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Adducchio S, Grant ED, Fonseca LD, Omoloja A, Kumar G. Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit. Neurol Clin Pract 2024; 14:e200270. [PMID: 38524835 PMCID: PMC10955335 DOI: 10.1212/cpj.0000000000200270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/08/2024] [Indexed: 03/26/2024]
Abstract
Background and Objectives Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio. Methods We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index. Results One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors. Discussion Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.
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Affiliation(s)
- Sara Adducchio
- Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH
| | - Ethan D Grant
- Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH
| | - Laura D Fonseca
- Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH
| | - Abiodun Omoloja
- Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH
| | - Gogi Kumar
- Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH
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Jošt M, Kerec Kos M, Kos M, Knez L. Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial. Front Pharmacol 2024; 15:1377781. [PMID: 38606174 PMCID: PMC11007427 DOI: 10.3389/fphar.2024.1377781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Transitions of care often lead to medication errors and unnecessary healthcare utilization. Medication reconciliation has been repeatedly shown to reduce this risk. However, the great majority of evidence is limited to the provision of medication reconciliation within clinical trials and countries with well-established clinical pharmacy. Thus, this pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on medication errors and unplanned healthcare utilization in adult general medical patients hospitalized in a teaching hospital in Slovenia. All patients hospitalized in a ward where medication reconciliation was integrated into routine clinical practice were included in the intervention group and received admission and discharge medication reconciliation, coupled with patient counselling. The control group consisted of randomly selected patients from the remaining medical wards. The primary study outcome was unplanned healthcare utilization within 30 days of discharge, and the secondary outcomes were clinically important medication errors at hospital discharge and serious unplanned healthcare utilization within 30 days of discharge. Overall, 414 patients (53.4% male, median 71 years) were included-225 in the intervention group and 189 in the control group. In the intervention group, the number of patients with clinically important medication errors at discharge was significantly lower (intervention vs control group: 9.3% vs 61.9%). Multiple logistic regression revealed that medication reconciliation reduced the likelihood of a clinically important medication error by 20-fold, while a higher number of medications on admission was associated with an increased likelihood. However, no significant differences were noted in any and serious unplanned healthcare utilization (intervention vs control group: 33.9% vs 27.8% and 20.3% vs 14.6%, respectively). The likelihood of serious healthcare utilization increased with the age of the patient, the number of medications on admission and being hospitalized for an acute medical condition. Our pragmatic trial confirmed that medication reconciliation, even when performed as part of routine clinical practice, led to a substantial reduction in the risk of clinically important medication errors at hospital discharge but not to a reduction in healthcare utilization. Medication reconciliation is a fundamental, albeit not sufficient, element to ensure patient safety after hospital discharge. Clinical Trial Registration: https://clinicaltrials.gov/search?id=NCT06207500, identifier NCT06207500.
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Affiliation(s)
- Maja Jošt
- University Clinic Golnik, Golnik, Slovenia
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mojca Kerec Kos
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mitja Kos
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Lea Knez
- University Clinic Golnik, Golnik, Slovenia
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
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Yailian AL, Biry L, Fontana A, Vignot E, Estublier C, Confavreux C, Pivot C, Chapurlat R, de Freminville H, Janoly-Dumenil A. Implementation and effectiveness of pharmacist-led interviews at patient hospital admission in a rheumatology department. Eur J Hosp Pharm 2023; 30:273-278. [PMID: 34649963 PMCID: PMC10447965 DOI: 10.1136/ejhpharm-2021-002786] [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: 03/18/2021] [Accepted: 09/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Medication reconciliation is time-consuming and its complete deployment can be difficult. The implementation of a simplified process, such as patient interviews at admission without full reconciliation, may contribute to improve patient care. The objective of the present study was to describe the feasibility and assess the potential effectiveness of implementing pharmacist-led interviews at patient admission to a rheumatology department. METHODS This is a prospective observational study of pharmacist-led interviews at patient admission conducted between April 2015 and May 2017 in the 34-bed rheumatology department of Edouard Herriot Hospital, a French university hospital. These interviews were structured to explore patient medication management at home. The main outcome was the number of medication errors at admission. Other outcomes were the total number of interviews, the number of interviews with at least one new item of information provided by the patient, the number of interviews with at least one medication error detected, and the number of interviews leading to a modification of the hospital medication order. RESULTS A total of 247 interviews were carried out; there was an increase in the number of interviews over the study period (n=54 in 2015, n=98 in 2016, and n=95 for the first 5 months of 2017). Among the interviews conducted, 135 (55%) provided new information concerning patient medication management and 117 medication errors were identified in hospital orders (0.47/patient). There were 76 interviews (31%) with at least one medication error; all led to a medication order modification. CONCLUSIONS The study found that pharmacist-led interviews at patient admission were effective in detecting medication errors. They could be an alternative to a full medication reconciliation process in targeted situations. When the patient interview does not provide sufficiently robust information, full medication reconciliation may be performed.
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Affiliation(s)
- Anne-Laure Yailian
- Department of Pharmacy, Hospices Civils de Lyon, Lyon, France
- EA 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Laura Biry
- Department of Pharmacy, Hospices Civils de Lyon, Lyon, France
| | - Aurélie Fontana
- Department of Rheumatology, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1033, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Emmanuelle Vignot
- Department of Rheumatology, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1033, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Charline Estublier
- INSERM UMR 1033, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- Department of Rheumatology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Cyrille Confavreux
- INSERM UMR 1033, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- Department of Rheumatology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Christine Pivot
- Department of Pharmacy, Hospices Civils de Lyon, Lyon, France
| | - Roland Chapurlat
- Department of Rheumatology, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1033, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Humbert de Freminville
- EA 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- Department of General Medicine, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Audrey Janoly-Dumenil
- Department of Pharmacy, Hospices Civils de Lyon, Lyon, France
- EA 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
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Coiffard J, Aubry A, Bleibtreu A, Fourniols E, Junot H. Impact of clinical pharmacist interventions in a bone and joint infection orthoseptic surgery unit. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:826-832. [PMID: 37075975 DOI: 10.1016/j.pharma.2023.04.004] [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: 08/02/2022] [Revised: 02/09/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the impact of interventions of a clinical pharmacist in a unit of orthopedic surgery specialized in bone and joint infections. METHODS Daily, in routine, a clinical pharmacist analyzed medication prescribed to inpatients via a computerized physician order entry (CPOE) (Phedra software). His attention was particularly focused on the impact of antibiotics on other medications. For this study, all of the pharmacist interventions (PI) have been retrospectively collected, then anonymized, and assessed over a two-month period. RESULTS Thirty-eight patients were hospitalized during the study period, with a mean age of 63 years old. Forty-five interventions were identified which represents a mean of 1.18 pharmaceutical interventions per patient. Most of them concerned lack of follow-up (24%) and drug-drug interactions (22%) and widely non-anti-infectious medication (35 interventions) with levothyroxine (10 interventions) as the most involved non-anti-infectious molecule. Among antibiotics, with respectively 9 and 8 interventions, rifampicin and fluoroquinolones (6 interventions for moxifloxacin) were the most concerned notably for drug-drug interactions with usual treatment. CONCLUSION In this observational retrospective study, 1.18 pharmacist interventions (PI) per patient were observed. Most of them are lack of follow-up and drug-drug interactions especially with usual treatment of patients. Moxifloxacin and rifampicin were the most antibiotics involved. Patients' characteristics (older, polypharmacy), long-term hospitalization and surgery are known to be predictive factors of medication errors and this study highlights the importance of the presence of clinical pharmacist in orthopedic surgery wards.
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Affiliation(s)
- Julie Coiffard
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France.
| | - Alexandra Aubry
- Laboratory of bacteriology, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Bleibtreu
- Infectious and tropical diseases ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Eric Fourniols
- Orthopaedic surgery ward, Pitié-Salpêtrière Hospital, Paris, France
| | - Helga Junot
- Department of pharmacy, Pitié-Salpêtrière Hospital, Paris, France
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Kabir R, Liaw S, Cerise J, Yi J, Mulvany C, Qiu M, Beizer JL, Sinvani LD. Obtaining the Best Possible Medication History at Hospital Admission: Description of a Pharmacy Technician-Driven Program to Identify Medication Discrepancies. J Pharm Pract 2023; 36:19-26. [PMID: 34080461 DOI: 10.1177/08971900211021254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Describe the process of obtaining the best possible medication history (BPMH) by Certified Pharmacy Technicians (CPhTs) on hospital admission to identify medication discrepancies. METHODS Cross-sectional, descriptive study conducted between December 2016 and June 2017 at a quaternary center in New York, including all patients 18 years and older admitted to the medicine service through the Emergency Department (ED) and seen by a CPhT. CPhTs obtained the BPMH using a systematic approach involving a standardized interview, checking medications with secondary sources and updating the electronic health record (EHR). Medication discrepancies were identified and categorized by type and risk. Summary statistics were provided as average and standard deviation (SD) for continuous variables, and as frequencies and percentages for categorical variables. Multivariable regression was used to test for associations between patient factors and presence of a medication discrepancy. RESULTS Of the 3,087 patient visits, the average age was 69 (SD 17.8), 54% were female (n = 1652) and 65% white (n = 2017); comorbidity score breakdown was: 0 (25%, n = 757), 1-2 (33%, n = 1023), 3-4 (23%, n = 699), > 4 (20%, n = 608). The average number of home and discharge medications were 10 (SD 6.1) and 10 (SD 5.4), respectively. The average time spent obtaining the BPMH was 30.6 minutes (SD 12.9). 69% of patients (n = 2130) had at least 1 discrepancy with an average of 4.2 (SD 4.6), of which 43% (n = 920) included high-risk medications. Having a medication discrepancy was associated with a higher number of home medications (p < 0.0001) comorbidities (p < 0.0001), and source of information (p < 0.04). CONCLUSION Obtaining the BPMH by CPhTs on hospital admission frequently identifies medication discrepancies. Further studies are needed to evaluate the association between obtaining the BPMH and clinical outcomes.
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Affiliation(s)
- Rubiya Kabir
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Samantha Liaw
- Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jane Cerise
- Feinstein Institute for Medical Research-Biostatistics Unit, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
| | - Jungen Yi
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Colm Mulvany
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Judith L Beizer
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Liron D Sinvani
- Center for Health Innovations and Outcomes Research, 88982Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Medicine, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA
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Moges TA, Akalu TY, Sema FD. Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation. BMC Health Serv Res 2022; 22:1251. [PMID: 36243696 PMCID: PMC9571466 DOI: 10.1186/s12913-022-08628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Medication reconciliation (MedRec) is a widely accepted tool for the identification and resolution of unintended medication discrepancies (UMD). Objective This study aimed at assessing the magnitude and associated factors of UMD identified through medication reconciliation upon patient admission to the internal medicine wards. Methods Prospective cross-sectional study was conducted at the internal medicine wards of Felege Hiwot and Tibebe Ghion comprehensive specialized hospitals in Bahir Dar city, Northwest Ethiopia, from May 01 to July 30, 2021. Data were collected by using a data abstraction format prepared based on standard MedRec tools and previous studies on medication discrepancy. Pharmacists-led MedRec was made by following the WHO High5s “retroactive medication reconciliation model”. SPSS® (IBM Corporation) version 25.0 was used to analyze the data with descriptive and inferential statistics. A binary logistic regression analysis was used to identify factors associated with UMD. A statistical significance was declared at a p-value < 0.05. Results Among 635 adult patients, 248 (39.1%) of them had at least one UMD. The most frequent types of UMDs were omission (41.75%) and wrong dose (21.9%). The majority (75.3%) of pharmacists’ interventions were accepted. Polypharmacy at admission (p-value < 0.001), age ≥ 65 (p-value = 0.001), a unit increase on the number of comorbidities (p-value = 0.008) and information sources used for MedRec (p-value < 0.001), and medium (p-value = 0.019) and low adherence (p-value < 0.001) were significantly associated with UMD. Conclusion The magnitude of UMD upon patient admission to the internal medicine wards was considerably high. Omission and the wrong dose of medication were common. Older age, polypharmacy, low and medium adherence, and an increase in the number of comorbidities and information sources used for MedRec are significantly associated with UMDs. Pharmacists' interventions were mostly acceptable. Thus, the implementation of pharmacists-led MedRec in the two hospitals is indispensable for patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08628-5.
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Affiliation(s)
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Faisel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Vallecillo T, Slimano F, Moussouni M, Ohl X, Bonnet M, Mensa C, Hettler D, Kanagaratnam L, Mongaret C. Development and validation of a ready-to-use score to prioritise medication reconciliation at patient admission in an orthopaedic and trauma department. Eur J Hosp Pharm 2022; 29:264-270. [PMID: 33293282 PMCID: PMC9660597 DOI: 10.1136/ejhpharm-2020-002283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/14/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Medication reconciliation (MR) is recognised as an important tool in preventing medication errors such as unintentional discrepancies (UDs). The aim of this study was to identify independent predictive factors of UDs during MR at patient admission to an orthopaedic and trauma department. The secondary objective was to build and validate a ready-to-use score to prioritise patients. METHOD A retrospective study was performed on 3.5 years of pharmacist-led MR in the orthopaedic and trauma department of a large university teaching hospital. Independent predictors of UD were identified by multivariable logistic regression. A priority score to identify patients at risk of at least one UD was constructed from the odds ratios of the risk factors, and validated in a separate cohort. Performance was assessed with sensitivity, specificity, C-statistic and Hosmer-Lemeshow goodness-of-fit. RESULTS In total, 888 patients were included and 387 UDs were identified, mainly drug omissions (65.1%). Five independent predictors of UD were identified: age >75 years (OR 2.05, 95% CI 1.41 to 3.00; p<0.001), admission during school holidays (OR 1.69, 95% CI 1.17 to 2.44; p=0.005), female gender (OR 2.20, 95% CI 1.53 to 3.16; p<0.001), emergency hospitalisation (OR 2.05, 95% CI 1.45 to 2.92; p<0.001), and ≥5 medications on the best possible medication history (BPMH) (OR 3.29, 95% CI 2.20 to 4.94; p<0.001). Based on these predictors, a priority score ranging from 0 to 10 was built and internally and externally validated (C statistic 0.72, 95% CI 0.67 to 0.76). CONCLUSIONS This study confirms the high prevalence of UD in patients admitted to orthopaedic and trauma surgery departments. Five independent predictive factors of UD during MR were identified (female gender, emergency hospitalisation, hospitalisation during school holidays, age ≥75 years, and ≥5 medicines on the BPMH). The developed risk score will help to prioritise MR among patients at risk of medication error and is ready-to-use in other orthopaedic and trauma departments.
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Affiliation(s)
| | - Florian Slimano
- Pharmacy, CHU Reims, Reims, France
- MEDyC UMR CNRS/URCA n°7369, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
| | | | - Xavier Ohl
- Orthopaedic Surgery, CHU Reims Pôle Locomoteur, Reims, France
- EA 4691, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
| | | | | | | | | | - Céline Mongaret
- Pharmacy, CHU Reims, Reims, France
- EA 4691, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
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Abu Hammour K, Abu Farha R, Ya’acoub R, Salman Z, Basheti I. Impact of Pharmacist-Directed Medication Reconciliation in Reducing Medication Discrepancies: A Randomized Controlled Trial. Can J Hosp Pharm 2022; 75:169-177. [PMID: 35847464 PMCID: PMC9245405 DOI: 10.4212/cjhp.3143] [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: 01/07/2023]
Abstract
Background In hospital surgical wards, patients are at higher risk for medication errors, in part because physicians may not consider themselves sufficiently trained to prescribe medications. Hence, collaborative teamwork involving the pharmacist is needed. Objectives To assess the impact of medication reconciliation directed by pharmacists on decreasing medication discrepancies after discharge from the surgical ward. Methods Patients admitted to the surgical unit at a tertiary teaching hospital in Amman, Jordan, between July 2017 and July 2018 were selected and randomly assigned to either the control or the intervention group. Upon admission, the number and kinds of unintentional medication discrepancies were determined for both groups. Medication reconciliation was then provided to patients in the intervention group. The number of unintentional discrepancies was re-evaluated upon discharge for both groups. To assess differences between the control and intervention groups, the χ2 or Fisher exact test was used for categorical variables and an independent-sample t test for continuous data. A paired t test was conducted to determine whether the number of medication discrepancies was reduced as a result of pharmacists' recommendations. Results A total of 123 patients met the inclusion criteria, 61 in the intervention group and 62 in the control group. Discrepancies of omission and wrong dose constituted 41 (77%) of the 53 discrepancies in the intervention group and 25 (76%) of the 33 discrepancies in the control group. The number of unintentional discrepancies was significantly reduced from admission to discharge in both the intervention group (p = 0.002) and the control group (p = 0.007). Of 53 recommendations made by pharmacists, 20 (38%) were accepted by the treating physician, and all of these discrepancies were resolved. Conclusions This study sheds light on the existence of unintentional medication discrepancies upon admission for surgical patients, which may expose the patients to potential harm upon discharge from hospital. Additional studies with a larger sample size are needed to gain further insights on pharmacists' role in implementing medication reconciliation for surgical patients.
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Savva G, Merkouris A, Charalambous A, Papastavrou E. Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From an Observational Study. J Patient Saf 2022; 18:e645-e651. [PMID: 34508041 DOI: 10.1097/pts.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors. METHODS This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors. RESULTS From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected. CONCLUSIONS Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.
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Affiliation(s)
| | - Anastasios Merkouris
- From the Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Evridiki Papastavrou
- From the Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Lin WC, Chen JS, Kaluzny J, Chen A, Chiang MF, Hribar MR. Extraction of Active Medications and Adherence Using Natural Language Processing for Glaucoma Patients. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:773-782. [PMID: 35308943 PMCID: PMC8861739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Accuracy of medication data in electronic health records (EHRs) is crucial for patient care and research, but many studies have shown that medication lists frequently contain errors. In contrast, physicians often pay more attention to the clinical notes and record medication information in them. The medication information in notes may be used for medication reconciliation to improve the medication lists' accuracy. However, accurately extracting patient's current medications from free-text narratives is challenging. In this study, we first explored the discrepancies between medication documentation in medication lists and progress notes for glaucoma patients by manually reviewing patients' charts. Next, we developed and validated a named entity recognition model to identify current medication and adherence from progress notes. Lastly, a prototype tool for medication reconciliation using the developed model was demonstrated. In the future, the model has the potential to be incorporated into the EHR system to help with realtime medication reconciliation.
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Affiliation(s)
| | | | - Joel Kaluzny
- Ophthalmology Oregon Health & Science University, Portland, OR
| | - Aiyin Chen
- Ophthalmology Oregon Health & Science University, Portland, OR
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Schmitz K, Lenssen R, Rückbeil M, Berning D, Thomeczek C, Brokmann JC, Jaehde U, Eisert A. The WHO High 5s project: medication reconciliation in a German university hospital. A prospective observational cohort study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:27-32. [PMID: 35148970 DOI: 10.1016/j.zefq.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ensuring medication accuracy during transitions in care is one of the five highly prevalent patient safety problems focused on within the World Health Organization High 5s Project. Medication reconciliation is a standardized patient care process that can be used to address this problem. The aim of the current study is to implement medication reconciliation in a German university hospital. METHODS The study was conducted at the Emergency Department of the University Hospital Aachen, Germany. All discrepancies between the Best Possible Medication History and the Admission Medication Order were documented and classified as documentation errors or medication errors. The type of error was also recorded. A negative binomial regression model was used to test several factors influencing the number of discrepancies. RESULTS The medications of 105 patients were reconciled. The mean number of discrepancies per patient was 4.6± 3.6, with a total of 298 medication errors and 189 documentation errors. The most common type of medication error was the omission of a drug (n=208; 69.8 %). In the negative binomial regression analysis, the care status (p=0.0015) as well as the number of preadmission drugs (p=0.0007) were significantly associated with medication errors. DISCUSSION A high number of discrepancies was detected and analysed. Patients admitted from nursing homes were less likely to have discrepancies in their medication reconciliation, perhaps because a structured documentation system for medications is already in place at nursing homes including error prone products (special dosage forms or food supplements). CONCLUSIONS In this study, medication reconciliation was implemented at a German full-care university hospital. The actual number of discrepancies observed strongly indicates the need for medication reconciliation at hospital admission.
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Affiliation(s)
- Katharina Schmitz
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany.
| | - Rebekka Lenssen
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany
| | - Marcia Rückbeil
- Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Berning
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | | | | | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Albrecht Eisert
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Clinical Pharmacology of the University Hospital RWTH Aachen, Aachen, Germany
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12
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van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. Risk factors for clinically relevant deviations in patients' medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting. Int J Clin Pharm 2022; 44:539-547. [PMID: 35032251 PMCID: PMC9007785 DOI: 10.1007/s11096-022-01376-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Background Personal health records have the potential to identify medication discrepancies. Although they facilitate patient empowerment and broad implementation of medication reconciliation, more medication discrepancies are identified through medication reconciliation performed by healthcare professionals. Aim We aimed to identify the factors associated with the occurrence of a clinically relevant deviation in a patient’s medication list based on a personal health record (used by patients) compared to medication reconciliation performed by a healthcare professional. Method Three- to 14 days prior to a planned admission to the Cardiology-, Internal Medicine- or Neurology Departments, at Amphia Hospital, Breda, the Netherlands, patients were invited to update their medication file in their personal health records. At admission, medication reconciliation was performed by a pharmacy technician. Deviations were determined as differences between these medication lists. Associations between patient-, setting-, and medication-related factors, and the occurrence of a clinically relevant deviation (National Coordinating Council for Medication Error Reporting and Prevention class \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ E) were analysed. Results Of the 488 patients approached, 155 patients were included. Twenty-four clinically relevant deviations were observed. Younger patients (adjusted odds ratio (aOR) 0.94; 95%CI:0.91–0.98), patients who used individual multi-dose packaging (aOR 14.87; 95%CI:2.02–110), and patients who used \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 8 different medications, were at highest risk for the occurrence of a clinically relevant deviation (sensitivity 0.71; specificity 0.62; area under the curve 0.64 95%CI:0.52–0.76). Conclusion Medication reconciliation is the preferred method to identify medication discrepancies for patients with individual multi-dose packaging, and patients who used eight or more different medications.
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Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Breda, The Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
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13
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Magalhães GF, Rosa MB, Noblat LACB. Patients’ medication reconciliation in a university hospital. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Quintana-Barcena P, Sinner C, Berger J. Domiciliary medication review (ReMeDo): development, reliability and acceptability of a tool for community pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 30:129-135. [PMID: 34969087 DOI: 10.1093/ijpp/riab078] [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: 04/14/2021] [Accepted: 11/25/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Polymedication and medication hoarding in patients' homes may increase the risk of drug-related problems (DRPs). Community pharmacists can prevent DRPs through medication reconciliation and review. This study aims to (1) develop a tool for community pharmacists to perform domiciliary medication review (ReMeDo) and (2) assess the interrater and test-retest reliability and acceptability of the tool. METHODS The ReMeDo tool was first developed 6 years before this study to perform medication review during pharmacist home visits. A literature review was performed to update the content of the existing tool. Ten pharmacy students participated in the assessment of the interrater and test-retest reliability using three vignettes based on former ReMeDo patients. Test-retest reliability coefficients were calculated for the entire tool and each segment. Global and individual interrater reliability coefficients were also computed. Acceptability was assessed through a satisfaction survey. KEY FINDINGS The ReMeDo tool was structured to guide the collection of information before, during and after the pharmacist home visit. The global kappa coefficients for interrater and test-retest reliability were 0.70 (95% confidence interval (CI), 0.67 to 0.73) and 0.71 (95% CI, 0.68 to 0.74), respectively. The test-retest reliability coefficients for each segment and the interrater reliability coefficients for participants were higher than 0.60 (except for one participant), demonstrating a moderate to substantial level of agreement. The tool was deemed acceptable by participants. CONCLUSIONS The ReMeDo tool proved to be reliable and acceptable for use by community pharmacists to perform medication review in patients' homes.
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Affiliation(s)
- Patricia Quintana-Barcena
- Community Pharmacy of the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Caroline Sinner
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Jérôme Berger
- Community Pharmacy of the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Falconer N, Snoswell C, Morris C, Barras M. The right time and place: the need for seven‐day pharmacist service models. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Centaine Snoswell
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Christopher Morris
- Department of Internal Medicine Princess Alexandra Hospital Metro South Health Brisbane Australia
| | - Michael Barras
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
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16
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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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17
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Gebre M, Addisu N, Getahun A, Workye J, Gamachu B, Fekadu G, Tekle T, Wakuma B, Fetensa G, Mosisa B, Bayisa G. Medication Errors Among Hospitalized Adults in Medical Wards of Nekemte Specialized Hospital, West Ethiopia: A Prospective Observational Study. Drug Healthc Patient Saf 2021; 13:221-228. [PMID: 34795534 PMCID: PMC8593339 DOI: 10.2147/dhps.s328824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mohammed Gebre
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Mohammed Gebre Email
| | - Nigatu Addisu
- Department of Pharmacy, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
| | - Ayantu Getahun
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Jenber Workye
- Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Busha Gamachu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tesfa Tekle
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getahun Fetensa
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Balisa Mosisa
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Bayisa
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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18
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Enríquez-Gómez A, Ortega-Navarro C, Fernández-Cordón C, Díez-Villanueva P, Martínez-Sellés M, de Lorenzo-Pinto A, de Miguel-Yanes JM. Comparison of a polypharmacy-based scale with Charlson comorbidity index to predict 6-month mortality in chronic complex patients after an ED visit. Br J Clin Pharmacol 2021; 88:1795-1803. [PMID: 34570393 DOI: 10.1111/bcp.15096] [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] [Received: 12/09/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to test whether a newly designed polypharmacy-based scale would perform better than Charlson's Comorbidity Index (CCI) to predict outcomes in chronic complex adult patients after a reference Emergency Department (ED) visit. METHODS We built a polypharmacy-based scale with prespecified drug families. The primary outcome was 6-month mortality after the reference ED visit. Predefined secondary outcomes were need for hospital admission, 30-day readmission, and 30-day and 90-day mortality. We evaluated the ability of the CCI and the polypharmacy-based scale to independently predict 6-month mortality using logistic regression, receiver operating characteristic (ROC) curves, and cumulative survival curves using Kaplan-Meier estimates and the log-rank test for three-category distributions of the polypharmacy-based scale and the CCI. Finally, we sought to replicate our results in two different external validation cohorts. RESULTS We included 201 patients (53.7% women, mean age = 81.4 years), 162 of whom were admitted to the hospital at the reference ED visit. In separate multivariable analyses accounting for gender, age and main diagnosis at discharge, both the polypharmacy-based scale (P < .001) and the CCI (P = .005) independently predicted 6-month mortality. The polypharmacy-based scale performed better in the ROC analyses (area under the curve [AUC] = 0.838, 95% confidence interval [CI] = 0.780-0.896) than the CCI (AUC = 0.628, 95% CI = 0.548-0.707). In the 6-month cumulative survival analysis, the polypharmacy-based scale showed statistical significance (P < .001), whereas the CCI did not (P = .484). We replicated our results in the validation cohorts. CONCLUSIONS Our polypharmacy-based scale performed significantly better than the CCI to predict 6-month mortality in chronic complex patients after a reference ED visit.
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Affiliation(s)
- Andrés Enríquez-Gómez
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ortega-Navarro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Clara Fernández-Cordón
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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19
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Dalton K, Fleming A, O'Mahony D, Byrne S. Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults. Br J Clin Pharmacol 2021; 88:628-654. [PMID: 34270111 DOI: 10.1111/bcp.14987] [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: 01/08/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. METHODS Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. RESULTS Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. CONCLUSION This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.,Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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20
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Gadallah A, McGinnis B, Nguyen B, Olson J. Assessing the impact of virtual medication history technicians on medication reconciliation discrepancies. Int J Clin Pharm 2021; 43:1404-1411. [PMID: 33871769 DOI: 10.1007/s11096-021-01267-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Background To overcome resource limitations, Ascension hospitals have implemented a virtual pharmacy technician program to facilitate the completion of medication histories in select emergency departments. Objective This multicenter retrospective study aimed to assess the impact of taking a medication history virtually by pharmacy technicians on medication reconciliation accuracy in comparison to other clinicians. Setting Ascension Seton hospitals in Austin, Texas, United States. Method A retrospective chart review including patients above the age of 18, who were directly admitted from the emergency department between January 1, 2019 and August 31, 2019. Study investigators identified, quantified and categorized unintentional discrepancies by comparing medication histories to reconciled medication orders at admission. Descriptive analysis was applied to patient demographics. Mann-Whitney U and chi-square tests were applied to continuous and categorical outcomes, respectively. Main outcome measure The type and number of unintentional discrepancies at admission. Results In 208 patients, a total of 190 unintentional discrepancies were identified. The rate of unintentional discrepancies per medication was significantly lower for virtual pharmacy technicians than other clinicians (8.6% vs. 14.8% respectively, p < 0.0001). The most common type of unintentional discrepancies was omission in both groups. Length of stay, readmissions, and emergency department visits were similar in both groups. The rate of incomplete medication histories was significantly lower for virtual pharmacy technicians than other clinicians (6.7% vs. 62.5% respectively, p < 0.0001). Conclusion Implementing a virtual medication history technician program in the emergency department can revolutionize the medication history completion process and lower unintentional medication discrepancy rates.
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Affiliation(s)
| | - Brandy McGinnis
- Ascension Texas Department of Pharmacy, Austin, TX, USA
- University of Texas College of Pharmacy, Austin, TX, USA
| | - Brian Nguyen
- Ascension Texas Department of Pharmacy, Austin, TX, USA
| | - Jon Olson
- Ascension Texas Department of Pharmacy, Austin, TX, USA
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21
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González C, González G, Plaza-Plaza JC, Inés Godoy M, Cárcamo M, Rojas C. Reduction of reconciliation errors in chronic pediatric patients through an educational strategy. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.07.009] [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] Open
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22
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Laroche ML, Van Ngo TH, Sirois C, Daveluy A, Guillaumin M, Valnet-Rabier MB, Grau M, Roux B, Merle L. Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. Eur Geriatr Med 2021; 12:485-497. [PMID: 33745106 DOI: 10.1007/s41999-021-00482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS A narrative overview. RESULTS The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/CONCLUSION Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.
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Affiliation(s)
- Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France. .,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France. .,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France.
| | - Thi Hong Van Ngo
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Caroline Sirois
- Université Laval, Faculté de Pharmacie, Québec, Canada.,Centre de Recherche VITAM en Santé Durable, Centre D'excellence sur le Vieillissement de Québec, Québec, Canada
| | - Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Michel Guillaumin
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France.,Département de Gériatrie, CHU de Besançon, Besançon, France
| | - Marie-Blanche Valnet-Rabier
- Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France
| | - Muriel Grau
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
| | - Barbara Roux
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France
| | - Louis Merle
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France.,Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France
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23
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Audurier Y, Roubille C, Manna F, Zerkowski L, Faucanie M, Macioce V, Castet-Nicolas A, Jalabert A, Villiet M, Fesler P, Lohan-Descamps L, Breuker C. Development and validation of a score to assess risk of medication errors detected during medication reconciliation process at admission in internal medicine unit: SCOREM study. Int J Clin Pract 2021; 75:e13663. [PMID: 32770845 DOI: 10.1111/ijcp.13663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medication errors (ME) can be reduced through preventive strategies such as medication reconciliation. Such strategies are often limited by human resources and need targeting high risk patients. AIMS To develop a score to identify patients at risk of ME detected during medication reconciliation in a specific population from internal medicine unit. METHODS Prospective observational study conducted in an internal medicine unit of a French University Hospital from 2012 to 2016. Adult hospitalised patients were eligible for inclusion. Medication reconciliation was conducted by a pharmacist and consisted in comparing medication history with admission prescription to identify MEs. Risk factors of MEs were analysed using multivariate stepwise logistic regression model. A risk score was constructed using the split-sample approach. The split was done at random (using a fixed seed) to define a development data set (N = 1256) and a validation sample (N = 628). A regression coefficient-base scoring system was used adopting the beta-Sullivan approach (Sullivan's scoring). RESULTS Pharmacists detected 740 MEs in 368/1884 (19.5%) patients related to medication reconciliation. Female gender, number of treatments >7, admission from emergency department and during night or weekend were significantly associated with a higher risk of MEs. Risk score was constructed by attributing 1 or 2 points to these variables. Patients with a score ≥3 (OR [95% CI] 3.10 [1.15-8.37]) out of 5 (OR [95% CI] 8.11 [2.89-22.78]) were considered at high risk of MEs. CONCLUSIONS Risk factors identified in our study may help prioritising patients admitted in internal medicine units who may benefit the most from medication reconciliation (ClinicalTrials.gov number NCT03422484).
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Affiliation(s)
- Yohan Audurier
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Federico Manna
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- IRCM-INSERM U1194, University of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Laura Lohan-Descamps
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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24
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Soares ADS, Trevisol DJ, Schuelter-Trevisol F. Medication discrepancies in a hospital in Southern Brazil: the importance of medication reconciliation for patient safety. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-979020200004181064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alessandra de Sá Soares
- Universidade do Sul de Santa Catarina, Brasil; Universidade do Sul de Santa Catarina, Brasil
| | - Daisson José Trevisol
- Universidade do Sul de Santa Catarina, Brasil; Universidade do Sul de Santa Catarina, Brasil
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25
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Pourrat X, Leyrat C, Allenet B, Bouzige B, Develay A, Fraysse M, Garnier V, Halimi J, Roux‐Marson C, Giraudeau B. Effectiveness of a multicomponent pharmacist intervention at hospital discharge for drug-related problems: A cluster randomised cross-over trial. Br J Clin Pharmacol 2020; 86:2441-2454. [PMID: 32383801 PMCID: PMC7688527 DOI: 10.1111/bcp.14349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 02/04/2023] Open
Abstract
AIMS The aim of this study was to assess whether a pharmacist intervention associating medication reconciliation at discharge with a link to the community pharmacist reduces drug-related problems (DRP) in adult patients during the 7 days after hospital discharge in 22 university or general hospitals in France. METHODS We conducted a cluster randomised cross-over superiority trial with hospital units as the cluster unit. The primary outcome was a composite of any kind of DRP (prescription/dispensation, patient error or gap due to no medication available) during the 7 days after discharge, assessed by phone with the patient and community pharmacist. Among secondary outcomes, we studied self-reported unplanned hospitalisations at day 35 after discharge and severe iatrogenic problems. RESULTS A total of 1092 patients were enrolled in 48 units (538 in the experimental periods and 554 in the control periods). Three patients refused to have their data analysed and were excluded from the analyses. As compared with usual care, the pharmacist intervention led to a lower proportion of patients with at least one DRP (44.0% vs 50.6%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.61-0.98) and severe iatrogenic problems (5.2% vs 8.7%; OR 0.57, 95% CI 0.35-0.93) but no significant difference in unplanned hospitalisations at day 35 (5.8% vs 4.5%; OR 1.46, 95% CI 0.91-2.35). CONCLUSION Medication reconciliation associated with communication between the hospital and community pharmacist may decrease patient exposure to DRP and severe iatrogenic problems but not unplanned hospitalisation. However, this intervention could be recommended in health policies to improve drug management.
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Affiliation(s)
| | - Clémence Leyrat
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Benoît Allenet
- Pharmacy Department, CHU de Grenoble, Grenoble, France; ThEMAS TIMC‐IMAG (UMR CNRS 5525)J Fourier UniversityGrenobleFrance
| | | | | | - Martial Fraysse
- Pharmacy Fraysse52 Rue du Commandant Jean DuhailFontenay‐sous‐Bois94120France
| | | | | | - Clarisse Roux‐Marson
- Pharmacy Department, CHU de Nîmes, Nîmes, France, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA 2415University Institute of Clinical Research, Montpellier UniversityMontpellierFrance
| | - Bruno Giraudeau
- INSERM CIC1415, CHRU de Tours, Tours, France; Université de ToursUniversité de NantesINSERM, SPHERE U1246ToursFrance
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26
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Hellström L, Eriksson T, Bondesson Å. Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems. Eur J Hosp Pharm 2020; 28:e128-e133. [PMID: 33199398 DOI: 10.1136/ejhpharm-2020-002492] [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] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process. OBJECTIVE To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs. METHOD Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken. RESULTS A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations. CONCLUSION DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.
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Affiliation(s)
- Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, Skåne County Council, Kristianstad, Sweden
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27
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Mohammad RA, Betthauser KD, Korona RB, Coe AB, Kolpek JH, Fritschle AC, Jagow B, Kenes M, MacTavish P, Slampak‐Cindric AA, Whitten JA, Jones C, Simonelli R, Rowlands I, Stollings JL. Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rima A. Mohammad
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Kevin D. Betthauser
- Department of Pharmacy Services Barnes‐Jewish Hospital Saint Louis Missouri USA
| | | | - Antoinette B. Coe
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | | | - Benjamin Jagow
- Department of Pharmacy MercyOne Des Moines Medical Center Des Moines Iowa USA
| | - Michael Kenes
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | | | | | - Carol Jones
- Department of Pharmacy Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | - Ian Rowlands
- Department of Pharmacy Barts Health NHS Trust London UK
| | - Joanna L. Stollings
- Department of Pharmacy and Critical Illness Brain Dysfunction, Survivorship (CIBS) Center, Vanderbilt University Medical Center Nashville Tennessee USA
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28
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Mardani A, Griffiths P, Vaismoradi M. The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review. J Multidiscip Healthc 2020; 13:1347-1361. [PMID: 33154651 PMCID: PMC7608001 DOI: 10.2147/jmdh.s276061] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To synthesise knowledge and to explore the role of the nurse in medicines management during transitional care. METHODS An integrative systematic review was conducted. Electronic databases such as PubMed [including Medline], Web of Knowledge, Scopus, and Cinahl from January 2010 to April 2020 were searched. Original qualitative and quantitative studies written in English that focused on the role of the nurse in medicines management during transitional care, which included movement between short-term, long-term, and community healthcare settings were included. RESULTS The search process led to the retrieval of 10 studies, which were published in English from 2014 to 2020. They focused on the role of the nurse in patients' medicines management during transitional care in various healthcare settings. Given variations in the aims and methods of selected studies, the review findings were presented narratively utilizing three categories developed by the authors. In the first category as 'medication reconciliation process' the nurse participated in obtaining medication history, performing medication review, identifying medication discrepancies, joint medication reconciliation and adjustment. The second category as 'collaboration with other healthcare providers' highlighted the nurses' role in clarifying medicines' concerns, interdisciplinary communication and consultation, discharge planning and monitoring. In the third category as 'provision of support to healthcare recipients', the nurse was responsible for interpersonal communication with patients, education about medicines, and simplification of medication regimens, and symptoms management during transitional care. CONCLUSION Nurses play a crucial role in the safety of medicines management during transitional care. Therefore, they should be empowered and more involved in medicines management initiatives in the healthcare system. Patient safety and avoidance of medication errors during transitional care require that medicines management becomes a multidisciplinary collaboration with effective communication between healthcare providers.
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Affiliation(s)
- Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Pauline Griffiths
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
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29
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González C, González G, Plaza-Plaza JC, Godoy MI, Cárcamo M, Rojas C. [Reduction of reconciliation errors in chronic pediatric patients through an educational strategy]. An Pediatr (Barc) 2020; 94:238-244. [PMID: 32917544 DOI: 10.1016/j.anpedi.2020.07.005] [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: 04/23/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medication reconciliation errors, also known as unintentional discrepancies, are frequent during admission, especially in chronic patients, and have an impact on safety. Educational interventions can be a reduction strategy. MATERIAL AND METHODS Quasi-experimental study, before-after design. Participants were chronic patients admitted into hospitalization services. Medication reconciliation was conducted at admission. The intervention consisted of a training to each prescribing physician with study contents and printed educational material. To study the association between intervention and change of frequency of unintentional discrepancies was made a logistic regression model, adjusting for selected variables. RESULTS A sample of 54 patients was studied in each stage. In the first stage it was observed that 42.6% of patients had at least one unintentional discrepancy. After intervention the proportion of patients with at least one unintentional discrepancy decreased to 24.1% (p = 0.041). In both stages, omission was the main category of unintentional discrepancy. The significant reduction after the intervention is maintained by controlling for variables such as emergency admission and pre-admission service. CONCLUSIONS Incidence of unintentional discrepancies in admission is high in chronic hospitalized patients and can be reduced through an educative strategy.
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Affiliation(s)
- Claudio González
- Hospital de niños Dr. Exequiel González Cortés, San Miguel, Santiago, Chile; Depto. Salud Pública y Epidemiología, Universidad de los Andes, Santiago, Chile.
| | - Gabriela González
- Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - María Inés Godoy
- Unidad de Desarrollo, Análisis e Investigación, Departamento de Evaluación, Medición y Registro Educacional, Universidad de Chile, Santiago, Chile
| | - Marcela Cárcamo
- Depto. Salud Pública y Epidemiología, Universidad de los Andes, Santiago, Chile
| | - Cecilia Rojas
- Hospital de niños Dr. Exequiel González Cortés, San Miguel, Santiago, Chile
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30
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Tong EY, Edwards G, Hua PU, Yip G. Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Erica Y. Tong
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Australia
| | - Gail Edwards
- Pharmacy Department Alfred Health Melbourne Australia
| | | | - Gary Yip
- General Medicine Unit Alfred Health Melbourne Australia
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31
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Dei Tos M, Canova C, Dalla Zuanna T. Evaluation of the medication reconciliation process and classification of discrepancies at hospital admission and discharge in Italy. Int J Clin Pharm 2020; 42:1061-1072. [PMID: 32556895 DOI: 10.1007/s11096-020-01077-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/02/2020] [Indexed: 11/26/2022]
Abstract
Background Medication errors at different transitions of care are common and potentially harmful. Medication reconciliation process should be evaluated to reduce the unintentional discrepancies. Objective This study aims to identify and classify unintentional medication discrepancies at hospital admission and discharge and associated risk factors. Setting Two general internal medicine and a pulmonology wards of an Italian non-academic hospital. Method A retrospective observational study was conducted among adult patients admitted to the wards. In order to evaluate the current medication reconciliation process of these wards, the frequency and type of unintentional chronic medication discrepancies between the physician assessment of home medication and hospital admission and discharge prescriptions were studied. Patients' characteristic associated with the presence of at least one unintentional discrepancy were evaluated. Main outcome measure Frequencies of unintentional medication discrepancies upon admission and discharge and associated patients' characteristics. Results Among the 144 patients enrolled in the study, 53 and 64 unintentional medication discrepancies were identified at hospital admission and at discharge, respectively. Both at admission and discharge a quarter of patients had at least one unintentional discrepancy. 'Medication omission' was the most frequent type of discrepancy identified and respiratory system and nervous system were the classes of medication with the highest rate of unintentional discrepancies. Unintentional discrepancies were more likely to occur in patients receiving more medicine pre-admission, longer hospitalization stays and coming from or discharged to a nursing home. Conclusion Transitions of care are critical moments for patient safety in terms of unintentional medication discrepancies and a more structured medication reconciliation process is needed. The medication reconciliation process should be considered in terms of a multidisciplinary approach involving all health professionals as well as patients and caregivers directly.
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Affiliation(s)
- Mattia Dei Tos
- Emergency Department, AULSS 2, Via C. Forlanini 71, 31029, Vittorio Veneto, Treviso, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy
| | - Teresa Dalla Zuanna
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy.
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32
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Holbrook A, Bannerman H, Ahmed A, Georgy M, Liu JT, Troyan S, Watt A. Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge. Can J Hosp Pharm 2019; 72:421-427. [PMID: 31853142 PMCID: PMC6910843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals. OBJECTIVES To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. METHODS The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors. RESULTS The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors. CONCLUSIONS The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.
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Affiliation(s)
- Anne Holbrook
- , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario
| | - Heather Bannerman
- , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario
| | - Amna Ahmed
- , MD, is with the Department of Medicine, McMaster University, Hamilton, Ontario
| | - Michael Georgy
- , MBBCh, is a student currently affiliated with the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Tiger Liu
- , MSc, was, at the time of this study, a student with the eHealth Master's Program, McMaster University, Hamilton, Ontario
| | - Sue Troyan
- , BA, is with the Division of Clinical Pharmacology & Toxicology, St Joseph's Hospital Hamilton, Hamilton, Ontario
| | - Alice Watt
- , BSc(Pharm), RPh, is with the Institute for Safe Medication Practices Canada, Toronto, Ontario
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33
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Slight SP, Tolley CL, Bates DW, Fraser R, Bigirumurame T, Kasim A, Balaskonis K, Narrie S, Heed A, Orav EJ, Watson NW. Medication errors and adverse drug events in a UK hospital during the optimisation of electronic prescriptions: a prospective observational study. LANCET DIGITAL HEALTH 2019; 1:e403-e412. [PMID: 33323222 DOI: 10.1016/s2589-7500(19)30158-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND WHO's Third Global Patient Safety Challenge, Medication Without Harm, focused on reducing the substantial burden of iatrogenic harm associated with medications by 50% in the next 5 years. We aimed to assess whether the number and type of medication errors changed as an electronic prescribing system was optimised over time in a UK hospital. METHODS We did a prospective observational study at a tertiary-care teaching hospital. Eight senior clinical pharmacists reviewed patients' records and collected data across four adult wards (renal, cardiology, general medical, and orthopaedic surgical) over a 2-year period (from Sept 29, 2014, to June 9, 2016). All medication errors and potential and actual adverse drug events were documented and the number of medication errors measured over the course of four time periods 7-10 weeks long. Pharmacists also recorded instances where the electronic prescribing system contributed to an error (system-related errors). A negative-binomial model and a Poisson model were used to identify factors related to medication error rates. FINDINGS 5796 primary errors were recorded over the four time periods (period 1, 47 days [Sep 29-Dec 2, 2014]; period 2, 38 days [April 20-June 12, 2015, for the renal, medical, and surgical wards and April 20-June 15, 2015, for the cardiology ward]; period 3, 35 days [Sep 28-Nov 27, 2015] for the renal ward, 37 days [Sep 28-Nov 23, 2015] for the medical ward, and 40 days [Sep 28-Nov 20, 2015] for the cardiology and surgical wards; and period 4, 37 days [Feb 22-April 15, 2015] for the renal and medical wards and 39 days for the cardiology [April 13-June 7, 2015] and surgery [April 18-June 9, 2015] wards; unanticipated organisational factors prevented data collection on some days during each time period). There was no change in the rate of primary medication errors per admission over the observation periods: 1·53 medication errors in period 1, 1·44 medication errors in period 2, 1·70 medication errors in period 3, and 1·43 medication errors in period 4, per admission. By contrast, the overall rate of different types of medication errors decreased over the four periods. The most common types of error were medicine-reconciliation, dose, and avoidable delay-of-treatment errors. Some types of errors appeared to reduce over time (eg, dose errors [from 52 errors in period 1 to 19 errors in period 4, per 100 admissions]), whereas others increased (eg, inadequate follow-up of therapy [from 12 errors in period 1 to 24 errors in period 4, per 100 admissions]). We also found a reduction in the rates of potential adverse drug events between the first three periods and period 4. 436 system-related errors were recorded over the study period. INTERPRETATION Although the overall rates of primary medication errors per admission did not change, we found a reduction in some error types and a significant decrease in the rates of potential adverse drug events over a 2-year period, during which system optimisation occurred. Targeting some error types could have the added benefit of reducing others, which suggests that system optimisation could ultimately help improve patient safety and outcomes. FUNDING No funding.
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Affiliation(s)
- Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK; The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK; The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Clare L Tolley
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David W Bates
- The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Health and Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA; Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rachel Fraser
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | | | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Stockton on Tees, UK
| | | | - Steven Narrie
- Northumbria Healthcare National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Heed
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - E John Orav
- The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Neil W Watson
- The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
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Walsh EK, Kirby A, Kearney PM, Bradley CP, Fleming A, O'Connor KA, Halleran C, Cronin T, Calnan E, Sheehan P, Galvin L, Byrne D, Sahm LJ. Medication reconciliation: time to save? A cross-sectional study from one acute hospital. Eur J Clin Pharmacol 2019; 75:1713-1722. [PMID: 31463579 DOI: 10.1007/s00228-019-02750-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.
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Affiliation(s)
- Elaine K Walsh
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Ann Kirby
- School of Economics, University College Cork, Cork, Ireland
| | | | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Aoife Fleming
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran A O'Connor
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Ciaran Halleran
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Timothy Cronin
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Calnan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Patricia Sheehan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura Galvin
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Derina Byrne
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
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Redmond P, McDowell R, Grimes TC, Boland F, McDonnell R, Hughes C, Fahey T. Unintended discontinuation of medication following hospitalisation: a retrospective cohort study. BMJ Open 2019; 9:e024747. [PMID: 31167862 PMCID: PMC6561421 DOI: 10.1136/bmjopen-2018-024747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/01/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice. DESIGN Retrospective cohort study between 2012 and 2015. SETTING Electronic records and hospital supplied discharge notifications in 44 Irish general practices. PARTICIPANTS 20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions. PRIMARY AND SECONDARY OUTCOMES Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient's general practitioner (GP) prescribing record at 6 months follow-up. RESULTS In patients admitted to hospital, medication discontinuity ranged from 6%-11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01). CONCLUSION Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.
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Affiliation(s)
- Patrick Redmond
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Ronald McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen’s University, Cancer Epidemiology and Health Services Group, Belfast, UK
| | | | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Giannini O, Rizza N, Pironi M, Parlato S, Waldispühl Suter B, Borella P, Pagnamenta A, Fishman L, Ceschi A. Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward. BMJ Open 2019; 9:e026259. [PMID: 31133583 PMCID: PMC6538074 DOI: 10.1136/bmjopen-2018-026259] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Medication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including a best possible medication history (BPMH) compared with a standard medication history in patients admitted to an internal medicine ward. DESIGN Prospective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model. SETTING Internal medicine ward in a secondary care hospital in Southern Switzerland. PARTICIPANTS The first 100 consecutive patients admitted in an internal medicine ward. PRIMARY AND SECONDARY OUTCOME MEASURES Medication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified. RESULTS The median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model. CONCLUSION Even in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.
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Affiliation(s)
- Olivier Giannini
- Department of Internal Medicine, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Ticino, Switzerland
| | - Nicole Rizza
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michela Pironi
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Saida Parlato
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Paola Borella
- Department of Internal Medicine, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Ticino, Switzerland
| | - Alberto Pagnamenta
- Unit of Clinical Epidemiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Pneumology, University of Geneva, Geneva, Switzerland
| | | | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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Chung C, Gauthier V, Marques-Tavares F, Hindlet P, Cohen A, Fernandez C, Antignac M. Medication reconciliation: Predictors of risk of unintentional medication discrepancies in the cardiology department. Arch Cardiovasc Dis 2019; 112:104-112. [DOI: 10.1016/j.acvd.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/26/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
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Van Der Luit CD, De Jong IR, Ebbens MM, Euser S, Verweij SL, Van Den Bemt PM, Luttikhuis HM, Becker ML. Frequency of occurrence of medication discrepancies and associated risk factors in cases of acute hospital admission. Pharm Pract (Granada) 2018; 16:1301. [PMID: 30637032 PMCID: PMC6322986 DOI: 10.18549/pharmpract.2018.04.1301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/01/2018] [Indexed: 11/14/2022] Open
Abstract
Background Medication discrepancies are a common occurrence following hospital admission and carry the potential for causing harm. However, little is known about the potential risk factors involved in medication discrepancies. Objective The objective of this study was to determine how frequently medication discrepancies occur and their associated risk factors, in patients hospitalized via the emergency department of the Spaarne Gasthuis Hospital, located in The Netherlands. Methods This retrospective observational study examines 832 hospital admissions which took place between April 1st and June 30th, 2015. Medication reconciliation was performed within 24 hours of admission and medication discrepancies were registered. The primary outcome recorded in the study was the proportion of patients experiencing one or more medication discrepancies, as verified by the physician. As a secondary outcome, the association between these discrepancies and pre-specified variables was analyzed using univariate and multivariate logistic regression. Results At least one medication discrepancy was found to have occurred with 97 of the 832 patients (11.7%), the most common discrepancies involving incorrect drug dose (44.9%) and omission of medication (36.4%). In the univariate analysis, age (OR=1.03 [95% CI 1.02:1.04] p<0.001) and number of pre-admission medications taken (OR=1.13 [95%CI 1.09:1.17] p<0.001) were revealed to be significantly associated with the risk of medication discrepancies. Sex, type of medical specialty, and surgical versus non-surgical specialty were found not to be significantly associated with discrepancies. In the multivariate analysis, both the number of pre-admission medications (OR=1.10 [95%CI 1.06:1.15] p<0.001) and age (OR=1.02 [95%CI 1.01:1.03] p=0.004) were independently associated with the risk of medication discrepancy. Conclusions Of the total number of patients, 11.7% experienced one or more medication discrepancies following admission to the hospital. Elderly patients taking multiple drugs were found to be particularly at risk.
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Affiliation(s)
| | - Iris R De Jong
- Pharmacy Foundation of Haarlem Hospitals. Haarlem; & University of Groningen, Faculty of Science and Engineering. Groningen (Netherlands).
| | - Marieke M Ebbens
- Clinical Pharmacist, Researcher. Department of Pharmacy, St Jansdal Hospital. Harderwijk; & Department of Hospital Pharmacy, Erasmus University Medical Centre. Rotterdam (Netherlands).
| | - Sjoerd Euser
- Spaarne Gasthuis Academy, Spaarne Gasthuis. Haarlem (Netherlands).
| | - Sjoerd L Verweij
- Clinical Pharmacist. Pharmacy Foundation of Haarlem Hospitals. Haarlem (Netherlands).
| | - Patricia M Van Den Bemt
- Clinical Pharmacist, Professor in Medication Safety. Department of Hospital Pharmacy, Erasmus University Medical Centre. Rotterdam (Netherlands).
| | - Hanneke M Luttikhuis
- Clinical Pharmacist. Pharmacy Foundation of Haarlem Hospitals. Haarlem (The Netherlands).
| | - Matthijs L Becker
- Clinical Pharmacist, Researcher. Pharmacy Foundation of Haarlem Hospitals. Haarlem (Netherlands).
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Pisa FE, Palese F, Romanese F, Barbone F, Logroscino G, Riedel O. How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data. Int J Methods Psychiatr Res 2018; 27:e1724. [PMID: 29869820 PMCID: PMC7133096 DOI: 10.1002/mpr.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. METHODS We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. RESULTS Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). CONCLUSION Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used.
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Affiliation(s)
- Federica Edith Pisa
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | | | - Fabio Barbone
- Department of Medicine, University of Udine, Udine, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Salameh LK, Abu Farha RK, Abu Hammour KM, Basheti IA. Impact of pharmacist's directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies and improving patient's outcomes at discharge from hospital.
Methods
During the 3-month study period, 200 patients were randomly selected from internal medicine department from Jordan University Hospital (JUH) and allocated into two groups (intervention and control groups). The number and types of medication discrepancies were identified at admission. Then, pharmacist implemented medication reconciliation and medication counselling services to the intervention group patients. At discharge, the number of unintentional discrepancies was evaluated for both groups. Patients were assessed at 1 month following their discharge for any subsequent hospital readmissions, emergency department visits or side effects of medication therapy.
Key findings
The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group. Omission and addition represented the most common types of discrepancies for both groups. Of the 84 recommendations submitted by pharmacists, clinicians accepted 78 cases (92.8%), and implemented only 46 recommendations (54.7%). At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, P-value (0.014), while no significant change was found for the control group, P-value = 0.508. One month postdischarge, a significantly higher number of patients in the control group reported experiencing side effects compared with the intervention group, P-value = 0.020.
Conclusion
The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors and improving health outcomes.
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Affiliation(s)
- Lana K. Salameh
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rana K. Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Khawla M. Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Iman A. Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Motulsky A, Weir DL, Couture I, Sicotte C, Gagnon MP, Buckeridge DL, Tamblyn R. Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada. J Am Med Inform Assoc 2018; 25:722-729. [PMID: 29590350 DOI: 10.1093/jamia/ocy015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
Objective (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. Methods A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. Results There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Conclusions Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.
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Affiliation(s)
- Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada
| | - Daniala L Weir
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | | | - Claude Sicotte
- Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.,Healthcare organization management host team (EA7348 MOS - Management des organisations de santé - Healthcare Organization Management), EHESP - École des hautes études en santé publique, France
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
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Niederhauser A, Zimmermann C, Fishman L, Schwappach DLB. Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study. BMJ Open 2018; 8:e020566. [PMID: 29773700 PMCID: PMC5961573 DOI: 10.1136/bmjopen-2017-020566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. DESIGN Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. SETTING Internal medicine units in two mid-sized Swiss hospitals. PARTICIPANTS 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). RESULTS Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. CONCLUSION The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety.
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Affiliation(s)
| | | | - Liat Fishman
- Swiss Patient Safety Foundation, Zürich, Switzerland
| | - David L B Schwappach
- Swiss Patient Safety Foundation, Zürich, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Gillespie U, Eriksson T. Medication reconciliation activities among pharmacists in Europe. Eur J Hosp Pharm 2018; 25:100-102. [DOI: 10.1136/ejhpharm-2016-000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 11/04/2022] Open
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Canning ML, Munns A, Tai B. Accuracy of best possible medication history documentation by pharmacists at an Australian tertiary referral metropolitan hospital. Eur J Hosp Pharm 2018; 25:e52-e58. [PMID: 31157067 DOI: 10.1136/ejhpharm-2016-001177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 11/04/2022] Open
Abstract
Aim To determine the quality of best possible medication history (BPMH) taking activities undertaken by pharmacists. To identify factors which impact upon erroneous documentation. To assess risks associated with erroneous documentation of BPMH by pharmacists. Method A clinical pharmacist randomly selected patients across a tertiary referral, metropolitan hospital over an 9-day period and documented comparator medication histories (CMHs) using a structured interview. BPMH documented by pharmacists as part of routine care and CMH were compared, and erroneous documentation was classified according to previous definitions in the literature. Erroneous documentation was risk stratified. Results 99 BPMH and CMH were compared. There were 14 medication omissions which occurred across 10 patients and 14 discrepancies across 12 patients. There was no association identified between erroneous documentation and pharmacist seniority/experience (p=0.25), where BPMH taken (p=0.7), day of week BPMH documented (p=0.45) or time since admission to when BPMH was documented (p=1). Patient age did not impact erroneous documentation rates (p=0.22). There was an association between the number of sources used to confirm a medication history and erroneous documentation incidence (p=0.035). The number of medications increased the rate of documentation error. While 85.19% (n=115) of erroneous documentation were deemed unlikely to cause patient discomfort or clinical deterioration, 1.48% (n=2) had the potential to result in severe discomfort or clinical deterioration. Conclusion Six out of seven BPMH documented by pharmacists as part of usual clinical practice are accurate. Major influences on accuracy include the number of medications and sources used. There is a low possibility that erroneous documentation by pharmacists will cause harm.
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Affiliation(s)
- Martin L Canning
- Pharmacy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
| | - Andrew Munns
- Pharmacy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
| | - Bonnie Tai
- Pharmacy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
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Mongaret C, Quillet P, Vo TH, Aubert L, Fourgeaud M, Michelet-Huot E, Bonnet M, Bedouch P, Slimano F, Gangloff SC, Drame M, Hettler D. Predictive factors for clinically significant pharmacist interventions at hospital admission. Medicine (Baltimore) 2018; 97:e9865. [PMID: 29489684 PMCID: PMC5851721 DOI: 10.1097/md.0000000000009865] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pharmaceutical care activities at hospital admission have a significant impact on patient safety. The objective of this study was to identify predictive factors for clinically significant pharmacist interventions (PIs) performed during medication reconciliation and medication review at patient hospital admission.A 4-week prospective study was conducted in 4 medicine wards. At hospital admission, medication reconciliation and medication review were conducted and PIs were performed by the pharmaceutical team. The clinical impact of PIs was determined using the clinical economic and organizational (CLEO) tool. Clinical characteristics, laboratory results, and medication data for each patient were collected and analyzed as potential predictive factors of clinically significant PIs. Univariate and multivariate binary logistic regression were subsequently used to identify independent predictive factors for clinically relevant PIs.Among 265 patients admitted, 150 patients were included. Among 170 PIs performed at hospital admission, 71 were related to unintentional discrepancies (41.8%) during medication reconciliation, and 99 were related to drug-related problems (DRPs) (58.8%) during medication review. Overall, 115 PIs (67.7%) were considered to have a clinical impact. By multivariate analysis, number of medications ≥5 (P = .01) based on the best possible medication history, and Charlson comorbidity index score ≥2 (P < .01) were found to be independent predictive factors of clinically significant PIs at hospital admission.Identifying predictive factors of clinically significant PIs is valuable to optimize clinical pharmacist practices at hospital admission during both medication reconciliation and medication review. These 2 steps of the pharmaceutical care process improve medication safety at hospital admission.
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Affiliation(s)
- Céline Mongaret
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
- UFR of Pharmacy, Reims Champagne Ardennes BIOS URCA; Reims Cedex
| | - Pauline Quillet
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
| | - Thi Ha Vo
- University Grenoble Alpes/CNRS, ThEMAS TIMC UMR, Grenoble Cedex
| | - Léa Aubert
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
| | - Mathieu Fourgeaud
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
| | | | - Morgane Bonnet
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
| | - Pierrick Bedouch
- University Grenoble Alpes/CNRS, ThEMAS TIMC UMR, Grenoble Cedex
- Pharmacy Department, University Hospital of Grenoble, Hôpital Michallon, Grenoble Cedex
| | - Florian Slimano
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
- University of Reims Champagne Ardennes, Research Unit MEDyC UMR CNRS/URCA, rue Cognacq Jay, Reims Cedex
| | | | - Moustapha Drame
- Department of Research and Innovation, University Hospital of Reims, Reims, France
| | - Dominique Hettler
- Pharmacy Department, University Hospital of Reims, Rue du General Koenig
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Bonaudo M, Martorana M, Dimonte V, D'Alfonso A, Fornero G, Politano G, Gianino MM. Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy. PLoS One 2018; 13:e0191028. [PMID: 29329310 PMCID: PMC5766134 DOI: 10.1371/journal.pone.0191028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. METHODS A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). RESULTS Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. CONCLUSIONS This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.
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Affiliation(s)
- Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | - Maria Martorana
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | - Valerio Dimonte
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
| | | | - Giulio Fornero
- AOU Città della salute e della Scienza, Teaching Hospital, Torino, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy
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Impact of collaborative pharmaceutical care on in-patients' medication safety: study protocol for a stepped wedge cluster randomized trial (MEDREV study). Trials 2018; 19:19. [PMID: 29310711 PMCID: PMC5759250 DOI: 10.1186/s13063-017-2412-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022] Open
Abstract
Background Clinical pharmaceutical care has long played an important role in the improvement of healthcare safety. Pharmaceutical care is a collaborative care approach, implicating all the actors of the medication circuit in order to prevent and correct drug-related problems that can lead to adverse drug events. The collaborative pharmaceutical care performed during patients’ hospitalization requires two mutually reinforcing activities: medication reconciliation and medication review. Until now, the impact of the association of these two activities has not been clearly studied. Methods This is a multicentric stepped wedge randomized study involving six care units from six French University Hospitals (each unit corresponding to a cluster) over seven consecutive 14-day periods. Each hospital unit will start with a control period and switch to an experimental period after a randomized number of 14-day periods. Patients aged at least 65 years hospitalized in one of the participating care units and having given their consent to be called for a 30-day and 90-day follow-up can be enrolled. For each 14-day period, 15 patients will be recruited in each care unit to obtain a total of 630 patients enrolled in all centers. Patients with a hospital stay of more than 21 days will be excluded. During the control period, there will be no clinical pharmacist in the care unit, whereas during the experimental period a clinical pharmacist will perform medication reconciliation and review with the healthcare team. The primary outcome will assess the impact of collaborative pharmaceutical care on preventable medication error rate. The secondary outcomes will evaluate the clinical impact of the strategy, the acceptance rate of pharmaceutical interventions, the induced and avoided costs of the strategy (cost-consequence analysis), and the healthcare team’s satisfaction. Discussion This study will assess the impact of collaborative pharmaceutical care associating medication reconciliation and review at patient admission to hospital in terms of preventable medication error rate and costs. This activity will prevent and correct medication errors arising earlier in the hospitalization. Trial registration ClinicalTrials.gov, NCT02598115. Registered on 4 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2412-7) contains supplementary material, which is available to authorized users.
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Salameh L, Abu Farha R, Basheti I. Identification of medication discrepancies during hospital admission in Jordan: Prevalence and risk factors. Saudi Pharm J 2018; 26:125-132. [PMID: 29379344 PMCID: PMC5783820 DOI: 10.1016/j.jsps.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/01/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Medication errors are considered among the most common causes of morbidity and mortality in hospital setting. Among these errors are discrepancies identified during transfer of patients from one care unit to another, from one physician care to another, or upon patient discharge. Thus, the aims of this study were to identify the prevalence and types of medication discrepancies at the time of hospital admission to a tertiary care teaching hospital in Jordan and to identify risk factors affecting the occurrence of these discrepancies. METHODS A three months prospective observational study was conducted at the department of internal medicine at Jordan university hospital. During the study period, 200 patients were selected using convenience sampling, and a pre-prepared data collection form was used for data collection. Later, a comparison between the pre-admission and admission medication was conducted to identify any possible discrepancies, and all of these discrepancies were discussed with the responsible resident to classify them into intentional (documentation errors) or unintentional. Linear regression analysis was performed to assess risk factors associated with the occurrence of unintentional discrepancies. RESULTS A total of 412 medication discrepancies were identified at the time of hospital admission. Among them, 144 (35%) were identified as unintentional while the remaining 268 (65%) were identified as intentional discrepancies. Ninety-four patients (47%) were found to have at least one unintentional discrepancy and 92 patients (46%) had at least one documentation error. Among the unintentional discrepancies, 97 (67%) were found to be associated with a potential harm/deterioration to the patients. Increasing patients' age (beta = 0.195, p-value = .013) and being treated by female residents (beta = 0.139, p-value = .045) were significantly associated with higher number of discrepancies. CONCLUSION The prevalence of unintentional discrepancies at the time of hospital admission was alarmingly high. Majority of these discrepancies were associated with a potential harm to the patients. These findings support the necessity for implementing the medication reconciliation service in the country, engaging healthcare providers in the process of identification and resolution of medication discrepancies.
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Affiliation(s)
| | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Onatade R, Quaye S. Economic value of pharmacy-led medicines reconciliation at admission to hospital: an observational, UK-based study. Eur J Hosp Pharm 2018; 25:26-31. [PMID: 31156981 PMCID: PMC6452339 DOI: 10.1136/ejhpharm-2016-001071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/12/2016] [Accepted: 11/16/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the cost-benefits of pharmacy-led medicines reconciliation (MR) on admission by applying a theoretical model (University of Sheffield School of Health and Related Research-SCHARR model) to real-world data. METHODS This was a retrospective, single-centre study. Setting 1000-bedded teaching hospital in London, UK. Clinical pharmacy contributions related to unintended medication discrepancies (averted preventable adverse drug events, pADEs), documented by pharmacy staff on prearranged days during 2012, were assessed for clinical significance by a panel of senior clinical pharmacists using the SCHARR model. Costs avoided were allocated according to the SCHARR model. Pharmacy staff carrying out admission MR were timed. Net cost avoidance was calculated by subtracting cost of time taken to carry out MR from the costs avoided by averting pADEs. Sensitivity analyses were carried out. RESULTS 118 pADEs averted as a result of MR were recorded over the 6 reporting days. 116 were rated for clinical significance. Gross costs avoided were £36 135-£75 249 (€44 446-€92 556). The admission MR process was timed for 48 patients. The mean time to complete MR for one patient was 14 min (range 1-40 min). The cost of carrying out one MR, based on the cost of employing a first-level post-foundation clinical pharmacist was £7.56 (€9.30). The net benefit of one MR was £34-£80 (€42-€98). The benefit:cost ratio was 5.53:1-11.51:1. CONCLUSIONS Pharmacy-led MR on admission has significant economic, as well as clinical benefits. Further work is required for full economic evaluations of MR.
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Affiliation(s)
- Raliat Onatade
- King's College London, Institute of Pharmaceutical Sciences, London, UK
- King's Health Partners, Pharmaceutical Sciences Clinical Academic Group, London, UK
| | - Samantha Quaye
- King's Health Partners, Pharmaceutical Sciences Clinical Academic Group, London, UK
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
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Athuraliya N, Sarunac J, Robertson J. Medication reconciliation at two teaching hospitals in Australia: a missed opportunity? Intern Med J 2017; 47:1440-1444. [DOI: 10.1111/imj.13634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/07/2017] [Accepted: 05/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nimmi Athuraliya
- Department of Medicine; The Maitland Hospital Clinical School, The Maitland Hospital; Maitland New South Wales Australia
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
- Department of General Medicine; Calvary Mater Newcastle; Newcastle New South Wales Australia
| | - Jasminka Sarunac
- Department of Pharmacy; The John Hunter Hospital; Newcastle New South Wales Australia
| | - Jane Robertson
- Department of Clinical Pharmacology; School of Medicine and Public Health, University of Newcastle; Newcastle New South Wales Australia
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