in 36% of patients and had potentially moderate severity in almost 40% of patients. The risk of UMDs increased constantly with the number of treatments (P < 0.001). Thyroid (adjusted odds ratio [OR] = 1.79, 95% CI = 1.12-2.86) and infectious diseases (adjusted OR = 1.80, 95% CI = 1.17-2.78) were associated with UMDs risk at admission. The best type of source for the detection of UMDs was the general practitioner or nurse (OR = 2.64, 95% CI = 1.51-4.63). CONCLUSIONS Unintended medication discrepancies are frequent at hospital and depend on intrinsic clinical parameters but also on practice of medication reconciliation process, such as number and type of sources used.
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Affiliation(s)
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | | | - Yohan Audurier
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Catherine Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Maxime Villiet
- From the Clinical Pharmacy Department, University Hospital of Montpellier
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22
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Dong PTX, Pham VTT, Nguyen TT, Nguyen HTL, Hua S, Li SC. Unintentional Medication Discrepancies at Admission Among Elderly Inpatients with Chronic Medical Conditions in Vietnam: A Single-Centre Observational Study. Drugs Real World Outcomes 2021; 9:141-151. [PMID: 34586593 PMCID: PMC8844342 DOI: 10.1007/s40801-021-00274-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background Elderly patients are at high risk of unintentional medication discrepancies during transition of care as they are more likely to have multiple comorbidities and chronic diseases that require multiple medications. Objective The aim of the study was to assess the frequency of unintentional medication discrepancies and identify the associated risk factors and potential clinical impact of them in elderly inpatients during hospital admission. Patients and Methods A prospective observational study was conducted from July to December 2018 in an 800-bed geriatric hospital in Hanoi, North Vietnam. Patients over 60 years of age, admitted to one of selected internal medicine wards, taking at least one chronic medication before admission, and staying at least 48 h were eligible for enrollment. Medication discrepancies of chronic medications before and after admission of each participant were identified by a pharmacist using a step-by-step protocol for the medication reconciliation process. The identified discrepancies were then classified as intentional or unintentional by an assessment group comprising a pharmacist and a physician. A logistic regression model was used to identify risk factors of medication discrepancies. Results Among 192 enrolled patients, 328 medication discrepancies were identified, with 87 (26.5%) identified as unintentional. Nearly a third of enrolled patients (32.3%) had at least one unintentional medication discrepancy. The most common unintentional medication discrepancy was omission of drugs (75.9% of 87 medication discrepancies). The logistic regression analysis revealed a positive association between the number of discrepancies at admission and the type of treatment wards. Conclusions Medication discrepancies are common at admission among Vietnamese elderly inpatients. This study highlights the importance of obtaining a comprehensive medication history at hospital admission and supports implementing a medication reconciliation program to reduce the negative impact of medication discrepancy, especially for the elderly population. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00274-3.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Thao Thi Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Huong Thi Lien Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Susan Hua
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
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[Pharmaceutical cares as means of prevention against drug iatrogenic: Case of oral anticoagulant]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:494-506. [PMID: 34481783 DOI: 10.1016/j.pharma.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
Oral anticoagulant can have a significant risk of adverse events, particularly when it is initiated, modified or interrupted. Pharmaceutical care through medication reconciliation could improve the benefit-to-risk ratio of these drugs. A prospective and interventional single center study was conducted from March through August 2018 in medicine and surgical units. Patients with an oral anticoagulant prescribed and coming from outpatient sector were included. These patients received a medication reconciliation at admission and discharge. Frequency and type of discrepancies were studied. Their gravity rating was assessed using the Cornish et al. scale. This study included 162 patients. The medication reconciliation at the admission allowed the detection of 133 unintentional discrepancies which 16 of them represented a high risk for the patient included nine errors about oral anticoagulant prescribing. Concerning the reconciliation at discharge, 51 unintentional discrepancies had been detected: 12 of them represented a high risk for the patient included eight errors about oral anticoagulant prescription. The acceptance rate of the discrepancies was 86% and reflected discrepancies severity. This result reached 96.4% if we took into account discrepancies with a severe clinical impact. This study highlighted oral anticoagulant represented relevant prioritization criteria to the long-lasting implementation of pharmaceutical care. This secures the management of the patient since the admission until the hospital discharge. The last step of our approach would be to study the needs about data transmission to the community caregivers.
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Bülow C, Noergaard JDSV, Faerch KU, Pontoppidan C, Unkerskov J, Johansson KS, Kornholt J, Christensen MB. Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications. Basic Clin Pharmacol Toxicol 2021; 129:221-231. [PMID: 34137181 DOI: 10.1111/bcpt.13626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non-adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9-15] medications listed and 3 [IQR 1-5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non-adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Josefine D S V Noergaard
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Ullitz Faerch
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Pontoppidan
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Unkerskov
- Quality in General Practice in the Capital Region of Denmark (KAP-H), Hillerød, Denmark
| | - Karl Sebastian Johansson
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonatan Kornholt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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25
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Stolldorf DP, Ridner SH, Vogus TJ, Roumie CL, Schnipper JL, Dietrich MS, Schlundt DG, Kripalani S. Implementation strategies in the context of medication reconciliation: a qualitative study. Implement Sci Commun 2021; 2:63. [PMID: 34112265 PMCID: PMC8193884 DOI: 10.1186/s43058-021-00162-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/19/2021] [Indexed: 11/12/2022] Open
Abstract
Background Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. How to best implement MedRec interventions remains unclear. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, we report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit). Methods A qualitative study was conducted with implementation teams and executive leaders of hospitals participating in the federally funded “Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety” (known as MARQUIS2) research study. Data consisted of transcripts from web-based focus groups and individual interviews, as well as meeting minutes. Interview data were transcribed and analyzed using content analysis and the constant comparison technique. Results Data were collected from 16 hospitals using 2 focus groups, 3 group interviews, and 11 individual interviews, 10 sites’ meeting minutes, and an email interview of an executive. Major categories of implementation strategies predominantly mirrored the ERIC strategies of “Plan,” “Educate,” “Restructure,” and “Quality Management.” Participants rarely used the ERIC strategies of finance and attending to policy context. Two new non-ERIC categories of strategies emerged—“Integration” and “Professional roles and responsibilities.” Of the 73 specific strategies in the ERIC taxonomy, 32 were used to implement the MARQUIS Toolkit and 11 new, and non-ERIC strategies were identified (e.g., aligning with existing initiatives and professional roles and responsibilities). Conclusions Complex interventions like the MARQUIS MedRec Toolkit can benefit from the ERIC taxonomy, but adaptations and new strategies (and even categories) are necessary to fully capture the range of approaches to implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00162-5.
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Affiliation(s)
- Deonni P Stolldorf
- Vanderbilt University School of Nursing, 461 21st Ave S., Nashville, TN, USA.
| | - Sheila H Ridner
- Vanderbilt University School of Nursing, 461 21st Ave S., Nashville, TN, USA
| | - Timothy J Vogus
- Vanderbilt University Owen Graduate School of Management, 401 21st Ave S., Nashville, TN, USA
| | - Christianne L Roumie
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.,VA Tennessee Valley Healthcare System, 1310 24th Ave S., Nashville, TN, 37212, USA
| | - Jeffrey L Schnipper
- Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Boston, MA, USA
| | - Mary S Dietrich
- Vanderbilt University School of Medicine, Vanderbilt University School of Nursing, Nashville, TN, USA
| | - David G Schlundt
- Vanderbilt University Department of Psychology, 323 Wilson Hall, 2301 Vanderbilt Place, Nashville, TN, 37240, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA
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Downey E, Olds DM. Comparison of Documentation on Inpatient Discharge and Ambulatory End-of-Visit Summaries. J Healthc Qual 2021; 43:e43-e52. [PMID: 32544137 DOI: 10.1097/jhq.0000000000000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Providing complete pending diagnostic test information and medication lists on inpatient discharge and ambulatory end-of-visit summaries decreases adverse events, reduces medical errors, and improves patient satisfaction. The purpose was to compare inpatient and ambulatory settings regarding percentages of records with documentation of pending diagnostic test result information and medication lists given at discharge/end of visit. METHODS Using a cross-sectional, observational design, 2018 NDNQI discharge/end-of-visit data from 133 inpatient and 90 ambulatory units in 20 hospitals were examined. Trained site coordinators reviewed records for documentation of discharge/end-of-visit elements. Mann-Whitney U tests were used to compare inpatient and ambulatory percent of elements completed. RESULTS Across all discharge/end-of-visit elements, there were differences (all p < .001) between inpatient and ambulatory settings. Ambulatory units had a lower percent completion for all medication list and pending diagnostic result elements. Depending on the element, the sample means for documentation in discharge/end-of-visit summaries were 18.6-98.8% for inpatient and 4.5-61.8% for ambulatory settings. CONCLUSIONS Discharge instructions and end-of-visit summaries are crucial forms of communication between clinicians and patients. However, many patients are not receiving complete information. IMPLICATIONS In a large nationwide sample, we found substantial opportunities to improve completeness of summaries, particularly in ambulatory settings.
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Volpi E, Giannelli A, Toccafondi G, Baroni M, Tonazzini S, Alduini S, Biagini S, Gini R, Bellandi T, Emdin M. Medication Reconciliation During Hospitalization and in Hospital-Home Interface: An Observational Retrospective Study. J Patient Saf 2021; 17:e143-e148. [PMID: 28333697 DOI: 10.1097/pts.0000000000000360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases. METHODS A retrospective observational study was conducted in the Cardiothoracic Department of the Fondazione Toscana Gabriele Monasterio hospitals. Medication history was reviewed for all the patients admitted from and discharged to the community, from January to March 2013. Patients were excluded if they had less than 4 drugs or less than 2 drugs for cardiovascular system in their prescription list at admission or if they died during follow-up. We selected 714 patients, and we obtained the clinical charts and all drug prescriptions collected during patients' hospitalization by the electronic clinical recording system. We also analyzed the list of prescriptions of this sample of patients, from 6 months before admission to 9 months after discharge, extracted from the regional prescription registry. In the resulting sample, prescriptions were analyzed to assess unintentional discrepancies. RESULTS The study included 298 patients (mean age, 71.2 years), according to the inclusion and exclusion criteria. Among 14,573 prescriptions analyzed, we found 4363 discrepancies (14.6 discrepancies per patient). Among these discrepancies, 1310 were classified as unintentional (4.4 discrepancies per patient). Among unintentional discrepancies, only 63 (4.8%) took place during hospitalization. Although at the hospital-home interface, 33.1% of unintentional discrepancies were detected through the comparison between the patients' declared therapy and the previous medication consumption and 62.1% were identified in the comparison between the prescription at the discharge and the following medication pattern at home. CONCLUSIONS Medication errors have important implications for patient safety, and their identification is a main target for improving clinical practice. The comparison between the medication patterns acquired through the regional prescription registry before and after hospitalization outlined critical touchpoint in the current medication reconciliation process, calling for the definition of shared medication reconciliation standards between hospitals and primary care services to minimize medication discrepancies and enhance patient safety.
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Affiliation(s)
- Elisabetta Volpi
- From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa
| | - Alessandro Giannelli
- From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence
| | - Monica Baroni
- Clinical Risk Manager, Fondazione Toscana G. Monasterio, Massa
| | - Sara Tonazzini
- From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa
| | - Stefania Alduini
- From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa
| | - Stefania Biagini
- From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana
| | - Tommaso Bellandi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana G. Monasterio, San Cataldo Hospital, Pisa, Italy
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Impact of pharmacist driven medication reconciliation in psychiatric emergency services on length of stay, medication errors, and medication discrepancies. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Laroche ML, Van Ngo TH, Sirois C, Daveluy A, Guillaumin M, Valnet-Rabier MB, Grau M, Roux B, Merle L. Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. Eur Geriatr Med 2021; 12:485-497. [PMID: 33745106 DOI: 10.1007/s41999-021-00482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS A narrative overview. RESULTS The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/CONCLUSION Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.
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Affiliation(s)
- Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France. .,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France. .,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France.
| | - Thi Hong Van Ngo
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Caroline Sirois
- Université Laval, Faculté de Pharmacie, Québec, Canada.,Centre de Recherche VITAM en Santé Durable, Centre D'excellence sur le Vieillissement de Québec, Québec, Canada
| | - Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Michel Guillaumin
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France.,Département de Gériatrie, CHU de Besançon, Besançon, France
| | - Marie-Blanche Valnet-Rabier
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France
| | - Muriel Grau
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
| | - Barbara Roux
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Louis Merle
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
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Parro Martín MDLÁ, Muñoz García M, Delgado Silveira E, Martín-Aragón Álvarez S, Bermejo Vicedo T. Intervention study for the reduction of medication errors in elderly trauma patients. J Eval Clin Pract 2021; 27:160-166. [PMID: 32369877 DOI: 10.1111/jep.13407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the impact of a set of measures designed by a working group to reduce medication errors (MEs) during the care transition of elderly trauma patients. The secondary objectives were to classify MEs and determine their location. METHODS A 43-month pre-post prospective intervention study in a university hospital. A working group was set up in the Trauma Service. A pharmacist analysed the pharmacotherapeutic processes of all patients admitted to the Trauma Service in different healthcare locations from Monday to Friday. To detect MEs, the pharmacist reviewed this process at the following points: reconciliation, prescription, validation, dispensing, and administration records. Errors were classified according to the Ruiz Jarabo classification. Subsequently, the working group designed a set of measures that were implemented with the incorporation into the Acute Care Team and the intervention of a pharmacist. Data on MEs were again collected in a post-implementation phase. RESULTS There was a statistically significant reduction in MEs between phases. A total of 132 (31.3%) patients experienced MEs during the pre-implementation phase and 75 (16.2%) during the post-implementation phase. Among the measures implemented, the incorporation of the pharmacist to the team, as well as training sessions and design of medication protocols. During the pre-implementation and post-implementation phases, the ME rates were respectively as follows: reconciliation 31.6% (172) vs 14.8% (91); prescription 7.7% (79) vs 1.9% (23); dispensing 1% (10) vs 0.3% (3); administration record 0.4% (4) vs 0.0% (0); and validation 0.3% (3) vs 0.1% (1). There were significant reductions in reconciliation, prescription, and dispensing errors. The majority of the MEs occurred in the Trauma Service. CONCLUSIONS The implementation of specific measures by a Multidisciplinary Safety Group reduced MEs in the care transition of elderly trauma patients, particularly those MEs that occurred during reconciliation. The greatest reduction in MEs occurred in the Trauma Service.
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Affiliation(s)
| | - María Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Eriksen CU, Kyriakidis S, Christensen LD, Jacobsen R, Laursen J, Christensen MB, Frølich A. Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ Open 2020; 10:e036158. [PMID: 32895268 PMCID: PMC7477975 DOI: 10.1136/bmjopen-2019-036158] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity. METHODS We systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients' medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach. RESULTS We included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients' lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking. DISCUSSION Polypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients' perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients' social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.
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Affiliation(s)
- Christian Ulrich Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | - Stavros Kyriakidis
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | | | - Ramune Jacobsen
- Research Group for Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jannie Laursen
- Global Business Quality Management, Falck, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Anne Frølich
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Innovation and Research Center for Multimorbidity and Chronic Conditions, Region Zealand, Slagelse, Denmark
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Dei Tos M, Canova C, Dalla Zuanna T. Evaluation of the medication reconciliation process and classification of discrepancies at hospital admission and discharge in Italy. Int J Clin Pharm 2020; 42:1061-1072. [PMID: 32556895 DOI: 10.1007/s11096-020-01077-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/02/2020] [Indexed: 11/26/2022]
Abstract
Background Medication errors at different transitions of care are common and potentially harmful. Medication reconciliation process should be evaluated to reduce the unintentional discrepancies. Objective This study aims to identify and classify unintentional medication discrepancies at hospital admission and discharge and associated risk factors. Setting Two general internal medicine and a pulmonology wards of an Italian non-academic hospital. Method A retrospective observational study was conducted among adult patients admitted to the wards. In order to evaluate the current medication reconciliation process of these wards, the frequency and type of unintentional chronic medication discrepancies between the physician assessment of home medication and hospital admission and discharge prescriptions were studied. Patients' characteristic associated with the presence of at least one unintentional discrepancy were evaluated. Main outcome measure Frequencies of unintentional medication discrepancies upon admission and discharge and associated patients' characteristics. Results Among the 144 patients enrolled in the study, 53 and 64 unintentional medication discrepancies were identified at hospital admission and at discharge, respectively. Both at admission and discharge a quarter of patients had at least one unintentional discrepancy. 'Medication omission' was the most frequent type of discrepancy identified and respiratory system and nervous system were the classes of medication with the highest rate of unintentional discrepancies. Unintentional discrepancies were more likely to occur in patients receiving more medicine pre-admission, longer hospitalization stays and coming from or discharged to a nursing home. Conclusion Transitions of care are critical moments for patient safety in terms of unintentional medication discrepancies and a more structured medication reconciliation process is needed. The medication reconciliation process should be considered in terms of a multidisciplinary approach involving all health professionals as well as patients and caregivers directly.
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Affiliation(s)
- Mattia Dei Tos
- Emergency Department, AULSS 2, Via C. Forlanini 71, 31029, Vittorio Veneto, Treviso, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy
| | - Teresa Dalla Zuanna
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy.
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Applying the Medications at Transitions and Clinical Handoffs Toolkit in a Rural Primary Care Clinic: Implications for Nursing, Patients, and Caregivers. J Nurs Care Qual 2020; 35:233-239. [PMID: 32433146 PMCID: PMC7247934 DOI: 10.1097/ncq.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Adequate medication reconciliation is related to patients' safety. Rural populations are at increased risk of adverse drug events due to errors in medication reconciliation and often receiving medical care across multiple health care entities and across long distances with separate electronic medical records. Methods: This study examined the implementation of Medications at Transitions and Clinical Handoffs Toolkit (MATCH) in a rural primary care clinic and assessed the acceptability and feasibility of implementation. Intervention: MATCH was developed as a workflow process intervention to improve medication reconciliation. Results: Findings from MATCH implementation indicate that the process improved medication reconciliation workflow. A shared definition of current medications across providers and patients was essential. Conclusions: Empowering patients and caregivers with tools and language to work with providers, particularly nurses, to conduct medication reconciliation during primary care clinic visits is key to improving patient medication reconciliation in rural settings.
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Daliri S, Boujarfi S, El Mokaddam A, Scholte Op Reimer WJM, Ter Riet G, den Haan C, Buurman BM, Karapinar-Çarkit F. Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis. BMJ Qual Saf 2020; 30:146-156. [PMID: 32434936 DOI: 10.1136/bmjqs-2020-010927] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related interventions and show conflicting results. However, until now, no review has focused on the effect of intervention components delivered both in hospital and following discharge from hospital to home. OBJECTIVE To examine effects of medication-related interventions on hospital readmissions, medication-related problems (MRPs), medication adherence and mortality. METHODS For this systematic review and meta-analysis, we searched the PubMed, Embase, CINAHL and CENTRAL databases without language restrictions. Citations of included articles were checked through Web of Science and Scopus from inception to 20 June 2019. We included prospective studies that examined effects of medication-related interventions delivered both in hospital and following discharge from hospital to home compared with usual care. Three authors independently extracted data and assessed study quality in pairs. RESULTS Fourteen original studies were included, comprising 8182 patients. Interventions consisted mainly of patient education and medication reconciliation in the hospital, and patient education following discharge. Nine studies were included in the meta-analysis; compared with usual care (n=3376 patients), medication-related interventions (n=1820 patients) reduced hospital readmissions by 3.8 percentage points within 30 days of discharge (number needed to treat=27, risk ratio (RR) 0.79 (95% CI 0.65 to 0.96)). Meta-regression analysis suggested that readmission rates were reduced by 17% per additional intervention component (RR 0.83 (95% Cl 0.75 to 0.91)). Medication adherence and MRPs may be improved. Effects on mortality were unclear. CONCLUSIONS Studied medication-related interventions reduce all-cause hospital readmissions within 30 days. The treatment effect appears to increase with higher intervention intensities. More evidence is needed for recommendations on adherence, mortality and MRPs.
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Affiliation(s)
- Sara Daliri
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Samira Boujarfi
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Asma El Mokaddam
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, North-Holland, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, North-Holland, The Netherlands
| | - Chantal den Haan
- Department of Research and Education, Medical Library, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands
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Fernandes BD, Almeida PHRF, Foppa AA, Sousa CT, Ayres LR, Chemello C. Pharmacist-led medication reconciliation at patient discharge: A scoping review. Res Social Adm Pharm 2020; 16:605-613. [DOI: 10.1016/j.sapharm.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
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Aiezza M, Bresciani A, Guglielmi G, Massa M, Tortori E, Marfella R, Aliberti E, Iannuzzi A. Medication review versus usual care to improve drug therapies in hospitalised older patients admitted to internal medicine wards. Eur J Hosp Pharm 2020. [DOI: 10.1136/ejhpharm-2019-002072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Medication Discrepancies in Community Pharmacies in Switzerland: Identification, Classification, and Their Potential Clinical and Economic Impact. PHARMACY 2020; 8:pharmacy8010036. [PMID: 32182863 PMCID: PMC7151719 DOI: 10.3390/pharmacy8010036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Transitions of care are high-risk situations for the manifestation of medication discrepancies and, therefore, present threats for potential patient harm. Medication discrepancies can occur at any transition within the healthcare system. Methods: Fifth-year pharmacy students assessed a best possible medication list (BPML) during a medication review (based on medication history and patient interview) in community pharmacies. They documented all discrepancies between the BPML and the latest medication prescription. Discrepancies were classified using the medication discrepancy taxonomy (MedTax) classification system and were assessed for their potential clinical and economic impact. Results: Overall, 116 patients with a mean age and medication prescription of 74 (± 10.3) years and 10.2 (± 4.2), respectively, were analyzed. Of the 317 discrepancies identified, the most frequent type was related to strength and/or frequency and/or number of units of dosage form and/or the total daily dose. Although, the majority of discrepancies were rated as inconsequential (55.2%) on health conditions, the remainder posed a potential moderate (43.2%) or severe impact (1.6%). In 49.5% of the discrepancies, the current patients’ medication cost less than the prescribed. Conclusion: Community pharmacies are at a favorable place to identify discrepancies and to counsel patients. To improve patient care, they should systematically perform medication reconciliation whenever prescriptions are renewed or added.
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Stolldorf DP, Schnipper JL, Mixon AS, Dietrich M, Kripalani S. Organisational context of hospitals that participated in a multi-site mentored medication reconciliation quality improvement project (MARQUIS2): a cross-sectional observational study. BMJ Open 2019; 9:e030834. [PMID: 31678944 PMCID: PMC6830625 DOI: 10.1136/bmjopen-2019-030834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Medication reconciliation (MedRec) is an important patient safety strategy and is widespread in US hospitals and globally. Nevertheless, high quality MedRec has been difficult to implement. As part of a larger study investigating MedRec interventions, we evaluated and compared organisational contextual factors and team cohesion by hospital characteristics and implementation team members' profession to better understand the environmental context and its correlates during a multi-site quality improvement (QI) initiative. DESIGN We conducted a cross-sectional observational study using a web survey (contextual factors) and a national hospital database (hospital characteristics). SETTING Hospitals participating in the second Multi-Centre Medication Reconciliation Quality Improvement Study (MARQUIS2). PARTICIPANTS Implementation team members of 18 participating MARQUIS2 hospitals. OUTCOMES Primary outcome: contextual factor ratings (ie, organisational capacity, leadership support, goal alignment, staff involvement, patient safety climate and team cohesion). Secondary outcome: differences in contextual factors by hospital characteristics. RESULTS Fifty-five team members from the 18 participating hospitals completed the survey. Ratings of contextual factors differed significantly by domain (p<0.001), with organisational capacity scoring the lowest (mean=4.0 out of 7.0) and perceived team cohesion and goal alignment scoring the highest (mean~6.0 out of 7.0). No statistically significant differences were observed in contextual factors by hospital characteristics (p>0.05). Respondents in the pharmacy profession gave lower ratings of leadership support than did those in the nursing or other professions group (p=0.01). CONCLUSIONS Hospital size, type and location did not drive differences in contextual factors, suggesting that tailoring MedRec QI implementation to hospital characteristics may not be necessary. Strong team cohesion suggests the use of interdisciplinary teams does not detract from cohesion when conducting mentored QI projects. Organisational leaders should particularly focus on supporting pharmacy services and addressing their concerns during MedRec QI initiatives. Future research should correlate contextual factors with implementation success to inform how best to prepare sites to implement complex QI interventions such as MedRec.
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Affiliation(s)
- Deonni P Stolldorf
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeffrey L Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda S Mixon
- Vanderbilt Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education and Clinical Centers, VA Tennessee Valley Healthcare System Nashville Campus, Nashville, Tennessee, USA
| | - Mary Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Vanderbilt Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Holbrook A, Bannerman H, Ahmed A, Georgy M, Liu JT, Troyan S, Watt A. Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge. Can J Hosp Pharm 2019; 72:421-427. [PMID: 31853142 PMCID: PMC6910843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals. OBJECTIVES To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. METHODS The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors. RESULTS The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors. CONCLUSIONS The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.
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Affiliation(s)
- Anne Holbrook
- , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario
| | - Heather Bannerman
- , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario
| | - Amna Ahmed
- , MD, is with the Department of Medicine, McMaster University, Hamilton, Ontario
| | - Michael Georgy
- , MBBCh, is a student currently affiliated with the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Tiger Liu
- , MSc, was, at the time of this study, a student with the eHealth Master's Program, McMaster University, Hamilton, Ontario
| | - Sue Troyan
- , BA, is with the Division of Clinical Pharmacology & Toxicology, St Joseph's Hospital Hamilton, Hamilton, Ontario
| | - Alice Watt
- , BSc(Pharm), RPh, is with the Institute for Safe Medication Practices Canada, Toronto, Ontario
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George D, Supramaniam ND, Hamid SQA, Hassali MA, Lim WY, Hss AS. Effectiveness of a pharmacist-led quality improvement program to reduce medication errors during hospital discharge. Pharm Pract (Granada) 2019; 17:1501. [PMID: 31592290 PMCID: PMC6763293 DOI: 10.18549/pharmpract.2019.3.1501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/05/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events. Objective: The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge. Methods: A pharmacist-led quality improvement (QI) program over 6 months was conducted in medical wards at a tertiary public hospital. Percentage of patients discharge with one or more medication errors was reviewed in the pre-intervention and four main improvements were developed: increase the ratio of pharmacist to patient, prioritize discharge prescription order within office hours, complete discharge medication reconciliation by ward pharmacist, set up a Centralized Discharge Medication Pre-packing Unit. Percentage of patients with one or more medication errors in both pre- and post-intervention phase were monitored using process control chart. Results: With the implementation of the QI program, the percentage of patients with one or more medication errors during discharge that were corrected by pharmacists significantly increased from 77.6% to 95.9% (p<0.001). Percentage of patients with one or more clinically significant error was similar in both pre and post-QI with an average of 24.8%. Conclusions: Increasing ratio of pharmacist to patient to complete discharge medication reconciliation during discharge significantly recorded a reduction in the percentage of patients with one or more medication errors.
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Affiliation(s)
- Doris George
- Pharmacy Department, Raja Permaisuri Bainun Hospital; &. Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang (Malaysia).
| | | | - Siti Q Abd Hamid
- Pharmacy Department, Raja Permaisuri Bainun Hospital. Perak (Malaysia).
| | - Mohamad A Hassali
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang (Malaysia).
| | - Wei-Yin Lim
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health. Selangor (Malaysia).
| | - Amar-Singh Hss
- Pediatric Department, Raja Permaisuri Bainun Hospital, Ministry of Health. Perak (Malaysia).
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41
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Lines J, Lewis P. Accuracy of Antiretroviral Prescribing in a Community Teaching Hospital: A Medication Use Evaluation. J Pharm Pract 2019; 34:103-109. [PMID: 31256704 DOI: 10.1177/0897190019857842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication errors account for nearly 250 000 deaths in the United States annually, with approximately 60% of errors occurring during transitions of care. Previous studies demonstrated that almost 80% of participants with human immunodeficiency virus (HIV) have experienced a medication error related to their antiretroviral therapy (ART). OBJECTIVE This retrospective chart review examines propensity and type of ART-related errors and further seeks to identify risk factors associated with higher error rates. METHODS Participants were identified as hospitalized adults ≥18 years old with preexisting HIV diagnosis receiving home ART from July 2015 to June 2017. Medication error categories included delays in therapy, dosing errors, scheduling conflicts, and miscellaneous errors. Logistic regression was used to examine risk factors for medication errors. RESULTS Mean age was 49 years, 76.5% were men, and 72.1% used hospital-supplied medication. For the primary outcome, 60.3% (41/68) of participants had at least 1 error, with 31.3% attributed to delays in therapy. Logistic regression demonstrated multiple tablet regimens (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.22-9.48, P = .019) and serum creatinine (SCr) ≥1.5 mg/dL (OR: 8.87, 95% CI: 1.07-73.45, P = .043) were predictive for risk of medication errors. Regimens with significant drug-drug interactions (eg, cobicistat-containing regimens) were not significantly associated with increased risk of medication errors. CONCLUSIONS AND RELEVANCE ART-related medication error rates remain prevalent and exceeded 60%. Independent risk factors for medication errors include use of multiple tablet regimens and SCr ≥1.5 mg/dL.
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Affiliation(s)
- Jacob Lines
- Department of Pharmacy, 24851Johnson City Medical Center, Johnson City, TN, USA.,4154East Tennessee State University Physicians Infectious Diseases Clinic, Johnson City, TN, USA
| | - Paul Lewis
- Department of Pharmacy, 24851Johnson City Medical Center, Johnson City, TN, USA
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Graabæk T, Terkildsen BG, Lauritsen KE, Almarsdóttir AB. Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study. Ther Adv Drug Saf 2019; 10:2042098619858049. [PMID: 31244989 PMCID: PMC6580721 DOI: 10.1177/2042098619858049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/27/2019] [Indexed: 11/21/2022] Open
Abstract
Transitions of care may result in medication errors, when information about a
patient’s medications is not communicated sufficiently. In this clinical record
review study, we aimed to evaluate the frequency of undocumented medication
discrepancies at discharge from hospital and evaluate which patient
characteristics could be associated with undocumented medication discrepancies.
Preadmission medication lists were compared against the medication list in the
discharge letters, taking into account medication changes documented in the
patient record throughout the inpatient stay and in the discharge summary. Out
of 200 patients, 174 (87%) were affected by at least one undocumented medication
discrepancy, mostly for regular medication. Of the 1972 medications used, 744
(38%) medications were changed without documentation in the patient record, the
majority being over-the-counter supplements and herbal medications. Polypharmacy
at admission and discharge was associated with increased undocumented medication
discrepancies. This study indicates a lack of medication reconciliation during
inpatient stay. Correct and complete medication lists at admission and discharge
may resolve many of these discrepancies, supporting patient safety at
transitions of care.
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Affiliation(s)
| | - Babette Gorm Terkildsen
- Research Unit of Clinical Pharmacology and
Pharmacy, University of Southern Denmark, Odense C, Denmark
| | - Kira Emilie Lauritsen
- Research Unit of Clinical Pharmacology and
Pharmacy, University of Southern Denmark, Odense C, Denmark
| | - Anna Birna Almarsdóttir
- WHO Collaborating Centre for Research and
Training in the Patient Perspective on Medicines Use, University of
Copenhagen, Copenhagen Ø, Denmark
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Redmond P, McDowell R, Grimes TC, Boland F, McDonnell R, Hughes C, Fahey T. Unintended discontinuation of medication following hospitalisation: a retrospective cohort study. BMJ Open 2019; 9:e024747. [PMID: 31167862 PMCID: PMC6561421 DOI: 10.1136/bmjopen-2018-024747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/01/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice. DESIGN Retrospective cohort study between 2012 and 2015. SETTING Electronic records and hospital supplied discharge notifications in 44 Irish general practices. PARTICIPANTS 20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions. PRIMARY AND SECONDARY OUTCOMES Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient's general practitioner (GP) prescribing record at 6 months follow-up. RESULTS In patients admitted to hospital, medication discontinuity ranged from 6%-11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01). CONCLUSION Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.
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Affiliation(s)
- Patrick Redmond
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Ronald McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen’s University, Cancer Epidemiology and Health Services Group, Belfast, UK
| | | | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Role and impact of pharmacists in Spain: a scoping review. Int J Clin Pharm 2018; 40:1430-1442. [PMID: 30367376 DOI: 10.1007/s11096-018-0740-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
Background The role of the pharmacist has evolved greatly over the last decades, expanding to patient-oriented activities, administrative tasks and public health functions. However, considerable differences emerge across regions. Aim of the review To gather evidence in order to describe and highlight the different characteristics of the pharmacists' role and the impact of their activities in Spain. Method A review of the existing literature was conducted. The literature search was undertaken in PubMed between 01/01/2006 and 15/08/2017. Results were screened and reviewed to extract previously established criteria such as author(s), publication year, language, study design, setting, pharmaceutical activity, patient care programs, targeted diseases and intervention description using DEPICT2 tool. Pharmaceutical intervention were classified into eight outcome measures and categorized by types of outcomes reported: descriptive or impact evaluation regarding the effect of the service (positive, neutral or negative). Results The search strategy resulted in 473 articles and 108 articles met the inclusion criteria. The most common design was observational (n = 76, 70%). Most articles were published after 2011 (75%), in English (69%). Studies were conducted in hospitals (60%) and community pharmacies (30%). Of the 24 pharmaceutical activities identified, medication review was the activity most frequently studied (n = 42), followed by patient education (n = 29), risk and prevention (n = 27) and medication reconciliation (n = 19). Only 39 articles (36%) had outcome measures with impact evaluation. Of the 223 impact outcome measures, 48% (107/223) had a positive effect. Conclusion This review shows the substantial scientific production focusing on pharmacy practice in Spain over the last years. The evidence reviewed reflects the pharmacist role at various professional settings, providing a wide variety of activities on diverse targeted diseases and patient care programs, in line with the increasing specialization of clinical pharmacists over the last years.
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Penm J, Vaillancourt R, Pouliot A. Defining and identifying concepts of medication reconciliation: An international pharmacy perspective. Res Social Adm Pharm 2018; 15:632-640. [PMID: 30100200 DOI: 10.1016/j.sapharm.2018.07.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/04/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Medication discrepancies occur in up to 80% of hospitalized patients during transitions of care, either at admission or discharge. However, numerous organization have different definitions of medication reconciliation which may result in variations of services being implemented. OBJECTIVE To develop a consensus definition of medication reconciliation and define the essential components of medication reconciliation based on international consensus using a modified Delphi process. METHODS Statements and definitions about medication reconciliation found in the literature were used to build a Delphi Questionnaire and sent to experts around the world. Experts were identified based on their leadership in publication, education, professional interest and participation in the area of medication management. Delphi rounds continued until an 80% agreement was achieved. RESULTS In total, 24 experts were included in the Delphi panel. Three Delphi rounds were required to reach consensus on the key concepts included in a medication reconciliation. These concepts included 65 statements classified under (1) tasks involved, (2) who can conduct them, (3) when they should be conducted, (4) who should receive them, (5) how should it be measured and (6) clarifying the difference between medication reconciliation and medication review. This led to a proposed definition for medication reconciliation tasks as "the process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the prescriber's orders. In addition, the patient's allergies, history of side effects from medications and medication aids are listed with the goal of providing correct medication to the patient at all transition points within the health care system." CONCLUSION An international expert panel was able to receive consensus on the definition of tasks involved in medication reconciliation and its essential concepts after four Delphi rounds. This definition is broader in scope than previous definitions.
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Affiliation(s)
- Jonathan Penm
- University of Sydney School of Pharmacy, Pharmacy and Bank Building A15, Science Rd, Camperdown, NSW, 2006, Australia.
| | - Régis Vaillancourt
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
| | - Annie Pouliot
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
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A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management. Int J Clin Pharm 2018; 40:1189-1198. [PMID: 30051223 DOI: 10.1007/s11096-018-0643-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 01/28/2023]
Abstract
Background Drug-related problems (DRPs) endanger geriatric patients' safety. Especially a follow-up treatment with increased number of care transitions is a critical time for patients. Objective This study aimed at optimising medication therapy and the transfer of medication-related information to ambulatory care in geriatric rehabilitation patients. Setting German geriatric rehabilitation centre (GRC). Method A prospective, controlled intervention study was performed. Patients in the control group (CG) received standard care, those in the intervention group (IG) an additional dual pharmaceutical intervention: (i) medication review to optimise in-hospital medication and (ii) improvement of discharge letters for optimising transfer of medication-related information. Main outcome measure (i) Number of patients with at least one DRP at discharge and (ii) predefined quality criteria for the discharge letters. Results 150 patients were enrolled in CG and 163 in IG. (i) At discharge, 126 (84%) patients in the CG were affected by at least one DRP. In the IG, the number of affected patients decreased to 64 (39%, P < 0.05). (ii) In comparison to discharge letters in the CG, predefined quality criteria were improved in the IG. Following differences were measured (CG vs. IG, each P < 0.05): active ingredient indicated (60 vs. 99%), brand name indicated (60 vs. 96%), explanation of medication changes (47 vs. 68%), visualisation of explanations next to the discharge medication (26 vs. 91%) and recommended therapy duration for short-term medications (49 vs. 84%). Conclusion DRPs and incomplete discharge letters affected many patients. The dual intervention improved in-hospital medication therapy and optimised the transfer of medication-related information.
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Russ AL, Jahn MA, Patel H, Porter BW, Nguyen KA, Zillich AJ, Linsky A, Simon SR. Usability evaluation of a medication reconciliation tool: Embedding safety probes to assess users’ detection of medication discrepancies. J Biomed Inform 2018; 82:178-186. [DOI: 10.1016/j.jbi.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/12/2018] [Accepted: 05/06/2018] [Indexed: 10/16/2022]
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Kreckman J, Wasey W, Wise S, Stevens T, Millburg L, Jaeger C. Improving medication reconciliation at hospital admission, discharge and ambulatory care through a transition of care team. BMJ Open Qual 2018; 7:e000281. [PMID: 29713690 PMCID: PMC5922563 DOI: 10.1136/bmjoq-2017-000281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/05/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
Medication reconciliation is an important component to the care of hospitalised patients and their safe transition to the ambulatory setting. In our Family Medicine Hospitalist Service, patient care is frequently transferred between the various physicians, residents, nurses and eventually to a separate group of providers who provide ambulatory management. Due to frequent transitions of care, there was no clear ownership of the medication reconciliation process. To improve the medication reconciliation process, a Transition of Care Team composed of registered nurses was created to oversee the entire reconciliation process. The team engaged the patient and their family, when needed, contacted patients’ pharmacies and their providers, reconciled the patients’ hospital medication list with the ambulatory list at hospital admission and within 24 hours of discharge, and attended the hospital follow-up visit to verify medications and provide continuity of care. Implementation of the team allowed for additional investigative resources, redundancy in preventing errors and early recovery should an error occur. The percent of medications with error after implementation of the Transition of Care Team was reduced from 131/386 (33.9%) to 147/787 (18.7%) at hospital admission, 81/354 (22.9%) to 42/834 (5.0%) at discharge and 43/337 (12.8%) to 6/809 (0.7%) at follow-up visit (two proportion tests, p<0.001). In addition, the percent of charts without any errors improved at hospital discharge from 8/31 (25.8%) to 46/70 (65.7%) and at hospital follow-up visit from 16/31 (51.6%) to 64/70 (91.4%) (two-proportion test, p<0.001). Previously viewed as three separate reconciliations occurring at admission, discharge and hospital follow-up, the approach to medication reconciliation was reframed as a continuous process occurring throughout the hospitalisation and hospital follow-up resulting in improved reconciliation accuracy and safer transitions to the ambulatory setting.
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Affiliation(s)
- John Kreckman
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Waiz Wasey
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Sharron Wise
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Tammy Stevens
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Bonaudo M, Martorana M, Dimonte V, D'Alfonso A, Fornero G, Politano G, Gianino MM. Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy. PLoS One 2018; 13:e0191028. [PMID: 29329310 PMCID: PMC5766134 DOI: 10.1371/journal.pone.0191028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. METHODS A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). RESULTS Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. CONCLUSIONS This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.
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Affiliation(s)
- Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | - Maria Martorana
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | - Valerio Dimonte
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | | | - Giulio Fornero
- AOU Città della salute e della Scienza, Teaching Hospital, Torino, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
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Risk factors for medication errors at admission in preoperatively screened patients. Pharmacoepidemiol Drug Saf 2018; 27:272-278. [DOI: 10.1002/pds.4380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 11/07/2022]
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