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Maleki S, Gu G, Buntine P, Zamani M, Zhu V, Chan K, Martin C, Goulopoulos A. The effect of an extended-hours ED clinical pharmacy service on admission medication prescribing errors. Emerg Med Australas 2024. [PMID: 38686457 DOI: 10.1111/1742-6723.14415] [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: 10/05/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this study was to determine the effect of a 7-day extended-hours clinical pharmacy service in the ED on medication prescribing errors upon hospital admission and time to medication reconciliation. METHODS In this retrospective observational study, high-needs patients reviewed by ED pharmacists were compared against those not reviewed, to determine if the service was associated with reduction in admission medication errors. The primary outcome was the rate of medication errors. Errors were independently rated by two senior clinicians using a risk-probability matrix. Secondary outcomes included service's impact on time to best possible medication history (BPMH) and medication reconciliation. RESULTS There were 242 patients who met the inclusion criteria: 105 intervention vs 137 control. In the intervention arm, 74 patients had at least 1 medication error compared with 113 in the control arm (total errors 206 vs 407). The error rate per 10 medications (interquartile range) was 1.4 (0, 2.9) in the intervention arm compared with 2.7 (1.2, 4.3) in the control arm (risk ratio 0.66 [95% confidence interval: 0.56-0.78]; P < 0.001). There were 33 moderate-risk and no high-risk errors (intervention), compared with 84 moderate-risk and 3 high-risk errors (control). Percent agreement was 98.98% (weighted kappa: 0.62). Time to BPMH and medication reconciliation were reduced from 40.5 and 45.0 h to 7.8 and 40.0 h, respectively. CONCLUSIONS The 7-day extended-hours ED clinical pharmacy service was associated with a reduction in medication prescribing errors in high-needs patients and improved time to BPMH and medication reconciliation.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Galahad Gu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Paul Buntine
- Department of Emergency Medicine, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mazdak Zamani
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Violet Zhu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Kayin Chan
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Goulopoulos
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
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Fatima S, Arshad A, Zafar A, Farrukh S, Rahim A, Nazar S, Zafar H. Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review. BMJ Open Qual 2024; 13:e002527. [PMID: 38569666 PMCID: PMC10989168 DOI: 10.1136/bmjoq-2023-002527] [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: 07/30/2023] [Accepted: 03/23/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE There were three main objectives of the study: to determine the overall compliance of medication reconciliation over 4 years in a tertiary care hospital, to compare the medication reconciliation compliance between paper entry (initial assessment forms) and computerised physician order entry (CPOE), and to identify the discrepancies between the medication history taken by the physician at the time of admission and those collected by the pharmacist within 24 hours of admission. METHODS This study was conducted at a tertiary care hospital in a lower middle-income country. Data were gathered from two different sources. The first source involved retrospective data obtained from the Quality and Patient Safety Department (QPSD) of the hospital, consisting of records from 8776 patients between 2018 and 2021. The second data source was also retrospective from a quality project initiated by pharmacists at the hospital. Pharmacists collected data from 1105 patients between 2020 and 2021, specifically focusing on medication history and identifying any discrepancies compared with the history documented by physicians. The collected data were then analysed using SPSS V.26. RESULTS The QPSD noted an improvement in physician-led medication reconciliation, with a rise from 32.7% in 2018 to 69.4% in 2021 in CPOE. However, pharmacist-led medication reconciliation identified a 25.4% (n=281/1105) overall discrepancy in the medication history of patients admitted from 2020 to 2021, mainly due to incomplete medication records in the initial assessment forms and CPOE. Physicians missed critical drugs in 4.9% of records; pharmacists identified and updated them. CONCLUSION In a lower middle-income nation where hiring pharmacists to conduct medication reconciliation would be an additional cost burden for hospitals, encouraging physicians to record medication history more precisely would be a more workable method. However, in situations where cost is not an issue, it is recommended to adopt evidence-based practices, such as integrating clinical pharmacists to lead medication reconciliation, which is the gold standard worldwide.
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Affiliation(s)
- Samar Fatima
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ainan Arshad
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Amara Zafar
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sana Farrukh
- Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Anum Rahim
- Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saharish Nazar
- Pharmacy, The Aga Khan University Hospital, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Light J, Ruh C, Ott M, Banker C, Meaney D, Doloresco F, Noyes K. The Effect of Pharmacy-Led Medication Reconciliation on Odds of Psychiatric Relapse at a Community Hospital. J Pharm Pract 2024; 37:391-398. [PMID: 36314582 DOI: 10.1177/08971900221137100] [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] [Indexed: 02/16/2024]
Abstract
Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.
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Affiliation(s)
- Jamie Light
- Erie County Medical Center, Buffalo, NY, USA
| | | | - Michael Ott
- Erie County Medical Center, Buffalo, NY, USA
| | - Christopher Banker
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Drake Meaney
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Fred Doloresco
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Katia Noyes
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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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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Sheth S, Bialostozky M, Hollenbach K, Heitzman L, O'Crump D, Mishra S, Langley G, Santiago K, Saleh F, Billman G, Bryl A. Standardizing Medication Reconciliation in a Pediatric Emergency Department. Pediatrics 2024; 153:e2023061964. [PMID: 38273780 DOI: 10.1542/peds.2023-061964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Medication errors are common during transitions of care, such as discharge from the emergency department (ED) or urgent care (UC). The Joint Commission has identified medication reconciliation as a key safety practice. Our aim was to increase the percentage of patients with completed medication reconciliation at discharge from our pediatric ED and 4 UCs from 25% to 75% in 12 months. METHODS Key stakeholders included ED and UC physicians and nurses, informatics, and quality management. The baseline process for medication reconciliation was mapped and modified to create a standard process for nurses and physicians. An Ishikawa diagram was created to assess potential failures. Electronic health record interventions included adapting an inpatient workflow and using a clinical decision support tool. Educational interventions included just-in-time training, physician education via division meeting presentations, video tutorials, and physician-specific and group feedback using funnel plots. The secondary process measure was the proportion of patients discharged from the ED and UCs with completed home medication nursing review. We used statistical process control to analyze changes in measures over time. RESULTS In the UCs, home medication nursing review increased from 91% to 98% and medication reconciliation increased from 35% to 82% within 4 months. In the ED, home medication nursing review increased from 2% to 83% within 8 months and medication reconciliation increased from 26% to 64% within 18 months. CONCLUSIONS We successfully increased the proportion of UC and ED discharged patients with completed medication reconciliation.
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Affiliation(s)
- Sarika Sheth
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Mario Bialostozky
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Kathy Hollenbach
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | | | - Deven O'Crump
- Rady Children's Hospital San Diego, San Diego, California
| | - Seema Mishra
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Gregory Langley
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | | | - Fareed Saleh
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Glenn Billman
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Amy Bryl
- Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California-San Diego, San Diego, California
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Currey EM, Falconer N, Isoardi KZ, Barras M. Impact of pharmacists during in-hospital resuscitation or medical emergency response events: A systematic review. Am J Emerg Med 2024; 75:98-110. [PMID: 37939522 DOI: 10.1016/j.ajem.2023.10.020] [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: 05/28/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND We sought to determine the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill patients requiring resuscitation or medical emergency response team care in a hospital setting. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of databases from January 1995 to April 2023 was conducted to identify studies of contemporary pharmacist practice. Results were extracted and analysed for included studies, those evaluating the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill hospitalised patients requiring resuscitation or medical emergency response team care. To determine risk of bias, the Newcastle-Ottowa Quality Assessment scale was used for non-randomised studies and the Revised Cochrane risk-of-bias tool for randomised trials. RESULTS Of 1345 studies identified, 54 were selected for full text review, and 30 were included in the final analysis. There were 29 cohort studies and one randomised controlled trial. The studies reported the impact of a pharmacist for a variety of patient presentations. The study team assigned each study to one of eight patient cohorts: acute stroke, cardiac arrest, rapid response calls, S-T segment elevation myocardial infarction, acute haemorrhage, major trauma resuscitation, sepsis and status epilepticus. The most frequently reported outcome, associated with a statistically significant benefit in 23 studies, was time to medication administration. Few studies reported a significant difference in patient outcome measures such as mortality. Only 8 of the 30 studies were assessed to have a low risk of bias. CONCLUSIONS The results of this systematic review provide support for a beneficial impact of a pharmacist presence and intervention during resuscitation or medical emergency response team care, with significant improvements in outcomes such as time to initiation of time-critical medications, medication appropriateness and guideline compliance. However, studies were predominantly small and retrospective and were not powered to detect differences in patient related measures such as length of stay and mortality. Future research should investigate the clinical impacts of the pharmacist in ED resuscitation settings in controlled, prospective studies with robust sampling methods.
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Affiliation(s)
- Elizabeth M Currey
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Nazanin Falconer
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Katherine Z Isoardi
- Emergency Department and Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [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: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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Hermann M, Holt MD, Kjome RLS, Teigen A. Medication reconciliation -is it possible to speed up without compromising quality? A before-after study in the emergency department. Eur J Hosp Pharm 2023; 30:310-315. [PMID: 35086802 PMCID: PMC10647851 DOI: 10.1136/ejhpharm-2021-003071] [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: 09/20/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether it was possible to decrease the time used for medication reconciliation (MR) in the emergency department without compromising quality. A more efficient method will enable more patients to receive MR as early as possible after admission to hospital. METHODS Potential key factors for improvement of the standard method of MR by clinical pharmacists were identified through an observational period. A revised method was developed, focusing on decreasing time spent on the patient interview by use of a condensed checklist and probing questions based on information from a prescription database. Non-inferior quality (proportion of patients with at least one identified medication discrepancy and number of identified medication discrepancies per patient) of the revised method was evaluated using a before-after study design with 200 individuals in each group. Non-inferiority limit was set at 10%. The Mann-Whitney U test was used for statistical evaluation of the difference in time use per patient in the MR process between the before and after group. RESULTS Mean age of the included patients was 78 years in both groups. The time used for MR in the after group was 34% shorter (37 min vs 56 min, p<0.0001) compared with the before group. The revised method was shown to be non-inferior compared with the original method with respect to the proportion of patients with at least one identified discrepancy (81%, 95% CI 76% to 86% vs 79%, 95% CI 73% to 84%). Also, non-inferiority was shown for the number of identified discrepancies per patient, where the average number of discrepancies per patient was 1.9 (95% CI 1.7 to 2.1) in both groups. CONCLUSION This study showed that it was possible to speed up the MR process without compromising its effectiveness in identifying medication discrepancies.
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Affiliation(s)
- Monica Hermann
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Stord Campus, Stord, Norway
| | - Markus Dreetz Holt
- Western Norway Hospital Pharmacy in Stavanger, Stavanger, Rogaland, Norway
- Stavanger University Hospital, Stavanger, Norway
- Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Reidun L S Kjome
- Centre for Pharmacy, University of Bergen, Bergen, Norway
- Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Arna Teigen
- Western Norway Hospital Pharmacy in Stavanger, Stavanger, Rogaland, Norway
- Stavanger University Hospital, Stavanger, Norway
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Raymond J, Parrein P, Barat E, Chenailler C, Decreau-Gaillon G, Varin R, Joly LM. Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:1007-1017. [PMID: 37356662 DOI: 10.1016/j.pharma.2023.06.004] [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: 07/12/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.
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Affiliation(s)
- Johanna Raymond
- Pharmacy Department, CHU Rouen, Rouen, France; Observation ward, Adult Emergency Department, CHU Rouen, 76000 Rouen, France.
| | | | - Eric Barat
- Pharmacy Department, CHU Rouen, Rouen, France
| | | | | | - Rémi Varin
- Pharmacy Department, CHU Rouen, Rouen, France
| | - Luc-Marie Joly
- Observation ward, Adult Emergency Department, CHU Rouen, 76000 Rouen, France
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Sheber M, McKnight M, Liebzeit D, Seaman A, Husser EK, Buck H, Reisinger HS, Lee S. Older adults' goals of care in the emergency department setting: A qualitative study guided by the 4Ms framework. J Am Coll Emerg Physicians Open 2023; 4:e13012. [PMID: 37520079 PMCID: PMC10375261 DOI: 10.1002/emp2.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background We sought to identify what matters to older adults (60 years and older) presenting to the emergency department (ED) and the challenges or concerns they identify related to medication, mobility, and mentation to inform how the 4Ms framework could improve care of older adults in the ED setting. Methods A qualitative study was conducted using the 4Ms to identify what matters to older adults (≥60 years old) presenting to the ED and what challenges or concerns they identify related to medication, mobility, and mentation. We conducted semi-structured interviews with a convenience sample of patients in a single ED. Interview guide responses and interviewer field notes were entered into REDCap. Interviews were reviewed by the research team (2 coders per interview) who inductively assigned codes. A codebook was created through an iterative process and was used to group codes into themes and sub-themes within the 4Ms framework. Results A total of 20 ED patients participated in the interviews lasting 30-60 minutes. Codes identified for "what matters" included problem-oriented expectation, coordination and continuity, staying engaged, being with family, and getting back home. Codes related to the other 4Ms (medication, mobility, and mentation) described challenges. Medication challenges included: non-adherence, side effects, polypharmacy, and knowledge. Mobility challenges included physical activity and independence. Last, mentation challenges included memory concerns, depressed mood, and stress and worry. Conclusions Our study used the 4Ms to identify "what matters" to older adults presenting to the ED and the challenges they face regarding medication, mobility, and mentation. Understanding what matters to patients and the specific challenges they face can help shape and individualize a patient-centered approach to care to facilitate the goals of care discussion and handoff to the next care team.
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Affiliation(s)
- Melissa Sheber
- Department of Emergency MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Mackenzie McKnight
- Department of Emergency MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | | | - Aaron Seaman
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Erica K. Husser
- Ross and Carol Nese College of NursingPennsylvania State University, University ParkPennsylvaniaUSA
| | - Harleah Buck
- University of Iowa College of NursingIowa CityIowaUSA
| | - Heather S. Reisinger
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Sangil Lee
- Department of Emergency MedicineUniversity of Iowa Carver College of MedicineDepartment of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Atey TM, Peterson GM, Salahudeen MS, Bereznicki LR, Wimmer BC. Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis. J Accid Emerg Med 2023; 40:120-127. [PMID: 35914923 DOI: 10.1136/emermed-2021-211660] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised. OBJECTIVE This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED. METHODS A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses. RESULTS Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI -0.42 to -0.23, I2=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I2=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I2=95%) and quicker initiation of time-critical medications. CONCLUSION The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams. PROSPERO REGISTRATION NUMBER CRD42020165234.
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Affiliation(s)
- Tesfay Mehari Atey
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Luke R Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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Punj E, Collins A, Agravedi N, Marriott J, Sapey E. What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review. Pharmacol Res Perspect 2022; 10:e01007. [PMID: 36102210 PMCID: PMC9471999 DOI: 10.1002/prp2.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co-primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy-led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non-randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non-pharmacy control arm, with a Chi2 of 101.10 and I2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out-of-hours working.
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Affiliation(s)
- Ekta Punj
- Clinical Research NetworkUniversity of BirminghamBirminghamUK
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Abbie Collins
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Nirlep Agravedi
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - Elizabeth Sapey
- University of BirminghamBirminghamUK
- PIONEER, HDRUK Health Data Hub in Acute CareBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Acute MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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13
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Pharmacist Intervention in Portuguese Older Adult Care. Healthcare (Basel) 2022; 10:healthcare10101833. [DOI: 10.3390/healthcare10101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.
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Nymoen LD, Flatebø TE, Moger TA, Øie E, Molden E, Viktil KK. Impact of systematic medication review in emergency department on patients’ post-discharge outcomes—A randomized controlled clinical trial. PLoS One 2022; 17:e0274907. [PMID: 36121830 PMCID: PMC9484649 DOI: 10.1371/journal.pone.0274907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The main objective of this study was to investigate whether systematic medication review conducted by clinical pharmacists can impact clinical outcomes and post-discharge outcomes for patients admitted to the emergency department. Method This parallel group, non-blinded, randomized controlled trial was conducted in the emergency department, Diakonhjemmet Hospital, Oslo, Norway. The study was registered in ClinicalTrials.gov, Identifier: NCT03123640 in April 2017. From April 2017 to May 2018, patients ≥18 years were included and randomized (1:1) to intervention- or control group. The control group received standard care from emergency department physicians and nurses. In addition to standard care, the intervention group received systematic medication review including medication reconciliation conducted by pharmacists, during the emergency department stay. The primary outcome was proportion of patients with an unplanned contact with hospital within 12 months from inclusion stay discharge. Results In total, 807 patients were included and randomized, 1:1, to intervention or control group. After excluding 8 patients dying during hospital stay and 10 patients lacking Norwegian personal identification number, the primary analysis comprised 789 patients: 394 intervention group patients and 395 control group patients. Regarding the primary outcome, there was no significant difference in proportion of patients with an unplanned contact with hospital within 12 months after inclusion stay discharge between groups (51.0% of intervention group patients vs. 53.2% of control group patients, p = 0.546). Conclusion As currently designed, emergency department pharmacist-led medication review did not significantly influence clinical- or post-discharge outcomes. This study did, however pinpoint important practical implementations, which can be used to design tailored pharmacist-led interventions and workflow regarding drug-related issues in the emergency department setting.
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Affiliation(s)
- Lisbeth Damlien Nymoen
- Diakonhjemmet Hospital Pharmacy AS, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
- * E-mail:
| | | | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Kilvik Viktil
- Diakonhjemmet Hospital Pharmacy AS, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
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15
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Nguyen KH, Tolia V, Hart LA. Polypharmacy in the Emergency Department. Clin Geriatr Med 2022; 38:727-732. [DOI: 10.1016/j.cger.2022.05.012] [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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16
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Marshall J, Hayes BD, Koehl J, Hillmann W, Bravard M, Jacob S, Gil R, Mitchell E, Ferrante F, Giulietti J, Tull A, Liu X, Lucier D. Effects of a pharmacy-driven medication history program on patient outcomes. Am J Health Syst Pharm 2022; 79:1652-1662. [PMID: 35596269 DOI: 10.1093/ajhp/zxac143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Obtaining an accurate medication history is a vital component of medication reconciliation upon admission to the hospital. Despite the importance of this task, medication histories are often inaccurate and/or incomplete. We evaluated the association of a pharmacy-driven medication history initiative on clinical outcomes of patients admitted to the general medicine service of an academic medical center. METHODS Comparing patients who received a pharmacy-driven medication history to those who did not, a retrospective stabilized inverse probability treatment weighting propensity score analysis was used to estimate the average treatment effect of the intervention on general medical patients. Fifty-two patient baseline characteristics including demographic, operational, and clinical variables were controlled in the propensity score model. Hospital length of stay, 7-day and 30-day unplanned readmissions, and in-hospital mortality were evaluated. RESULTS Among 11,576 eligible general medical patients, 2,234 (19.30%) received a pharmacy-driven medication history and 9,342 (80.70%) patients did not. The estimated average treatment effect of receiving a pharmacy-driven medication history was a shorter length of stay (mean, 5.88 days vs 6.53 days; P = 0.0002) and a lower in-hospital mortality rate (2.34% vs 3.72%, P = 0.001), after adjustment for differences in patient baseline characteristics. No significant difference was found for 7-day or 30-day all-cause readmission rates. CONCLUSION Pharmacy-driven medication histories reduced length of stay and in-hospital mortality in patients admitted to the general medical service at an academic medical center but did not change 7-day and 30-day all-cause readmission rates. Further research via a large, multisite randomized controlled trial is needed to confirm our findings.
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Affiliation(s)
- John Marshall
- Beth Israel Lahey Health Pharmacy, Westwood, MA, USA
| | - Bryan D Hayes
- Beth Israel Lahey Health Pharmacy, Westwood, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Koehl
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - William Hillmann
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
| | - Marjory Bravard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
| | - Susan Jacob
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Rosy Gil
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Andrea Tull
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | - Xiu Liu
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | - David Lucier
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
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Walker D, Moloney C, SueSee B, Sharples R, Blackman R, Long D, Hou XY. Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. PREHOSP EMERG CARE 2022:1-18. [PMID: 35579544 DOI: 10.1080/10903127.2022.2068089] [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: 10/18/2022]
Abstract
INTRODUCTION There is limited research available on safe medication management practices in EMS practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment. METHODS AND ANALYSIS The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality, however this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and "qualitized" quantitative data. RESULTS 56 articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified. DISCUSSION The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication errors occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.
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Affiliation(s)
- Dennis Walker
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Clint Moloney
- Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Brendan SueSee
- School of Linguistics, Adult and Special Education, University of Southern Queensland, Springfield, Australia
| | - Renee Sharples
- College of Science, Health, and Engineering, LaTrobe University, Bendigo, Australia
| | - Rosanna Blackman
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - David Long
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Australia
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18
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Yu A, Wei G, Chen F, Wang Z, Fu M, Wang G, Wushouer H, Li X, Guan X, Shi L. Study protocol for the evaluation of pharmacist-participated medication reconciliation at county hospitals in China: a multicentre, open-label, assessor-blinded, non-randomised, controlled study. BMJ Open 2022; 12:e053741. [PMID: 35277404 PMCID: PMC8919460 DOI: 10.1136/bmjopen-2021-053741] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/04/2022] Open
Abstract
INTRODUCTION Pharmacist-participated medication reconciliation proved an effective strategy to decrease the risk of medication discrepancy-related errors. However, it is still under pilot in China and its effectiveness in the Chinese healthcare system remains unclear. This study aims to conduct a pharmacist-participated medication reconciliation intervention for elderly patients in county hospitals in China and to evaluate its effect. METHODS AND ANALYSIS This is a multicentre, prospective, open-label, assessor-blinded, cluster, non-randomised, controlled study for elderly patients. The study will be conducted in seven county hospitals, and the clusters will be hospital wards. In each hospital, two internal medicine wards will be randomly allocated into either intervention group or control group. Patients in the intervention group will receive pharmacist-participated medication reconciliation, and those in the control group will receive standard care. The primary outcome is the incidence of medication discrepancy, and the secondary outcomes are patients' medication adherence, healthcare utilisation and medical costs within 30 days after discharge. ETHICS AND DISSEMINATION Ethics committee approval of this study was obtained from Peking University Institution Review Board (IRB00001052-21016). We have also obtained ethical approvals from all the participating centres. The findings will be published in scientific and conference presentations. TRAIL REGISTRATION NUMBER ChiCTR2100045668.
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Affiliation(s)
- Aichen Yu
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Guilin Wei
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Fanghui Chen
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Zining Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Guoying Wang
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xixi Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Emergency department physicians' distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities. Int J Clin Pharm 2021; 44:448-458. [PMID: 34939132 PMCID: PMC9007764 DOI: 10.1007/s11096-021-01364-6] [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: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 10/26/2022]
Abstract
Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians' activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients' drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.
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Ciapponi A, Fernandez Nievas SE, Seijo M, Rodríguez MB, Vietto V, García-Perdomo HA, Virgilio S, Fajreldines AV, Tost J, Rose CJ, Garcia-Elorrio E. Reducing medication errors for adults in hospital settings. Cochrane Database Syst Rev 2021; 11:CD009985. [PMID: 34822165 PMCID: PMC8614640 DOI: 10.1002/14651858.cd009985.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death. OBJECTIVES To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible. MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131). Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724). Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311). Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88). Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775). AUTHORS' CONCLUSIONS Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.
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Affiliation(s)
- Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Simon E Fernandez Nievas
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mariana Seijo
- Quality of Health Care and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belén Rodríguez
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Vietto
- Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Sacha Virgilio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana V Fajreldines
- Quality and Patient Safety, Austral University Hospital, Buenos Aires, Argentina
| | - Josep Tost
- Urgencias � Calidad y Seguridad de pacientes, Consorcio Sanitario de Terrassa, Barcelona, Spain
| | | | - Ezequiel Garcia-Elorrio
- Quality and Safety in Health Care, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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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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22
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Wu MA, Carnovale C, Gabiati C, Montori D, Brucato A. Appropriateness of care: from medication reconciliation to deprescribing. Intern Emerg Med 2021; 16:2047-2050. [PMID: 34585360 DOI: 10.1007/s11739-021-02846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, Division of Internal Medicine, ASST Fatebenefratelli Sacco, Università Degli Studi di Milano, Milan, Italy.
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Claudia Gabiati
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Daniela Montori
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Antonio Brucato
- Division of Internal Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Università di Degli Studi Milano, Milan, Italy
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23
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Al Anazi A. Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists' perspective. Health Informatics J 2021; 27:1460458220987276. [PMID: 33467954 DOI: 10.1177/1460458220987276] [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] [Indexed: 11/16/2022]
Abstract
The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey's respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications' entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.
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Affiliation(s)
- Abdullah Al Anazi
- King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.,King Abdullah International Medical Research Center, Saudi Arabia.,Ministry of National Guard-Health Affairs, Saudi Arabia
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24
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Ie K, Aoshima S, Yabuki T, Albert SM. A narrative review of evidence to guide deprescribing among older adults. J Gen Fam Med 2021; 22:182-196. [PMID: 34221792 PMCID: PMC8245739 DOI: 10.1002/jgf2.464] [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: 03/23/2021] [Revised: 04/24/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Potentially inappropriate prescription and polypharmacy are well‐known risk factors for morbidity and mortality among older adults. However, recent systematic reviews have failed to demonstrate the overall survival benefits of deprescribing. Thus, it is necessary to synthesize the current evidence to provide a practical direction for future research and clinical practice. This review summarizes the existing body of evidence regarding deprescribing to identify useful intervention elements. There is evidence that even simple interventions, such as direct deprescribing targeted at risky medications and explicit criteria‐based approaches, effectively reduce inappropriate prescribing. On the other hand, if the goal is to improve clinical outcomes such as hospitalization and emergency department visits, patient‐centered multimodal interventions such as a combination of medication review, multidisciplinary collaboration, and patient education are likely to be more effective. We also consider the opportunities and challenges for deprescribing within the Japanese healthcare system.
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Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.,Division of General Internal Medicine Department of Internal Medicine Kawasaki Municipal Tama Hospital Kawasaki Japan.,Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Pittsburgh PA USA
| | | | - Taku Yabuki
- Department of Internal Medicine Tochigi Medical Center Tochigi Japan
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Pittsburgh PA USA
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25
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Bambach K, Southerland LT. Applying Geriatric Principles to Transitions of Care in the Emergency Department. Emerg Med Clin North Am 2021; 39:429-442. [PMID: 33863470 DOI: 10.1016/j.emc.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Each emergency department (ED) visit represents a crucial transition of care for older adults. Systems, provider, and patient factors are barriers to safe transitions and can contribute to morbidity and mortality in older adults. Safe transitions from ED to inpatient, ED to skilled nursing facility, or ED back to the community require a holistic approach, such as the 4-Ms model-what matters (patient goals of care), medication, mentation, and mobility-along with safety and social support. Clear written and verbal communication with patients, caregivers, and other members of the interdisciplinary team is paramount in ensuring successful care transitions.
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Affiliation(s)
- Kimberly Bambach
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Columbus, OH 43210, USA. https://twitter.com/kimbambach
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Columbus, OH 43210, USA.
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26
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Abstract
BACKGROUND Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology. OBJECTIVES The aim of this umbrella review was to synthesize the evidence from all systematic reviews investigating the effectiveness of medication safety interventions, in comparison to any or no comparator, for preventing medication errors, medication-related harms and death in acute care patients. METHOD The review considered quantitative systematic reviews with participants who were healthcare workers involved in prescribing, dispensing or administering medications. These healthcare workers were registered nurses, enrolled or licensed vocational nurses, midwives, pharmacists or medical doctors. Interventions of interest were those designed to prevent medication error in acute care settings. Eligible systematic reviews reported medication errors, medication-related harms and medication-related death as measured by error rates, numbers of adverse events and numbers of medication-related deaths. To qualify for inclusion, systematic reviews needed to provide a clearly articulated and comprehensive search strategy, and evidence of critical appraisal of the included studies using a standardized tool. Systematic reviews published in English since 2007 were included until present (March 2020). We searched a range of databases such MEDLINE, CINAHL, Web of Science, EMBASE, and The Cochrane Library for potentially eligible reviews. Identified citations were screened by two reviewers working independently. Potentially eligible articles were retrieved and assessed against the inclusion criteria and those meeting the criteria were then critically appraised using the JBI SUMARI instrument for assessing the methodological quality of systematic reviews and research syntheses. A predetermined quality threshold was used to exclude studies based on their reported methods. Following critical appraisal, data were extracted from the included studies by two independent reviewers using the relevant instrument in JBI SUMARI. Extracted findings were synthesized narratively and presented in tables to illustrate the reported outcomes for each intervention. The strength of the evidence for each intervention was indicated using 'traffic light' colors: green for effective interventions, amber for interventions with no evidence of an effect and red for interventions less effective than the comparison. RESULTS A total of 23 systematic reviews were included in this umbrella review. Most reviews did not report the number of participants in their included studies. Interventions targeted pharmacists, medical doctors, medical students and nurses, or were nonspecific about the participants. The majority of included reviews examined single interventions. All reviews were published and in English. Four interventions, medication administration education, medication reconciliation or review, specialist pharmacists' roles and physical or design modifications, reported effectiveness in reducing errors; however, heterogeneity between the included studies in these reviews was high. CONCLUSION For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
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27
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Alley A, Dorscheid H, Hentzen K. Pharmacist-Run Medication Reconciliation for Veterans Admitted to Non-Veterans Affairs Hospice Care. Sr Care Pharm 2021; 36:42-48. [PMID: 33384033 DOI: 10.4140/tcp.n.2021.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: The purpose of this quality improvement project was to increase pharmacist involvement in the outpatient hospice transition process to improve care of veterans, prevent medication errors, and to ensure medications are provided to the patient via the appropriate pharmacy.METHODS: This project began with implementation of a pilot process for the pharmacist to complete medication reconciliation for each patient admitted to non-Veterans Affairs (VA) hospice care from the Omaha VA Medical Center. The second step of this project was completion of a retrospective chart review of the interventions made. Statistical analysis was completed via descriptive statistics.RESULTS: A total of 21 patients were eligible for this study. The mean age was 78 years. The average total number of medications per veteran before and after medication reconciliation for VA meds were 13 and 4 and for non-VA meds were 4 and 6, respectively. The average total cost savings for one fill of all medications changed to non-VA was estimated to be $40.08. The pharmacist noted on average 12.6 medication discrepancies during medication reconciliation per veteran. Just less than half of the clinical recommendations made by the pharmacist were accepted by the providers.CONCLUSIONS: All veterans admitted to non-VA hospice care had at least one medication discrepancy noted by the pharmacist during medication reconciliation. A majority of the veterans had at least one VA medication changed to non-VA since hospice was now prescribing and providing. The cost savings on average appear to outweigh the time spent on medication reconciliation by the pharmacist.
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Affiliation(s)
- Anne Alley
- 1PGY1 Pharmacy Resident, Veterans Affairs Nebraska-Western Iowa Health Care System, Lincoln, Nebraska
| | - Holly Dorscheid
- 2PGY1 Pharmacy Resident, Veterans Affairs Nebraska-Western Iowa Health Care System, Lincoln, Nebraska
| | - Kathryn Hentzen
- 3Clinical Pharmacist-Geriatrics/Home Based Primary Care, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska
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28
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Uhlenhopp DJ, Aguilar O, Dai D, Ghosh A, Shaw M, Mitra C. Hospital-Wide Medication Reconciliation Program: Error Identification, Cost-Effectiveness, and Detecting High-Risk Individuals on Admission. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:195-203. [PMID: 33117666 PMCID: PMC7568630 DOI: 10.2147/iprp.s269857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Medication reconciliation (MR) on admission has potential to reduce negative patient outcomes. The objectives of this prospective observational study were to 1) measure the impact a hospital-wide MR program has on home medication error identification at hospital admission, 2) demonstrate cost-effectiveness of this program, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies. Methods Technicians obtained medication histories on adult patients admitted to the hospital that managed their own medications. Frequency and type of medication errors were recorded. Cost avoidance estimations were determined based on expected adverse drug event rates. Logistic regression analysis was used to test for associations between medication errors and patient characteristics. Results were considered significant when p-value was less than 0.05. Results The study included 817 patients. Technicians recorded a mean of 6.1 medication discrepancies per patient (SD ± 0.4) and took 28.5 minutes (SD ± 1.2 minutes) to complete a medication history. Omission, commission, and dosing/frequency errors occurred in 82%, 59%, and 50% of medication histories, respectively. We estimated cost avoidance of $210.33 per patient with this program. Female gender, age, and high alert/risk medication use were linked to an increase in the likelihood of occurrence of a medication discrepancy. Conclusion This study validated the ability of a pharmacy technician to identify errors, demonstrated economic cost-effectiveness, provided new data on time to obtain a BPMH, and further identified factors that contribute to the occurrence of medication discrepancies. Potentially harmful medication discrepancies were identified frequently on admission. With further research, it may be possible to identify those at highest risk for home medication discrepancies upon admission.
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Affiliation(s)
- Dustin J Uhlenhopp
- Department of Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, IA 50314, USA
| | - Oscar Aguilar
- Department of Business Administration, Grand View University, Des Moines, IA 50316, USA
| | - Dong Dai
- Department of Mathematics, Iowa State University, Ames, IA 50011, USA
| | - Arka Ghosh
- Department of Statistics, Iowa State University, Ames, IA 50011, USA
| | - Michael Shaw
- Department of Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, IA 50314, USA
| | - Chandan Mitra
- Department of Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, IA 50314, USA
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29
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Chee-How EL, Acquisto NM, Zhang YV. Appropriateness of tacrolimus therapeutic drug monitoring timing in the emergency department. Am J Emerg Med 2020; 45:233-236. [PMID: 33046300 DOI: 10.1016/j.ajem.2020.08.045] [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: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Evaluate the appropriateness of the timing of serum samples collected in the emergency department (ED) for tacrolimus (TAC) measurement. METHODS Single-center, retrospective review of TAC samples collected in the ED from September 1 to October 31, 2017. The primary evaluation was incidence of inappropriate sample collection for TAC measurement, defined as samples not collected 12 h (±2 h; 10-14 h) after the last dose, or within 2 h of the next dose if last known dose time was not documented. Incidence of repeat TAC measurements obtained within 24 h of ED presentation (if initial sample collection inappropriate), inappropriate TAC regimen adjustments, and healthcare costs of inappropriate TAC measurements was evaluated. Data collection included patient demographics, ED visit information, TAC measurement and timing related to last or next dose, changes to TAC regimen, and ED disposition. Descriptive data are reported. RESULTS Sixty-two patients were included. Forty-one (66%) initial TAC measurements were collected inappropriately in the ED. No patients had a regimen adjustment as a result of inappropriate concentration collection, but 32 patients (78%) did require a repeat measurement within 24 h of ED presentation due to initial inappropriate collection. Costs associated with incorrectly collected TAC measurements were $2,647.78 for the two-month time period and this is extrapolated to an estimated $15,886.68 annual expense for patients. CONCLUSIONS Inappropriate sample collection for TAC measurements was common in the ED, resulting in frequent repeat laboratory draws and increased healthcare costs.
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Affiliation(s)
- Emma L Chee-How
- Emergency Medicine Pharmacy Resident, Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America
| | - Nicole M Acquisto
- Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy and Associate Professor, Department of Emergency Medicine, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America.
| | - Y Victoria Zhang
- Vice Chair for Clinical Enterprise Strategy, Department of Pathology and Laboratory Medicine, Medical Director of Ambulatory Lab Services, Department of Pathology and Laboratory Medicine, Director of Regional Toxicology and Mass Spectrometry Laboratory, Department of Pathology and Laboratory Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 608, Rochester, NY 14642, United States of America.
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30
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Abstract
PURPOSE OF REVIEW With the growing of the aging population, increased and new methods of anesthesia and surgery allow for surgery and other interventions in older adults.Pharmacokinetics and pharmacodynamics of drugs in older adults differ from those in younger and middle-aged adults. However, the geriatric population is frequently neglected in the context of clinical trials. The present review focuses on the consequences of multimorbidity and pharmacokinetic and pharmacodynamic alterations and their implications on anesthesia. RECENT FINDINGS Physiologically based pharmacokinetic and pharmacodynamic modeling may serve as an option to better understand the influence of age on drugs used for anesthesia. However, difficulties to adequately characterize geriatric patients are described. SUMMARY Further research of drug effects in the aging population may include physiologically based pharmacokinetic and pharmacodynamic complex models and randomized controlled trials with thoroughly conducted geriatric assessments.
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