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Rhoten B, Jones AC, Maxwell C, Stolldorf DP. Hospital Adaptions to Mitigate the COVID-19 Pandemic Effects on MARQUIS Toolkit Implementation and Sustainability. J Healthc Qual 2024; 46:1-11. [PMID: 37788425 PMCID: PMC10840884 DOI: 10.1097/jhq.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To explore the perceived effects of COVID-19 on MARQUIS toolkit implementation and sustainability, challenges faced by hospitals in sustaining medication reconciliation efforts, and the strategies used to mitigate the negative effects of the pandemic. DATA SOURCES AND STUDY SETTINGS Primary qualitative data were extracted from a Web-based survey. Data were collected from hospitals that participated in MARQUIS2 ( n = 18) and the MARQUIS Collaborative ( n = 5). STUDY DESIGN A qualitative, cross-sectional study was conducted. DATA COLLECTION/DATA EXTRACTION Qualitative data were extracted from a Research Electronic Data Capture survey databased and uploaded into an Excel data analysis template. Two coders independently coded the data with a third coder resolving discrepancies. PRINCIPAL FINDINGS Thirty-one team members participated, including pharmacists ( n = 20; 65%), physicians ( n = 9; 29%), or quality-improvement (QI) specialists ( n = 2; 6%) with expertise in medication reconciliation (MedRec) (14; 45%) or QI (10; 32%). Organizational resources were limited, including funding, staffing, and access to pharmacy students. To support program continuation, hospitals reallocated staff and used new MedRec order sets. Telemedicine, workflow adaptations, leadership support, QI team involvement, and ongoing audits and feedback promoted toolkit sustainability. CONCLUSIONS COVID-19 affected the capacity of hospitals to sustain the MARQUIS toolkit. However, hospitals adapted various strategies to sustain the toolkit.
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Bongiovanni T, Pletcher MJ, Robinson A, Lancaster E, Zhang L, Behrends M, Wick E, Auerbach A. Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study. BMJ Health Care Inform 2023; 30:e100842. [PMID: 38159932 PMCID: PMC10759061 DOI: 10.1136/bmjhci-2023-100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Prescribing non-opioid pain medications, such as non-steroidal anti-inflammatory (NSAIDs) medications, has been shown to reduce pain and decrease opioid use, but it is unclear how to effectively encourage multimodal pain medication prescribing for hospitalised patients. Therefore, the aim of this study is to evaluate the effect of prechecking non-opioid pain medication orders on clinician prescribing of NSAIDs among hospitalised adults. METHODS This was a cluster randomised controlled trial of adult (≥18 years) hospitalised patients admitted to three hospital sites under one quaternary hospital system in the USA from 2 March 2022 to 3 March 2023. A multimodal pain order panel was embedded in the admission order set, with NSAIDs prechecked in the intervention group. The intervention group could uncheck the NSAID order. The control group had access to the same NSAID order. The primary outcome was an increase in NSAID ordering. Secondary outcomes include NSAID administration, inpatient pain scores and opioid use and prescribing and relevant clinical harms including acute kidney injury, new gastrointestinal bleed and in-hospital death. RESULTS Overall, 1049 clinicians were randomised. The study included 6239 patients for a total of 9595 encounters. Both NSAID ordering (36 vs 43%, p<0.001) and administering (30 vs 34%, p=0.001) by the end of the first full hospital day were higher in the intervention (prechecked) group. There was no statistically significant difference in opioid outcomes during the hospitalisation and at discharge. There was a statistically but perhaps not clinically significant difference in pain scores during both the first and last full hospital day. CONCLUSIONS This cluster randomised controlled trial showed that prechecking an order for NSAIDs to promote multimodal pain management in the admission order set increased NSAID ordering and administration, although there were no changes to pain scores or opioid use. While prechecking orders is an important way to increase adoption, safety checks should be in place.
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Affiliation(s)
- Tasce Bongiovanni
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew Robinson
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth Lancaster
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Matthias Behrends
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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Ciudad-Gutiérrez P, Del Valle-Moreno P, Lora-Escobar SJ, Guisado-Gil AB, Alfaro-Lara ER. Electronic Medication Reconciliation Tools Aimed at Healthcare Professionals to Support Medication Reconciliation: a Systematic Review. J Med Syst 2023; 48:2. [PMID: 38055124 DOI: 10.1007/s10916-023-02008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023]
Abstract
The development of health information technology available and accessible to professionals is increasing in the last few years. However, a low number of electronic health tools included some kind of information about medication reconciliation. To identify all the electronic medication reconciliation tools aimed at healthcare professionals and summarize their main features, availability, and clinical impact on patient safety. A systematic review of studies that included a description of an electronic medication reconciliation tool (web-based or mobile app) aimed at healthcare professionals was conducted. The review protocol was registered with PROSPERO: registration number CRD42022366662, and followed PRISMA guidelines. The literature search was performed using four healthcare databases: PubMed, EMBASE, Cochrane Library, and Scopus with no language or publication date restrictions. We identified a total of 1227 articles, of which only 12 met the inclusion criteria.Through these articles,12 electronic tools were detected. Viewing and comparing different medication lists and grouping medications into multiple categories were some of the more recurring features of the tools. With respect to the clinical impact on patient safety, a reduction in adverse drug events or medication discrepancies was detected in up to four tools, but no significant differences in emergency room visits or hospital readmissions were found. 12 e-MedRec tools aimed at health professionals have been developed to date but none was designed as a mobile app. The main features that healthcare professionals requested to be included in e-MedRec tools were interoperability, "user-friendly" information, and integration with the ordering process.
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Affiliation(s)
- Pablo Ciudad-Gutiérrez
- Department of Pharmacy, University Hospital Virgen del Rocio, Av. Manuel Siurot s/n., 41013, Seville, Spain
| | - Paula Del Valle-Moreno
- Department of Pharmacy, University Hospital Virgen del Rocio, Av. Manuel Siurot s/n., 41013, Seville, Spain
| | - Santiago José Lora-Escobar
- Department of Pharmacy, University Hospital Virgen del Rocio, Av. Manuel Siurot s/n., 41013, Seville, Spain
| | - Ana Belén Guisado-Gil
- Department of Pharmacy, University Hospital Virgen del Rocio, Av. Manuel Siurot s/n., 41013, Seville, Spain.
| | - Eva Rocío Alfaro-Lara
- Department of Pharmacy, University Hospital Virgen del Rocio, Av. Manuel Siurot s/n., 41013, Seville, Spain
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Bongiovanni T, Pletcher MJ, Lau C, Robinson A, Lancaster E, Zhang L, Behrends M, Wick E, Auerbach A. A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: A randomized controlled trial. J Hosp Med 2023; 18:685-692. [PMID: 37357367 PMCID: PMC10578203 DOI: 10.1002/jhm.13153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and has become a core strategy to decrease opioid use, but there is a lack of data to describe encouraging use when admitting patients using electronic health record systems. OBJECTIVE Assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. DESIGNS, SETTINGS AND PARTICIPANTS We performed a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a 9-month period. Clinicians were randomized to use a standard admission order set. INTERVENTION Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was shown the same order but without a required response. MAIN OUTCOME AND MEASURES The primary outcome was NSAIDs ordered and administered by the first full hospital day. Secondary outcomes included pain scores and opioid prescribing. RESULTS A total of 20,085 hospitalizations were included. Among these hospitalizations, patients had a mean age of 58 years, and a Charlson comorbidity score of 2.97, while 50% and 56% were female and White, respectively. Overall, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 2267 (22%) interventions and 2093 (22%) control admissions (p = .10). Similarly, there were no statistical differences in NSAID administration, pain scores, or opioid prescribing. Average pain scores (0-5 scale) were 3.36 in the control group and 3.39 in the intervention group (p = .46). There were no differences in clinical harms. CONCLUSIONS AND RELEVANCE Requiring an active decision to order an NSAID at admission had no demonstrable impact on NSAID ordering. Multicomponent interventions, perhaps with stronger decision support, may be necessary to encourage NSAID ordering.
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Affiliation(s)
- Tasce Bongiovanni
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Catherine Lau
- Division of Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew Robinson
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth Lancaster
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Matthias Behrends
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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Alqenae FA, Steinke D, Carson-Stevens A, Keers RN. Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study. Ther Adv Drug Saf 2023; 14:20420986231154365. [PMID: 36949766 PMCID: PMC10026140 DOI: 10.1177/20420986231154365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Improving medication safety during transition of care is an international healthcare priority. While existing research reveals that medication-related incidents and associated harms may be common following hospital discharge, there is limited information about their nature and contributory factors at a national level which is crucial to inform improvement strategy. Aim To characterise the nature and contributory factors of medication-related incidents during transition of care from secondary to primary care. Method A retrospective analysis of medication incidents reported to the National Reporting and Learning System (NRLS) in England and Wales between 2015 and 2019. Descriptive analysis identified the frequency and nature of incidents and content analysis of free text data, coded using the Patient Safety Research Group (PISA) classification, examined the contributory factors and outcome of incidents. Results A total of 1121 medication-related incident reports underwent analysis. Most incidents involved patients over 65 years old (55%, n = 626/1121). More than one in 10 (12.6%, n = 142/1121) incidents were associated with patient harm. The drug monitoring (17%) and administration stages (15%) were associated with a higher proportion of harmful incidents than any other drug use stages. Common medication classes associated with incidents were the cardiovascular (n = 734) and central nervous (n = 273) systems. Among 408 incidents reporting 467 contributory factors, the most common contributory factors were organisation factors (82%, n = 383/467) (mostly related to continuity of care which is the delivery of a seamless service through integration, co-ordination, and the sharing of information between different providers), followed by staff factors (16%, n = 75/467). Conclusion Medication incidents after hospital discharge are associated with patient harm. Several targets were identified for future research that could support the development of remedial interventions, including commonly observed medication classes, older adults, increase patient engagement, and improve shared care agreement for medication monitoring post hospital discharge. Plain language summary Study using reports about unsafe or substandard care mainly written by healthcare professionals to better understand the type and causes of medication safety problems following hospital discharge Why was the study done? The safe use of medicines after hospital discharge has been highlighted by the World Health Organization as an important target for improvement in patient care. Yet, the type of medication problems which occur, and their causes are poorly understood across England and Wales, which may hamper our efforts to create ways to improve care as they may not be based on what we know causes the problem in the first place.What did the researchers do? The research team studied medication safety incident reports collected across England and Wales over a 5-year period to better understand what kind of medication safety problems occur after hospital discharge and why they happen, so we can find ways to prevent them from happening in future.What did the researchers find? The total number of incident reports studied was 1121, and the majority (n = 626) involved older people. More than one in ten of these incidents caused harm to patients. The most common medications involved in the medication safety incidents were for cardiovascular diseases such as high blood pressure, conditions such as mental illness, pain and neurological conditions (e.g., epilepsy) and other illnesses such as diabetes. The most common causes of these incidents were because of the organisation rules, such as information sharing, followed by staff issues, such as not following protocols, individual mistakes and not having the right skills for the task.What do the findings mean? This study has identified some important targets that can be a focus of future efforts to improve the safe use of medicines after hospital discharge. These include concentrating attention on medication for the cardiovascular and central nervous systems (e.g., via incorporating them in prescribing safety indicators and pharmaceutical prioritisation tools), staff skill mix (e.g., embedding clinical pharmacist roles at key parts of the care pathway where greatest risk is suspected), and implementation of electronic interventions to improve timely communication of medication and other information between healthcare providers.
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Affiliation(s)
| | - Douglas Steinke
- Centre for Pharmacoepidemiology and Drug
Safety, Division of Pharmacy and Optometry, School of Health Sciences,
University of Manchester, Manchester, UK
- Pharmacy Department, Manchester University NHS
Foundation Trust, Manchester, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of
Medicine, Cardiff University, Cardiff, UK
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug
Safety, Division of Pharmacy and Optometry, School of Health Sciences,
University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater
Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Discrepancies in patients' medication lists from pharmacies in Sweden: an interview study before the implementation of the Swedish National Medication List. Int J Clin Pharm 2023; 45:88-96. [PMID: 36307661 PMCID: PMC9938824 DOI: 10.1007/s11096-022-01480-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. AIM The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. METHOD Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. RESULTS A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. CONCLUSION The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List.
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Dong PTX, Pham VTT, Nguyen LT, Le AV, Nguyen TT, Vu HD, Nguyen HTL, Nguyen HT, Hua S, Li SC. Impact of pharmacist-initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam. J Clin Pharm Ther 2022; 47:2107-2114. [PMID: 36543256 PMCID: PMC10086993 DOI: 10.1111/jcpt.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Unintentional medication discrepancies (UMDs) are common in geriatric patients during care transitions, resulting in frequent undesirable consequences. Medication reconciliation could be a useful practice to prevent or ameliorate UMD. However, this practice in Vietnamese hospitals has not been well established or standardized. This study aims to determine the effect of pharmacist-initiated educational interventions on improving medication reconciliation practice. METHODS This prospective 6-month pre-and post-study was conducted in two internal medicine wards in a Vietnamese 800-bed public hospital. Pharmacists provided training and short-term support to physicians on medication reconciliation. Primary outcome measures were the proportions of patients with at least one UMD at admission. Secondary outcome measures were the proportions of patients with preventable adverse drug events (pADEs) score ≥0.1 due to these UMDs. Odds ratio and 95% confidence intervals were assessed based on a multivariate logistic regression model. RESULTS AND DISCUSSION One hundred fifty-two patients were recruited in the pre-intervention phase, and 146 in the post-intervention phase. Following the intervention, the proportion of geriatric patients with ≥1 UMD at admission significantly decreased from 55.3 to 25.3 % (ORadj 0.255, 95% CI: 0.151-0.431). Similarly, the proportion of patients with a pADE ≥0.1 at admission reduced from 44.1 to 11.6% [ORadj 0.188, 95% CI: 0.105-0.340] post-intervention. WHAT IS NEW AND CONCLUSION Our pharmacist-initiated educational interventions have demonstrated the ability to produce substantial improvement in medication reconciliation practice, reducing UMDs and potential harm. Our approach may provide an alternate option to implement medication reconciliation for jurisdictions with limited healthcare resources.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Linh Thi Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Thao Thi Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Hoa Dinh Vu
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Hoa Thi Nguyen
- Department of Musculoskeletal System, Friendship Hospital, Hanoi, Vietnam
| | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
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Verman S, Anjankar A. A Narrative Review of Adverse Event Detection, Monitoring, and Prevention in Indian Hospitals. Cureus 2022; 14:e29162. [PMID: 36258971 PMCID: PMC9564564 DOI: 10.7759/cureus.29162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
An adverse event is any abnormal clinical finding associated with the use of a therapy. Adverse events are classified by reporting an event's seriousness, expectedness, and relatedness. Monitoring patient safety is of utmost importance as more and more data becomes available. In reality, very low numbers of adverse events are reported via the official path. Chart review, voluntary reporting, computerized surveillance, and direct observation can detect adverse drug events. Medication errors are commonly seen in hospitals and need provider and system-based interventions to prevent them. The need of the hour in India is to develop and implement medication safety best practices to avoid adverse events. The utility of artificial intelligence techniques in adverse event detection remains unexplored, and their accuracy and precision need to be studied in a controlled setting. There is a need to develop predictive models to assess the likelihood of adverse reactions while testing novel pharmaceutical drugs.
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El Hadidi S, Hamdi M, Sabry N. Should Pharmacists Lead Medication Reconciliation in Critical Care? A One-Stem Interventional Study in an Egyptian Intensive Care Unit. J Patient Saf 2022; 18:e895-e899. [PMID: 35190512 DOI: 10.1097/pts.0000000000000983] [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: 11/27/2022]
Abstract
OBJECTIVES The main objective was to compare physician-obtained medication histories to the practice of medication reconciliation undertaken by a pharmacist in the intensive care unit (ICU). METHODS A one-stem interventional study involving 500 adults 18 years and older admitted to the ICU (50 beds) of an Egyptian Joint Commission International-accredited reference hospital was conducted. The primary outcome measure was the proportion of ICU patients with missing medications in the cohorts of physician versus pharmacist-led medication reconciliation. The secondary outcome measure was the percentage of patients who had at least one clinical condition or adverse event (AE) that was left untreated during hospitalization of the 2 arms of patients after reconciliation. RESULTS A total of 500 patients received reconciliation. Medication discrepancies in the cohort of physician-led reconciliation were greater than that of the pharmacist (26.1% versus 2.6%, P = 0.001). The most common discrepancy was indication with no medication, which was found to be greater in the physician-led cohort of patients than that of the pharmacist cohort (25.2% versus 2.6%, P = 0.001). Untreated AEs in the former cohort were present in 9.1% of cases versus 1.5% in the pharmacist-led reconciliation cohort ( P = 0.001). CONCLUSIONS The present study revealed that pharmacist-led medication reconciliation in ICU has dramatically decreased medication discrepancies and AEs in adults with acute ICU admissions.
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Affiliation(s)
- Seif El Hadidi
- From the Cairo University Faculty of Pharmacy, Cairo, Egypt
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Alanazi AS, Awwad S, Khan TM, Asdaq SMB, Mohzari Y, Alanazi F, Alrashed A, Alamri AS, Alsanie WF, Alhomrani M, AlMotairi M. Medication reconciliation on discharge in a tertiary care Riyadh Hospital: An observational study. PLoS One 2022; 17:e0265042. [PMID: 35290378 PMCID: PMC8923456 DOI: 10.1371/journal.pone.0265042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to assess the frequency and characteristics of discharge medication discrepancies as identified by pharmacists during discharge medication reconciliation. We also attempted to identify the factors that influence the occurrence of drug discrepancies during medication reconciliation. From June to December 2019, a prospective study was performed at the cardiac center of King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh. The information from discharge prescriptions as compared to the medication administration record (MAR), medication history in the cortex system, and the patient home medication list collected from the medication reconciliation form on admission. The study included all adult patients discharged from KFMC’s cardiac center. These participants comprised 776 patients, 64.6 percent of whom were men and 35.4 percent of whom were women. Medication discrepancies were encountered in 180 patients (23.2%) out of 776 patients. In regards to the number of discharged medications, 651(83.9%) patients had ≥ 5 medications. Around, 174 (73.4%) discrepancies were intentional, and 63 (26.6%) were unintentional discrepancies. The risk of unintentional medication discrepancy was increased with an increasing number of medications (P-value = 0.008). One out of every four cardiac patients discharged from our hospital had at least one medication discrepancy. The number of drugs taken and the number of discrepancies was found to be related. Necessary steps should be taken to reduce these discrepancies and improve the standard of care.
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Affiliation(s)
- Ahmed S. Alanazi
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sameh Awwad
- The Institute of Pharmaceutical Science (IPS) of University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tahir M. Khan
- The Institute of Pharmaceutical Science (IPS) of University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | - Yahya Mohzari
- Pharmacy Department, Clinical Pharmacy Section, King Saudi Medical City, Riyadh, Saudi Arabia
| | - Foz Alanazi
- Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alrashed
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulhakeem S. Alamri
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Walaa F. Alsanie
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Majid Alhomrani
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Mohammed AlMotairi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
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Yu A, Wei G, Chen F, Wang Z, Fu M, Wang G, Wushouer H, Li X, Guan X, Shi L. Study protocol for the evaluation of pharmacist-participated medication reconciliation at county hospitals in China: a multicentre, open-label, assessor-blinded, non-randomised, controlled study. BMJ Open 2022; 12:e053741. [PMID: 35277404 PMCID: PMC8919460 DOI: 10.1136/bmjopen-2021-053741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pharmacist-participated medication reconciliation proved an effective strategy to decrease the risk of medication discrepancy-related errors. However, it is still under pilot in China and its effectiveness in the Chinese healthcare system remains unclear. This study aims to conduct a pharmacist-participated medication reconciliation intervention for elderly patients in county hospitals in China and to evaluate its effect. METHODS AND ANALYSIS This is a multicentre, prospective, open-label, assessor-blinded, cluster, non-randomised, controlled study for elderly patients. The study will be conducted in seven county hospitals, and the clusters will be hospital wards. In each hospital, two internal medicine wards will be randomly allocated into either intervention group or control group. Patients in the intervention group will receive pharmacist-participated medication reconciliation, and those in the control group will receive standard care. The primary outcome is the incidence of medication discrepancy, and the secondary outcomes are patients' medication adherence, healthcare utilisation and medical costs within 30 days after discharge. ETHICS AND DISSEMINATION Ethics committee approval of this study was obtained from Peking University Institution Review Board (IRB00001052-21016). We have also obtained ethical approvals from all the participating centres. The findings will be published in scientific and conference presentations. TRAIL REGISTRATION NUMBER ChiCTR2100045668.
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Affiliation(s)
- Aichen Yu
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Guilin Wei
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Fanghui Chen
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Zining Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Guoying Wang
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xixi Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Andersen TS, Gemmer MN, Sejberg HRC, Jørgensen LM, Kallemose T, Andersen O, Iversen E, Houlind MB. Medicines Reconciliation in the Emergency Department: Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication. Pharmaceuticals (Basel) 2022; 15:ph15020142. [PMID: 35215255 PMCID: PMC8877185 DOI: 10.3390/ph15020142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.
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Affiliation(s)
- Tanja Stenholdt Andersen
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Mia Nimb Gemmer
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Hayley Rose Constance Sejberg
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Lillian Mørch Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Ove Andersen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-28-83-85-63
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Gionfriddo M, Hu Y, Maddineni B, Kern M, Duboski V, Kaledas WR, Elder N, Border J, Frusciante K, Kobylinski M, Wright E. Evaluation of a web-based medication reconciliation application within a primary care setting: Results from a cluster randomized controlled trial. JMIR Form Res 2022; 6:e33488. [PMID: 35023836 PMCID: PMC8941436 DOI: 10.2196/33488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. Objective We aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT). Methods We conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews. Results Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement. Conclusions The use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.
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Affiliation(s)
- Michael Gionfriddo
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, US.,Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, US
| | - Bhumika Maddineni
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Melissa Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Nevan Elder
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Jeffrey Border
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Katie Frusciante
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
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Chiel L, Freiman E, Yarahuan J, Parsons C, Landrigan CP, Winn AS. Changes Made to Orders Placed by Overnight Admitting Residents on Teaching Rounds the Next Day. Hosp Pediatr 2022; 12:e35-e38. [PMID: 34904158 DOI: 10.1542/hpeds.2021-005823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Increased focus on health care quality and safety has generally led to additional resident supervision by attending physicians. At our children's hospital, residents place orders overnight that are not explicitly reviewed by attending physicians until morning rounds. We aimed to categorize the types of orders that are added or discontinued on morning rounds the morning after admission to a resident team and to understand the rationale for these order additions and discontinuations. METHODS We used our hospital's data warehouse to generate a report of orders placed by residents overnight that were discontinued the next morning and orders that were added on rounds the morning after admission to a resident team from July 1, 2017 to June 29, 2018. Retrospective chart review was performed on included orders to determine the reason for order changes. RESULTS Our report identified 5927 orders; 538 were included for analysis after exclusion of duplicate orders, administrative orders, and orders for patients admitted to non-Pediatric Hospital Medicine services. The reason for order discontinuation or addition was medical decision-making (n = 357, 66.4%), change in patient trajectory (n = 151, 28.1%), and medical error (n = 30, 5.6%). Medical errors were most commonly related to medications (n = 24, 80%) and errors of omission (n = 19, 63%). CONCLUSIONS New or discontinued orders commonly resulted from evolving patient management decisions or changes in patient trajectory; medical errors represented a small subset of identified orders. Medical errors were often errors of omission, suggesting an area to direct future safety initiatives.
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Affiliation(s)
- Laura Chiel
- Divisions of Pulmonary Medicine
- Department of Pediatrics
| | | | - Julia Yarahuan
- Section of Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Chase Parsons
- General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics
| | - Christopher P Landrigan
- General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ariel S Winn
- General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics
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15
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Abu Farha R, Yousef A, Gharaibeh L, Alkhalaileh W, Mukattash T, Alefishat E. Medication discrepancies among hospitalized patients with hypertension: assessment of prevalence and risk factors. BMC Health Serv Res 2021; 21:1338. [PMID: 34903221 PMCID: PMC8670213 DOI: 10.1186/s12913-021-07349-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Medication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients. Methods This was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized. Results A high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition. Conclusions Unintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.
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Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Alaa Yousef
- Faculty of Medicine, Al Balqa' Applied University, Salt, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Waed Alkhalaileh
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman Alefishat
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan. .,Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates. .,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
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16
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Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies. BMC Health Serv Res 2021; 21:1335. [PMID: 34903215 PMCID: PMC8670071 DOI: 10.1186/s12913-021-07346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation. The aim of this study was to investigate whether an electronically Shared Medication List (eSML) reduced discrepancies between medication lists in primary care. Methods In 2018, eSML was tested for patients in home care who received multidose drug dispensing (MDD) in Oslo, Norway. We followed this transition from the current paper-based medication list to an eSML. Medication lists from the GP, home care service and community pharmacy were compared 3 months before the implementation and 18 months after. MDD patients in a neighbouring district in Oslo served as a control group. Results One hundred eighty-nine patients were included (100 intervention; 89 control). Discrepancies were reduced from 389 to 122 (p < 0.001) in the intervention group, and from 521 to 503 in the control group (p = 0.734). After the implementation, the share of mutual prescription items increased from 77 to 94%. Missing prescriptions for psycholeptics, analgesics and dietary supplements was reduced the most. Conclusions The eSML greatly decreases discrepancies between the GP, home care and pharmacy medication lists, but does not eliminate the need for medication reconciliation.
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Ciapponi A, Fernandez Nievas SE, Seijo M, Rodríguez MB, Vietto V, García-Perdomo HA, Virgilio S, Fajreldines AV, Tost J, Rose CJ, Garcia-Elorrio E. Reducing medication errors for adults in hospital settings. Cochrane Database Syst Rev 2021; 11:CD009985. [PMID: 34822165 PMCID: PMC8614640 DOI: 10.1002/14651858.cd009985.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death. OBJECTIVES To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible. MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131). Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724). Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311). Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88). Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775). AUTHORS' CONCLUSIONS Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.
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Affiliation(s)
- Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Simon E Fernandez Nievas
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mariana Seijo
- Quality of Health Care and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belén Rodríguez
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Vietto
- Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Sacha Virgilio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana V Fajreldines
- Quality and Patient Safety, Austral University Hospital, Buenos Aires, Argentina
| | - Josep Tost
- Urgencias � Calidad y Seguridad de pacientes, Consorcio Sanitario de Terrassa, Barcelona, Spain
| | | | - Ezequiel Garcia-Elorrio
- Quality and Safety in Health Care, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Waldron C, Cahill J, Cromie S, Delaney T, Kennelly SP, Pevnick JM, Grimes T. Personal Electronic Records of Medications (PERMs) for medication reconciliation at care transitions: a rapid realist review. BMC Med Inform Decis Mak 2021; 21:307. [PMID: 34732176 PMCID: PMC8565006 DOI: 10.1186/s12911-021-01659-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Medication reconciliation (MedRec), a process to reduce medication error at care transitions, is labour- and resource-intensive and time-consuming. Use of Personal Electronic Records of Medications (PERMs) in health information systems to support MedRec have proven challenging. Relatively little is known about the design, use or implementation of PERMs at care transitions that impacts on MedRec in the ‘real world’. To respond to this gap in knowledge we undertook a rapid realist review (RRR). The aim was to develop theories to explain how, why, when, where and for whom PERMs are designed, implemented or used in practice at care transitions that impacts on MedRec. Methodology We used realist methodology and undertook the RRR between August 2020 and February 2021. We collaborated with experts in the field to identify key themes. Articles were sourced from four databases (Pubmed, Embase, CINAHL Complete and OpenGrey) to contribute to the theory development. Quality assessment, screening and data extraction using NVivo was completed. Contexts, mechanisms and outcomes configurations were identified and synthesised. The experts considered these theories for relevance and practicality and suggested refinements. Results Ten provisional theories were identified from 19 articles. Some theories relate to the design (T2 Inclusive design, T3 PERMs complement existing good processes, T7 Interoperability), some relate to the implementation (T5 Tailored training, T9 Positive impact of legislation or governance), some relate to use (T6 Support and on-demand training) and others relate iteratively to all stages of the process (T1 Engage stakeholders, T4 Build trust, T8 Resource investment, T10 Patients as users of PERMs). Conclusions This RRR has allowed additional valuable data to be extracted from existing primary research, with minimal resources, that may impact positively on future developments in this area. The theories are interdependent to a greater or lesser extent; several or all of the theories may need to be in play to collectively impact on the design, implementation or use of PERMs for MedRec at care transitions. These theories should now be incorporated into an intervention and evaluated to further test their validity. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01659-8.
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Affiliation(s)
- Catherine Waldron
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Joan Cahill
- Centre for Innovative Human Systems & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sam Cromie
- Centre for Innovative Human Systems & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
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19
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Welk B, Killin L, Reid JN, Anderson KK, Shariff SZ, Appleton A, Kearns G, Garg AX. Effect of electronic medication reconciliation at the time of hospital discharge on inappropriate medication use in the community: an interrupted time-series analysis. CMAJ Open 2021; 9:E1105-E1113. [PMID: 34848551 PMCID: PMC8648355 DOI: 10.9778/cmajo.20210071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unclear if enhanced electronic medication reconciliation systems can reduce inappropriate medication use and improve patient care. We evaluated trends in potentially inappropriate medication use after hospital discharge before and after adoption of an electronic medication reconciliation system. METHODS We conducted an interrupted time-series analysis in 3 tertiary care hospitals in London, Ontario, using linked health care data (2011-2019). We included patients aged 66 years and older who were discharged from hospital. Starting between Apr. 13 and May 21, 2014, physicians were required to complete an electronic medication reconciliation module for each discharged patient. As a process outcome, we evaluated the proportion of patients who continued to receive a benzodiazepine, antipsychotic or gastric acid suppressant as an outpatient when these medications were first started during the hospital stay. The clinical outcome was a return to hospital within 90 days of discharge with a fall or fracture among patients who received a new benzodiazepine or antipsychotic during their hospital stay. We used segmented linear regression for the analysis. RESULTS We identified 15 932 patients with a total of 18 405 hospital discharge episodes. Before the implementation of the electronic medication reconciliation system, 16.3% of patients received a prescription for a benzodiazepine, antipsychotic or gastric acid suppressant after their hospital stay. After implementation, there was a significant and immediate 7.0% absolute decline in this proportion (95% confidence interval [CI] 4.5% to 9.5%). Before implementation, 4.1% of discharged patients who newly received a benzodiazepine or antipsychotic returned to hospital with a fracture or fall within 90 days. After implementation, there was a significant and immediate 2.3% absolute decline in this outcome (95% CI 0.3% to 4.3%). INTERPRETATION Implementation of an electronic medication reconciliation system in 3 tertiary care hospitals reduced potentially inappropriate medication use and associated adverse events when patients transitioned back to the community. Enhanced electronic medication reconciliation systems may allow other hospitals to improve patient safety.
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Affiliation(s)
- Blayne Welk
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont.
| | - Lauren Killin
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Jennifer N Reid
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Kelly K Anderson
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Salimah Z Shariff
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Andrew Appleton
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Glen Kearns
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
| | - Amit X Garg
- Departments of Surgery (Welk), and Epidemiology and Biostatistics (Welk, Killin, Anderson, Garg), Western University; ICES Western (Welk, Killin, Reid, Anderson, Shariff, Garg); Arthur Labatt Family School of Nursing (Shariff) Western University; Department of Medicine (Appleton, Garg), Western University; St. Joseph's Healthcare and London Health Sciences Centre (Kearns), London, Ont
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20
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Al Anazi A. Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists' perspective. Health Informatics J 2021; 27:1460458220987276. [PMID: 33467954 DOI: 10.1177/1460458220987276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey's respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications' entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.
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Affiliation(s)
- Abdullah Al Anazi
- King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.,King Abdullah International Medical Research Center, Saudi Arabia.,Ministry of National Guard-Health Affairs, Saudi Arabia
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21
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Alshehri GH, Keers RN, Carson-Stevens A, Ashcroft DM. Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System. J Patient Saf 2021; 17:341-351. [PMID: 34276036 DOI: 10.1097/pts.0000000000000815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication safety incidents commonly occur in mental health hospitals. There is a need to improve the understanding of the circumstances that are thought to have played a part in the origin of these incidents to design safer systems to improve patient safety. AIM This study aimed to undertake a mixed-methods analysis of medication safety incidents reported to the National Reporting and Learning System in England and Wales in 2010 to 2017. METHOD Quantitative analyses of anonymized medication safety incidents occurring in mental health hospitals that were reported to the National Reporting and Learning System during an 8-year period were undertaken to characterize their type, severity, and the medication(s) involved. Second, a content analysis of the free-text reports associated with all incidents of at least moderate harm severity was undertaken to identify the underlying contributory factors. RESULTS Overall, 94,134 medication incident reports were examined, of which 10.4% (n = 9811) were reported to have resulted in harm. The 3 most frequent types of reported medication incidents involved omission of medication (17,302; 18.3%), wrong frequency (11,882; 12.6%), and wrong/unclear dose of medication (10,272; 10.9%). Medicines from the central nervous system (42,609; 71.0%), cardiovascular (4537; 7.6%), and endocrine (3669; 6.1%) medication classes were the most frequently involved with incidents. Failure to follow protocols (n = 93), lack of continuity of care (n = 92), patient behaviors (n = 62), and lack of stock (n = 51) were frequently reported as contributory factors. CONCLUSIONS Medication incidents pose an enduring threat to patient safety in mental health hospitals. This study has identified important targets that can guide the tailored development of remedial interventions.
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22
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Bülow C, Noergaard JDSV, Faerch KU, Pontoppidan C, Unkerskov J, Johansson KS, Kornholt J, Christensen MB. Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications. Basic Clin Pharmacol Toxicol 2021; 129:221-231. [PMID: 34137181 DOI: 10.1111/bcpt.13626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non-adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9-15] medications listed and 3 [IQR 1-5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non-adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Josefine D S V Noergaard
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Ullitz Faerch
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Pontoppidan
- The Hospital Pharmacy, The Capital Region of Denmark, Bispebjerg and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Unkerskov
- Quality in General Practice in the Capital Region of Denmark (KAP-H), Hillerød, Denmark
| | - Karl Sebastian Johansson
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonatan Kornholt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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23
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Patterson ME, Bollinger S, Coleman C, Rhodes JAM. Medication discrepancy rates and sources upon nursing home intake: A prospective study. Res Social Adm Pharm 2021; 18:2830-2836. [PMID: 34176761 DOI: 10.1016/j.sapharm.2021.06.013] [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: 01/21/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medication discrepancies at nursing home intake increase the risk of drug-related adverse events. Measuring discrepancy incidence rates and locating the origins of discrepancies can assist in identifying information exchange deficits for high-risk medications. OBJECTIVE To determine class-specific discrepancy rates, to determine discordance between medication lists, and to explore patient and system-level factors associated with medication discrepancies discovered between the first and second medication reconciliations conducted at nursing home intake. METHODS Medication discrepancy data were prospectively collected from four long-term care facilities over a 9-month period. Medication discrepancies were defined as mismatched prescribing orders between at least two medication history lists. Discrepancy locations were defined as the pairs or triads of facilities between which medication history lists were discordant. Unadjusted logistic regressions were used to identify medication classes with the highest discrepancy rates and patient factors significantly associated with any medication discrepancy. RESULTS 40.8% of newly admitted or re-admitted residents and 6.3% of medications reviewed had at least one medication discrepancy discovered during the second medication reconciliation conducted at nursing home intake. Residents prescribed fewer than 14 medications were at less risk of discrepancies. Residents with Charlson Comorbidity Index of 5, COPD, HF, anemia or HTN were at greater risk of discrepancies. Respiratory and analgesic medications were twice as likely as other medication classes to be discrepant (OR = 2.2, 95% CI 1.2-4.4; OR = 2.2, 95% CI 1.3-3.5). Most discrepancies occurred between hospital and nursing home lists (44.9%), or between the hospital, nursing home, and community pharmacy lists (39.3%) CONCLUSIONS: Given the higher risk of discrepancies within respiratory or analgesics, transitions of care teams need to prioritize residents with respiratory conditions or pain. Although re-admitted residents' increased discrepancy risk is likely due to poorer health status, miscommunications across the nursing home, hospital and community pharmacy require further research to clarify system failures.
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Affiliation(s)
- Mark E Patterson
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA.
| | | | - Chandler Coleman
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - James A M Rhodes
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
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24
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Beauchet O, Lubov J, Galery K, Afilalo M, Launay CP. Emergency room evaluation and recommendations for older emergency department users: results of the ER 2 experimental study. Eur Geriatr Med 2021; 12:921-929. [PMID: 34089148 DOI: 10.1007/s41999-021-00517-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study aims to examine whether the use of "emergency room evaluation and recommendations" (ER2) tool in daily ED practice reduces the length of stay in ED and hospital, and hospital admission in older patients visiting ED on stretcher. METHODS A total of 3931 older patients visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) on stretcher were recruited in this non-randomized, pre-post intervention, single arm, prospective and longitudinal open-label trial. ED staff and patients were blinded of the ER2 score and patients received usual ED care over the observational phase, whereas ED staff were informed about the ER2 score and patients had usual care plus interventions based on tailor-made geriatric recommendations during the interventional phase. The length of stay in ED and in hospital, and hospital admission were the outcomes. RESULTS The ER2 recommendations were associated with increased length of stay in ED (β = 2.94 with P ≤ 0.001) and decreased length of stay in hospital (β = - 2.07 with P = 0.011). No effect was found for hospital admission (Odd Ratio (OR) = 0.92 with P = 0.182). CONCLUSION Emergency room evaluation and recommendations (ER2) tool had mixed effects. Shorter hospital stay has been reported for older ED users hospitalized, but increased ED stay and no effects on hospital admission were found.
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Affiliation(s)
- Olivier Beauchet
- Department of Medicine, University of Montreal, Montreal, QC, Canada. .,Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada. .,Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Joshua Lubov
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Kevin Galery
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
| | - Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Cyrille P Launay
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
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25
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Ebbens MM, Gombert-Handoko KB, Wesselink EJ, van den Bemt PMLA. The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study. J Am Med Dir Assoc 2021; 22:2553-2558.e1. [PMID: 33905738 DOI: 10.1016/j.jamda.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal. OBJECTIVES To explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician. DESIGN (INCLUDING INTERVENTION) Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care). SETTING AND PARTICIPANTS Patients scheduled for elective surgery using at least 1 chronic medication were included. MEASURES The primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%. RESULTS A total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 ± 2.5 in the patient portal group and 2.8 ± 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care. CONCLUSIONS AND IMPLICATIONS Medication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.
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Affiliation(s)
- Marieke M Ebbens
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands; Department of Hospital Pharmacy, St Jansdal Hospital, Harderwijk, the Netherlands; Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kim B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elsbeth J Wesselink
- Department of Clinical Pharmacy, Zaans Medical Centre, Zaandam, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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26
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Killin L, Hezam A, Anderson KK, Welk B. Advanced Medication Reconciliation: A Systematic Review of the Impact on Medication Errors and Adverse Drug Events Associated with Transitions of Care. Jt Comm J Qual Patient Saf 2021; 47:438-451. [PMID: 34103267 DOI: 10.1016/j.jcjq.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The goal of this study was to conduct a systematic review on the impact of in-hospital electronic/enhanced medication reconciliation compared to basic medication reconciliation on medication errors, discrepancies, and adverse drug events (ADEs). METHODS The study team searched for peer-reviewed English-language articles in EMBASE, OVID, and Scopus databases up to October 2019. Included were randomized controlled trials (RCTs), pre-post, or interrupted time series designs with medication errors, discrepancies, or ADEs as an outcome, and medication reconciliation applied at hospital discharge. Basic medication reconciliation was defined as using a paper-based format, electronic medication reconciliation as using an electronic format, and enhanced medication reconciliation as incorporating additional interventions to reduce medication errors. RESULTS Ten studies (three RCTs, one retrospective cohort study, two interrupted time series studies, three pre-post studies, and one longitudinal study) were identified, with six and four studies comparing basic medication reconciliation to electronic and enhanced medication reconciliation, respectively. The overall risk of bias of the included studies was low (three), unclear (two), moderate (three), and serious/high (two). In general, studies demonstrated that electronic medication reconciliation reduced the odds of a medication discrepancy or ADE and may reduce the mean number of medication discrepancies. Enhanced medication reconciliation was more equivocal, with some studies showing improvement; however, risk of bias was generally significant. CONCLUSION Electronic medication reconciliation tends to reduce the risk of ADE; however, these conclusions were limited due to a lack of consistency in study settings, interventions, and outcome definitions. Future studies with more rigorous designs and standardized outcome definitions would provide clarity on this topic.
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27
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Co Z, Holmgren AJ, Classen DC, Newmark LP, Seger DL, Cole JM, Pon B, Zimmer KP, Bates DW. The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned. Appl Clin Inform 2021; 12:153-163. [PMID: 33657634 DOI: 10.1055/s-0041-1722917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. OBJECTIVE To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. METHODS The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. RESULTS For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug-drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. CONCLUSION Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.
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Affiliation(s)
- Zoe Co
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - A Jay Holmgren
- Harvard Business School, Boston, Massachusetts, United States
| | - David C Classen
- Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Lisa P Newmark
- Clinical and Quality Analysis, Mass General Brigham, Somerville, Massachusetts, United States
| | - Diane L Seger
- Clinical and Quality Analysis, Mass General Brigham, Somerville, Massachusetts, United States
| | - Jessica M Cole
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Barbara Pon
- Collaborative Healthcare Patient Safety Organization, Sacramento, California, United States
| | - Karen P Zimmer
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Clinical and Quality Analysis, Mass General Brigham, Somerville, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
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28
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Hung PL, Lin PC, Chen JY, Chen MT, Chou MY, Huang WC, Juang WC, Lin YT, Lin AC. Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients. J Med Syst 2021; 45:47. [PMID: 33644834 DOI: 10.1007/s10916-021-01717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1-November 30, 2015) and post-intervention (October 1-December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68-1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03-0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.
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Affiliation(s)
- Pi-Lien Hung
- Department of Pharmacy, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist, Kaohsiung City, 80708, Taiwan
| | - Pei-Chin Lin
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist, Kaohsiung City, 80708, Taiwan.
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan.
| | - Jung-Yi Chen
- Department of Pharmacy, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, Taiwan
| | - Miao-Ting Chen
- Department of Pharmacy, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Aging and Health Research Center, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan
- Department of Physical Therapy, Fooyin University, No. 151, Jinxue Road Daliao District, Kaohsiung City, 83102, Taiwan
| | - Wang-Chuan Juang
- Quality Management Center, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Department of Business Management, National Sun Yat-sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
| | - Alex C Lin
- Division of Pharmacy Practice and Administrative Sciences, The James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, 45267-0004, USA.
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Ebbens MM, van Dorp ELA, Gombert-Handoko KB, van den Bemt PMLA. Pre-operative medication reconciliation by pharmacy technicians or anaesthesiologists. Eur J Anaesthesiol 2021; 38 Suppl 1:S71-S72. [PMID: 33645936 DOI: 10.1097/eja.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marieke M Ebbens
- From the Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden (MME, KBG-H), Department of Pharmacy, St Jansdal Hospital, Harderwijk (MME), Department of Anesthesiology, Leiden University Medical Center, Leiden (ELAvD), Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen (PMLAvdB), Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam. Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands (MME, PMLAvdB)
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Kurteva S, Habib B, Moraga T, Tamblyn R. Incidence and Variables Associated With Inconsistencies in Opioid Prescribing at Hospital Discharge and Its Associated Adverse Drug Outcomes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:147-157. [PMID: 33518021 DOI: 10.1016/j.jval.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/02/2020] [Accepted: 07/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Opioid-related medication errors (MEs) can have a significant impact on patient health and contribute to opioid misuse. The objective of this study was to estimate the incidence of and variables associated with the receipt of an opioid prescription and opioid-related MEs (omissions, duplications, or dose changes) at hospital discharge. We also determined rates of adverse drug events and risks of emergency department visits, readmissions, or death 30 days and 90 days post discharge associated with MEs. METHODS A cohort of hospitalized patients discharged from the McGill University Health Centre between 2014 and 2016 was assembled. The impact of opioid-related MEs was assessed in a propensity score-adjusted logistic regression models. Multivariable logistic regression was used to determine characteristics associated with MEs and discharge opioid prescription. RESULTS A total of 1530 (43.9%) of 3486 patients were prescribed opioids, of which 13.4% (n = 205) of patients had at least 1 opioid-related ME. Rates of MEs were higher in handwritten prescriptions compared to the electronic reconciliation discharge prescription group (20.6% vs 1.2%). Computer-based prescriptions were associated with a 69% lower risk of opioid-related MEs (adjusted odds ratio: 0.31, 95% confidence interval: 0.14-0.65) as well as 63% lower risk of receiving an opioid prescription. Opioid-related MEs were associated with a 2.3 times increased risk of healthcare utilization in the 30 days postdischarge period (adjusted odds ratio: 2.32, 95% confidence interval: 1.24-4.32). CONCLUSIONS Opioid-related MEs are common in handwritten discharge prescriptions. Our findings highlight the need for computer-based prescribing platforms and careful review of medications during critical periods of care such as hospital transitions.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.
| | - Bettina Habib
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Teresa Moraga
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada; Department of Medicine, McGill University Health Center, Montreal, Canada
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Debacq C, Bourgueil J, Aidoud A, Bleuet J, Mennecart M, Dardaine-Giraud V, Fougère B. Persistence of Effect of Medication Review on Potentially Inappropriate Prescriptions in Older Patients Following Hospital Discharge. Drugs Aging 2021; 38:243-252. [PMID: 33474671 DOI: 10.1007/s40266-020-00830-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Potentially inappropriate prescriptions (PIPs) can lead to adverse drug reactions and should be avoided whenever possible. OBJECTIVE Our objective was to assess the PIP resumption rate 6 months after discharge from our geriatric unit and to compare it with data in the literature. METHODS This single-center observational study included patients aged ≥ 70 years with at least one PIP that had been stopped during hospitalization (according to Screening Tool for Older Persons Prescriptions [STOPP] and Screening Tool to Alert doctors to Right Treatment [START] criteria, version 2) between May 2018 and October 2018. We collected sociodemographic data, medication reconciliation data, and descriptive data during a comprehensive geriatric assessment. Each patient's medication history after discharge was determined in collaboration with their usual community pharmacist. RESULTS A total of 125 patients (females 70%, mean age 87.1 years) were included. Data for the admission and discharge medication reconciliations were available for 44 patients (35%). On admission, 121 of the 125 patients (97%) were taking cardiovascular medication. Of the 336 treatments withdrawn, 61 (18.2%) had been re-prescribed at 6 months post-discharge-including half within the first month. The most frequent STOPP criterion was lack of indication (32%), and the overall PIP resumption rate was 22%. According to the anatomical therapeutic chemical (ATC) classification, the main organ system affected by PIPs was the cardiovascular system (47%, with a resumption rate of 17%). CONCLUSION Our results highlighted a low PIP resumption rate at 6 months and showed that a collaborative medication review is associated with persistent medium-term medication changes.
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Affiliation(s)
- Camille Debacq
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France.
| | - Julie Bourgueil
- Pharmacie, CHU Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Amal Aidoud
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Joëlle Bleuet
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Marc Mennecart
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | | | - Bertrand Fougère
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
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Abstract
BACKGROUND Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology. OBJECTIVES The aim of this umbrella review was to synthesize the evidence from all systematic reviews investigating the effectiveness of medication safety interventions, in comparison to any or no comparator, for preventing medication errors, medication-related harms and death in acute care patients. METHOD The review considered quantitative systematic reviews with participants who were healthcare workers involved in prescribing, dispensing or administering medications. These healthcare workers were registered nurses, enrolled or licensed vocational nurses, midwives, pharmacists or medical doctors. Interventions of interest were those designed to prevent medication error in acute care settings. Eligible systematic reviews reported medication errors, medication-related harms and medication-related death as measured by error rates, numbers of adverse events and numbers of medication-related deaths. To qualify for inclusion, systematic reviews needed to provide a clearly articulated and comprehensive search strategy, and evidence of critical appraisal of the included studies using a standardized tool. Systematic reviews published in English since 2007 were included until present (March 2020). We searched a range of databases such MEDLINE, CINAHL, Web of Science, EMBASE, and The Cochrane Library for potentially eligible reviews. Identified citations were screened by two reviewers working independently. Potentially eligible articles were retrieved and assessed against the inclusion criteria and those meeting the criteria were then critically appraised using the JBI SUMARI instrument for assessing the methodological quality of systematic reviews and research syntheses. A predetermined quality threshold was used to exclude studies based on their reported methods. Following critical appraisal, data were extracted from the included studies by two independent reviewers using the relevant instrument in JBI SUMARI. Extracted findings were synthesized narratively and presented in tables to illustrate the reported outcomes for each intervention. The strength of the evidence for each intervention was indicated using 'traffic light' colors: green for effective interventions, amber for interventions with no evidence of an effect and red for interventions less effective than the comparison. RESULTS A total of 23 systematic reviews were included in this umbrella review. Most reviews did not report the number of participants in their included studies. Interventions targeted pharmacists, medical doctors, medical students and nurses, or were nonspecific about the participants. The majority of included reviews examined single interventions. All reviews were published and in English. Four interventions, medication administration education, medication reconciliation or review, specialist pharmacists' roles and physical or design modifications, reported effectiveness in reducing errors; however, heterogeneity between the included studies in these reviews was high. CONCLUSION For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
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Lillis S, Lack L. Repeat prescribing policy in New Zealand general practice: making it better. J Prim Health Care 2020; 12:373-376. [PMID: 33349326 DOI: 10.1071/hc20098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Repeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIM To inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODS At the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTS Issues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSION This research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.
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Affiliation(s)
- Steven Lillis
- General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland Grafton Campus, Grafton, Auckland, New Zealand; and Corresponding author.
| | - Liza Lack
- General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland Grafton Campus, Grafton, Auckland, New Zealand
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Anderson LJ, Schnipper JL, Nuckols TK, Shane R, Le MM, Robbins K, Pevnick JM. Effect of medication reconciliation interventions on outcomes: A systematic overview of systematic reviews. Am J Health Syst Pharm 2020; 76:2028-2040. [PMID: 31789354 DOI: 10.1093/ajhp/zxz236] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate and summarize published evidence from systematic reviews examining medication reconciliation. METHODS MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for English-language systematic reviews published from January 2004 to March 2019. Reviewers independently extracted information and scored review quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. For reviews with AMSTAR scores above 7, Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality, with evidence summarized and conclusions compared across reviews. RESULTS Eleven reviews met the inclusion criteria, 5 of which used meta-analytic pooling. Most systematic reviews included primary studies of comprehensive bundled interventions that featured medication reconciliation as a central component. Reviews largely focused on transitions into and out of hospital settings. Five reviews focused exclusively on pharmacist-led interventions. Of the 5 reviews that considered all types of medication discrepancies, 3 reviews found very low-quality evidence that interventions reduced medication discrepancies. Neither of the 2 reviews that examined clinically significant medication discrepancies found any intervention effect. Of the 5 reviews that examined healthcare utilization outcomes, only 1 found any intervention effect, and that finding was based on low- to very low-quality evidence. Four reviews considered clinical outcomes, but none found any intervention effect. CONCLUSION An overview of systematic reviews of medication reconciliation interventions found 9 high-quality systematic reviews. A minority of those reviews' conclusions were consistent with medication reconciliation alone having a measurable impact, and such conclusions were almost all based on very low-quality evidence.
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Affiliation(s)
- Laura J Anderson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jeff L Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Teryl K Nuckols
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rita Shane
- Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael M Le
- David Geffen School of Medicine, Los Angeles, CA
| | - Karen Robbins
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua M Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Marien S, Legrand D, Ramdoyal R, Nsenga J, Ospina G, Ramon V, Boland B, Spinewine A. A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study. J Am Med Inform Assoc 2019; 25:1488-1500. [PMID: 30137331 DOI: 10.1093/jamia/ocy107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 07/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the "patient app" and the "MedRec app." This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in "real-world" conditions. To achieve adoption and sustained use by patients, the app should meet patients' needs while also efficiently improving the quality of MedRec.
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Affiliation(s)
- Sophie Marien
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium.,Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Delphine Legrand
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium
| | - Ravi Ramdoyal
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Jimmy Nsenga
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Gustavo Ospina
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Valéry Ramon
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Benoit Boland
- Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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Ebbens MM, Errami H, Moes DJAR, van den Bemt PMLA, van der Boog PJM, Gombert-Handoko KB. Prevalence of medication transfer errors in nephrology patients and potential risk factors. Eur J Intern Med 2019; 70:50-53. [PMID: 31606307 DOI: 10.1016/j.ejim.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medication reconciliation in transitions of care can prevent medication transfer errors (MTE). MTE can cause patient harm. Since performing medication reconciliation for every patient is not always feasible, identification of potential risk factors of MTE could aid in targeting this intervention to the right patients. OBJECTIVE To establish the proportion of patients with one or more MTE in the outpatient nephrology setting. Secondary patient characteristics associated with MTE, type and potential harm, and medication groups were investigated. METHODS This retrospective observational cohort study was conducted in the Leiden University Medical Center, the Netherlands, between November 2017 and April 2018. The cohort involved patients in whom medication reconciliation was performed by a medical attendant using the electronic tool 'Medical Dashboard' prior to visiting the nephrologist. MTE were defined as unintended discrepancies between the medication in the hospital system and the result of the medication reconciliation. The proportion of patients with one or more MTE was calculated and the association of patient characteristics (age, sex, number of medications and kidney function (CKD-EPI)) with MTE was analyzed using multivariate logistic regression. RESULTS Of 380 patients, 235 patients (61.8%) had at least one MTE. On average patients used 10.3 medications. The number of medications per patient was significantly associated with MTE; OR 1.11 (95%CI 1.05-1.16). No association was found for age, sex, and kidney function. CONCLUSION In ambulatory nephrology patients 61.8% had at least one MTE. Nephrology patients using a higher number of drugs are more prone to MTE.
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Affiliation(s)
- M M Ebbens
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands; Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands; St Jansdal Hospital, Department of Pharmacy, Wethouder Jansenlaan 90, 3844, DG, Harderwijk, The Netherlands.
| | - H Errami
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - D J A R Moes
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - P M L A van den Bemt
- Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - P J M van der Boog
- Leiden University Medical Center, Department of Nephrology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - K B Gombert-Handoko
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
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Horsky J, Drucker EA, Ramelson HZ. Higher accuracy of complex medication reconciliation through improved design of electronic tools. J Am Med Inform Assoc 2019; 25:465-475. [PMID: 29121197 DOI: 10.1093/jamia/ocx127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/07/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Investigate the accuracy of 2 different medication reconciliation tools integrated into electronic health record systems (EHRs) using a cognitively demanding scenario and complex medication history. Materials and Methods Seventeen physicians reconciled medication lists for a polypharmacy patient using 2 EHRs in a simulation study. The lists contained 3 types of discrepancy and were transmitted between the systems via a Continuity of Care Document. Participants updated each EHR and their interactions were recorded and analyzed for the number and type of errors. Results Participants made 748 drug comparisons that resulted in 53 errors (93% accuracy): 12 using EHR2 (3% rate, 0-3 range) and 41 using EHR1 (11% rate, 0-9 range; P < .0001). Twelve clinicians made completely accurate reconciliations with EHR2 (71%) and 6 with EHR1 (35%). Most errors (28, 53%) occurred in medication entries containing discrepancies: 4 in EHR2 and 24 in EHR1 (P = .008). The order in which participants used the EHRs to complete the task did not affect the results. Discussion Significantly fewer errors were made with EHR2, which presented lists in a side-by-side view, automatically grouped medications by therapeutic class and more effectively identified duplicates. Participants favored this design and indicated that they routinely used several workarounds in EHR1. Conclusion Accurate assessment of the safety and effectiveness of electronic reconciliation tools requires rigorous testing and should prioritize complex rather than simpler tasks that are currently used for EHR certification and product demonstration. Higher accuracy of reconciliation is likely when tools are designed to better support cognitively demanding tasks.
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Affiliation(s)
- Jan Horsky
- Brigham & Women's Hospital, Department of Medicine, Division of General Internal Medicine and Primary Care, Boston, MA, USA.,Partners HealthCare, Information Systems, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Drucker
- Harvard Medical School, Boston, MA, USA.,Newton-Wellesley Hospital, Department of Radiology, Newton, MA, USA.,Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Harley Z Ramelson
- Brigham & Women's Hospital, Department of Medicine, Division of General Internal Medicine and Primary Care, Boston, MA, USA.,Partners HealthCare, Information Systems, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Chiewchantanakit D, Meakchai A, Pituchaturont N, Dilokthornsakul P, Dhippayom T. The effectiveness of medication reconciliation to prevent medication error: A systematic review and meta-analysis. Res Social Adm Pharm 2019; 16:886-894. [PMID: 31607507 DOI: 10.1016/j.sapharm.2019.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/20/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of medication reconciliation (MR) in low-middle-income countries, including Thailand, may differ from other developed countries. OBJECTIVE To evaluate the effect of medication reconciliation (MR) on the reduction of medication error in Thailand. METHODS A systematic search was conducted in the following databases: PubMed, CENTRAL, CINAHL, Scopus, Thai Journals Online, Thai index Medicus, Thai Medical Index, and Health Science Journal in Thailand from inception to January 2018. Studies that evaluated the effect of MR compared to usual care within hospitals in Thailand and reported the occurrence of medication error were included. Meta-analyses were performed using random-effects model. RESULTS Of the 107 articles retrieved, 7 articles involving 1581 patients were included in quantitative synthesis. Three of the included studies were randomized controlled trials (RCT). Overall, the risk of medication error in patients who received MR in all transitions of care was 75% lower than those receiving usual care (RR 0.25; 95%CI 0.15-0.43). The effect on the reduction of medication error appeared higher when MR was provided to ambulatory patients (RR 0.17 [95%CI 0.04-0.80] compared with hospitalized patients during admission (RR 0.37 [95%CI 0.20-0.65]) and discharge (RR 0.27 [95%CI 0.17-0.43]). Effects on reducing medication error was greater when MR was provided in secondary care hospitals compared with primary care hospitals both during admission (RR 0.49 [95%CI, 0.34-0.69] vs RR 0.25 [95%CI, 0.05-1.26]), and discharge transition (RR 0.19 [95%CI, 0.09-0.39] vs RR 0.30 [95%CI, 0.12-0.79]). CONCLUSION Overall, current evidence indicates that the provision of MR in Thailand is effective in reducing medication errors in all transitions of care. However, to promote patient safety, appropriate strategies should be developed to support MR in specific transition of care and hospital setting so patients can benefit most from this service.
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Affiliation(s)
- Daranee Chiewchantanakit
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Anupong Meakchai
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Natdanai Pituchaturont
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Teerapon Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
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Tamblyn R, Abrahamowicz M, Buckeridge DL, Bustillo M, Forster AJ, Girard N, Habib B, Hanley J, Huang A, Kurteva S, Lee TC, Meguerditchian AN, Moraga T, Motulsky A, Petrella L, Weir DL, Winslade N. Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial. JAMA Netw Open 2019; 2:e1910756. [PMID: 31539073 PMCID: PMC6755531 DOI: 10.1001/jamanetworkopen.2019.10756] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Adverse drug events (ADEs) account for up to 16% of emergency department (ED) visits and 7% of hospital admissions. Medication reconciliation is required for hospital accreditation because it can reduce medication discrepancies, but there is no evidence that reducing discrepancies reduces ADEs or other adverse outcomes. OBJECTIVE To evaluate whether electronic medication reconciliation reduces ADEs, medication discrepancies, and other adverse outcomes compared with usual care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized trial involved 3491 patients who were discharged from 2 medical units and 2 surgical units at the McGill University Health Centre, Montreal, Quebec, Canada, between October 2014 and November 2016. Data analysis took place from July 2017 to July 2019. INTERVENTION The RightRx intervention electronically retrieved community drugs from the provincial insurer and aligned them with in-hospital drugs to facilitate reconciliation and communication at care transitions. MAIN OUTCOMES AND MEASURES The primary outcome was ADEs in 30 days after discharge. Secondary outcomes included medication discrepancies, ED visits, hospital readmissions, and a composite outcome of ED visits, readmissions, and death up to 90 days after discharge. RESULTS Of 4656 eligible patients, 3567 (76.6%) consented to participate (2060 [57.8%] men; mean [SD] age, 69.8 [14.9] years). Overall, 76 patients died during the hospital stay, so 3491 patients were included in the analysis. There was no significant difference in the risk of ADEs between intervention and control groups (76 [4.6%] vs 73 [4.0%]; OR, 0.97; 95% CI, 0.33-1.48), ED visits (433 [26.2%] vs 488 [26.6%]; OR, 0.83; 95% CI, 0.36-1.42), hospital readmission (170 [10.3%] vs 261 [14.2%]; OR, 0.22; 95% CI, 0.06-1.14), or the composite outcome (447 [27.0%] vs 506 [27.6%]; OR, 0.75; 95% CI, 0.34-1.27) at 30 days. Medication discrepancies were significantly reduced in the intervention group compared with the control group (437 [26.4%] vs 1029 [56.0%]; OR, 0.24; 95% CI, 0.12-0.57). Changes made to community medications (OR, 1.05; 95% CI, 1.01-1.10) and new medications (OR, 1.09; 95% CI, 1.01-1.18) were significant risk factors for ADEs. CONCLUSIONS AND RELEVANCE Electronic medication reconciliation reduced medication discrepancies but did not reduce ADEs or other adverse outcomes. Hospital accreditation should focus on interventions that reduce the risk of adverse events for patients with multiple changes to community medications. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01179867.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - James Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Allen Huang
- Division of Geriatric Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Siyana Kurteva
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Todd C. Lee
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Ari N. Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Teresa Moraga
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Lina Petrella
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Daniala L. Weir
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nancy Winslade
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
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Morelock SG, Kirk JD. An urban medical system's exploratory study of medication errors. Nurs Open 2019; 6:1197-1204. [PMID: 31367446 PMCID: PMC6650646 DOI: 10.1002/nop2.319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/21/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022] Open
Abstract
AIMS This study sought to identify patterns of medication errors with respect to shifts, day of week, unit involved, severity, medication class and cause of errors and to propose possible solutions. DESIGN This was a retrospective explorative study using a database containing 605 medication events from two medical centres. Variables assessed include medication type, the error severity, and time the medication was ordered, the unit that the error occurred on and the day of the week of the errors. METHODS Simple percentages were used to report the results, and point-biserial correlation was employed to test for significant differences between the day and night shifts. RESULTS There were no statistically significant findings when comparing event severity against the a.m. or p.m. shifts. The medication classes with the most errors were antibiotics, and the most common reason cited for errors was dose omission. The most commonly reported severity level was a 2 which requires increased patient monitoring.
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Schiff G, Mirica MM, Dhavle AA, Galanter WL, Lambert B, Wright A. A Prescription For Enhancing Electronic Prescribing Safety. Health Aff (Millwood) 2019; 37:1877-1883. [PMID: 30395495 DOI: 10.1377/hlthaff.2018.0725] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While electronic prescribing has been shown to reduce medication errors and improve prescribing safety, it is vulnerable to error-prone processes. We review six intersecting areas in which changes to electronic prescribing systems, particularly in the outpatient setting, could transform medication ordering quality and safety. We recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing the transmission of electronic cancellation orders to pharmacies (CancelRx) to ensure that drugs are safely and reliably discontinued, implementing standardized structured and codified prescription instructions, reengineering clinical decision support, and redesigning electronic prescribing to facilitate the ordering of nondrug alternatives.
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Affiliation(s)
- Gordon Schiff
- Gordon Schiff ( ) is associate director of the Center for Patient Safety Research and Practice, Brigham and Women's Hospital, and quality and safety director of the Harvard Medical School Center for Primary Care, both in Boston, Massachusetts
| | - Maria M Mirica
- Maria M. Mirica is a project manager in the Center for Patient Safety Research and Practice, Brigham and Women's Hospital
| | - Ajit A Dhavle
- Ajit A. Dhavle is founder and CEO of Adviva Health, Inc., in Alexandria, Virginia
| | - William L Galanter
- William L. Galanter is an associate professor, Academic Internal Medicine and Geriatrics, at the University of Illinois at Chicago
| | - Bruce Lambert
- Bruce Lambert is a professor in the Department of Communication Studies and director of the Center for Communication and Health at Northwestern University, in Chicago
| | - Adam Wright
- Adam Wright is an associate professor of general medicine at Brigham and Women's Hospital and Harvard Medical School
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de Araújo BC, de Melo RC, de Bortoli MC, Bonfim JRDA, Toma TS. How to Prevent or Reduce Prescribing Errors: An Evidence Brief for Policy. Front Pharmacol 2019; 10:439. [PMID: 31263409 PMCID: PMC6584796 DOI: 10.3389/fphar.2019.00439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/05/2019] [Indexed: 12/26/2022] Open
Abstract
- Preventing prescribing errors is critical to improving patient safety.- We developed an evidence brief for policy to identify effective interventions to avoid or reduce prescribing errors.- Four options were raised: promoting educational actions on prudent prescribing directed to prescribers; incorporating computerized alert systems into clinical practice; implementing the use of tools for guiding medication prescribing; and, encouraging patient care by a multidisciplinary team, with the participation of a pharmacist.- These options can be incorporated into health systems either alone or together, and for that, it is necessary that the context be considered.- Aiming to inform decision makers, we included considerations on the implementation of these options regarding upper-middle income countries, like the Brazilian, and we also present considerations regarding equity.
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Affiliation(s)
| | | | | | | | - Tereza Setsuko Toma
- Department of Health, Institute of Health, Government of the State of São Paulo, São Paulo, Brazil
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43
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Pharmacy-supported interventions at transitions of care: an umbrella review. Int J Clin Pharm 2019; 41:831-852. [DOI: 10.1007/s11096-019-00833-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
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Raman R, Grover V. Studying the multilevel impact of cohesion versus structural holes in knowledge networks on adaptation to IT‐enabled patient‐care practices. INFORMATION SYSTEMS JOURNAL 2019. [DOI: 10.1111/isj.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Roopa Raman
- Department of MIS, Operations Management, and Decision SciencesUniversity of Dayton Dayton OH 45469 USA
| | - Varun Grover
- David D Glass Endowed Chair and Distinguished Professor of Information Systems, University of ArkansasWalton College of Business Fayetteville AR 72701 USA
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A User-Centered design and usability testing of a web-based medication reconciliation application integrated in an eHealth network. Int J Med Inform 2019; 126:138-146. [PMID: 31029255 DOI: 10.1016/j.ijmedinf.2019.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 11/09/2018] [Accepted: 03/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Medication discrepancies, which are a threat to patient safety, can be reduced by medication reconciliation (MedRec). MedRec is a complex process that can be supported by the use of information technology and patient engagement. Therefore, the SEAMPAT project aims to develop a MedRec IT platform based on two applications. The application for the professionals is called: the "MedRec app". OBJECTIVE In the present study, we aimed to describe the development and usability testing of the MedRec app, reporting results of a three iterations user-centered usability evaluation. METHODS We used a three phase iterative user-centered study spread over 16 months. At each phase, the usability evaluation included several methods (observations, questionnaires, and follow-up discussions with participants) to collect quantitative and qualitative data in order to improve the current prototype and evolve to the next prototype. RESULTS In total, 48 healthcare professionals (25 general practitioners and 23 hospital clinicians) participated to the MedRec app evaluation. There were 14, 32 and 5 participants for phases 1, 2 and 3 respectively. At each phase, many design modifications were done to strengthen usability. Concerning usability, participants considered the prototypes as an acceptable interface with a median System Usability Score of 73 at phase 2 and 75 at phase 3. Participants emphasized the need for improvements concerning workflow integration, usefulness and interoperability. CONCLUSION The MedRec app was perceived as being useful, usable and satisfying. However, further improvements are required in several usability aspects. Our study demonstrates the importance of conducting usability assessments before investing time and resources in a large study evaluating the effect of an eMedRec approach on clinical outcomes. Our findings may also increase the chances of acceptability and sustained use over time by clinicians.
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DeAntonio JH, Nguyen T, Chenault G, Aboutanos MB, Anand RJ, Ferrada P, Goldberg S, Leichtle SW, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Wijesinghe DS, Jayaraman S. Medications and patient safety in the trauma setting: a systematic review. World J Emerg Surg 2019; 14:5. [PMID: 30815027 PMCID: PMC6377727 DOI: 10.1186/s13017-019-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/03/2019] [Indexed: 02/17/2023] Open
Abstract
Background Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population. Materials and methods We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms "trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR errors OR intervention OR improvements." Results The search resulted in 82 articles. After screening for relevance and duplicates, the 43 remaining were further reviewed, and only four articles, which presented results on medication reconciliation in 3041 trauma patients, were included. Two were retrospective and two were prospective. Two showed only 4% accuracy at time of admission with 48% of medication reconciliations having at least one medication discrepancy. There were major differences across the studies prohibiting comparative statistical analysis. Conclusions Trauma medication reconciliation is important because of the potential for adverse outcomes given the emergent nature of the illness. The few articles published at this time on medication reconciliation in trauma suggest poor accuracy. Numerous strategies have been implemented in general medicine to improve its accuracy, but these have not yet been studied in trauma. This topic is an important but unrecognized area of research in this field.
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Affiliation(s)
- Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Department of Surgery, VCU School of Medicine, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Gregory Chenault
- VCU Health Department of Pharmacy Services, Critical Care, Richmond, Virginia USA
| | - Michel B. Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Sarah Hobgood
- Division of Geriatrics, Department of Internal Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Dayanjan S. Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences and Laboratory of Pharmacometabolomics and Companion Diagnostics, Virginia Commonwealth University School of Pharmacy, VCU Health, Richmond, Virginia USA
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- VCU School of Medicine, Richmond, Virginia USA
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Automated E-mail Reminders Linked to Electronic Health Records to Improve Medication Reconciliation on Admission. Pediatr Qual Saf 2018; 3:e109. [PMID: 30584636 PMCID: PMC6221599 DOI: 10.1097/pq9.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 08/15/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction: Medication reconciliation can reduce medication discrepancies, errors, and patient harm. After a large academic hospital introduced a medication reconciliation software program, there was low compliance with electronic health record documentation of home medication reconciliation. This quality improvement project aimed to improve medication reconciliation on admission in 4 pediatric inpatient units by 50% over 3 months. Methods: We used Lean Sigma methodology to observe medication reconciliation processes; interview residents, nurses, pharmacists, and families; and perform swim lane process mapping and Ishikawa Cause and Effect analysis. The improvement plan included education and automated e-mails sent to admitting residents who had not completed medication reconciliation within 24 hours of admission. The daily percentage of patients without medication reconciliation within 24 hours of admission, indicated by the presence of old prescriptions in Sunrise Prescription Writer (RxWriter) (Allscripts Healthcare Solutions, Chicago, Ill.) from prior admissions, was assessed from March 2015-June 2016. We constructed statistical process control charts and identified special causes. Results: Key barriers included lack of knowledge about RxWriter and lack of accountability for completing medication reconciliation. The percentage of patients without medication reconciliation decreased from 32% at baseline to 22% with education (P < 0.001), to 15% with the use of automated e-mail reminders (P < 0.001). We sustained improvement over the following year. Statistical process control testing indicated shifts aligning with each stage of the study. Conclusion: Provider-tailored, automated e-mail reminders linked to electronic health record with educational training significantly improved resident compliance with use of an electronic tool for documentation of home medication reconciliation on hospital admission.
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Wang H, Meng L, Song J, Yang J, Li J, Qiu F. Electronic medication reconciliation in hospitals: a systematic review and meta-analysis. Eur J Hosp Pharm 2018; 25:245-250. [PMID: 31157034 PMCID: PMC6452330 DOI: 10.1136/ejhpharm-2017-001441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Medication reconciliation (MedRec) is recognised as a multiprofessional process for the prevention of medication discrepancies. The goal of this study is to evaluate the available electronic medication reconciliation (eMedRec) tools and their effect on unintended discrepancies that occur in hospital institutions. METHOD PubMed, EMBASE, the Cochrane Library, Web of Science, the ClinicalTrials.gov website and four other Chinese databases were searched for relevant studies starting from their inception through October 2017. Methodological quality was assessed using the nine standard criteria of Cochrane Effective Practice and Organisation of Care Review Group (EPOC) and meta-analysis was performed using RevMan5.3 software. RESULTS A total of 13 studies (three randomised controlled trials and 10 non-randomised controlled trials) were identified. Meta-analysis results demonstrated a reduced number of medications with unintended discrepancies (relative risk (RR)=1.85, 95% confidence interval (CI) 1.55 to 2.21), while no statistically significant differences were observed in the number of patients with unintended medication discrepancies (RR=2.74, 95% CI 0.59 to 12.73). Common discrepancies included medication omission, dose discrepancy, and frequency discrepancy. We found that the clinical impact of medication discrepancy was mild. A total of 12 electronic tools were reported and were mostly integrated into the hospital's information system. However, the usability, user adherence, and user satisfaction were found to lack sufficient evidence. CONCLUSION eMedRec was shown to reduce the incidence of medication with unintended discrepancies and improve medication safety. However, the electronic tools are diversified and the effects on other outcomes still require a comprehensive evaluation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017067528.
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Affiliation(s)
- Hongmei Wang
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Meng
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Song
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiadan Yang
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Li
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Qiu
- Department of Pharmacy, TheFirst Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tamiru A, Edessa D, Sisay M, Mengistu G. Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia. BMC Res Notes 2018; 11:554. [PMID: 30075803 PMCID: PMC6076390 DOI: 10.1186/s13104-018-3668-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study is to determine the magnitude of medication discrepancies and its associated factors at transitions in care of a Specialized University Hospital in eastern Ethiopia. Results This study enrolled 411 patients having at least one prescription medication. For each of the patient enrolled, a medication reconciliation process was accomplished between medication use history before transition and medication orders at the transition. A total of 1027 medications were reconciled and 298 of them showed discrepancies. From such medication discrepancies, 96 (32.2%) of them were unintended discrepancies. Patients admitted to surgical ward (adjusted odds ratio {AOR} 0.27 [95% confidence interval 0.10–0.74]) and on malnutrition therapy (AOR 0.13 [0.03–0.52]) had reduced likelihoods of medication discrepancies. However, patients on cardiovascular drug therapy (AOR 5.69 [2.4–13.62]) and who were hospitalized for more than 5 days (AOR 5.69 [2.97–10.9] {5–10 days}) had significantly increased likelihoods of discrepancies. Accordingly, one-third of the medication discrepancies identified were unintentional and these discrepancies were more likely to occur with cardiovascular drugs, in medical or pediatric wards and patients hospitalized for prolonged time. Therefore, this pharmacist-led medication reconciliation indicates the potential of pharmacists in reducing drug-related adverse health outcomes that arise from medication discrepancy. Electronic supplementary material The online version of this article (10.1186/s13104-018-3668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Addisu Tamiru
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia
| | - Dumessa Edessa
- Department of Pharmacy Practice, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia.
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia
| | - Getnet Mengistu
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
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Jurado C, Calmels V, Lobinet E, Divol E, Hanaire H, Metsu D, Sallerin B. The Electronic Pharmaceutical Record: A new method for medication reconciliation. J Eval Clin Pract 2018; 24:681-687. [PMID: 29761596 DOI: 10.1111/jep.12942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 01/17/2023]
Abstract
RATIONALE, AIM, AND OBJECTIVE There are several ways to establish an accurate medication list in the hospital admission medication reconciliation (MedRec). The challenge for MedRec lies in the availability, reliability, and completeness of the data used. In France, the Electronic Pharmaceutical Record (ePR) was developed to register each medication taken by ambulatory patients, primarily to make dispensation in community pharmacies safe. We evaluated the suitability of this tool in the MedRec when patients were admitted to the hospital. METHOD We conducted a 6-month pilot study of 249 MedRec files from a hospital diabetology department. The analysis was supplemented by the ePR for any patient for whom this information was recorded. The study evaluated the ePR as a new MedRec tool, as well as the clinical impact (CI) of the new data collected. RESULTS The ePR was contributory for 28% of the patients. Discrepancies were associated with polypharmacy, most of which had a CI = 1. Medication omission was the most frequently found discrepancy (72%), but self-medication (8%) and lack of medication adherence (9%) were also observed. CONCLUSION This tool provided added value for reconciliation, as it quickly identifies regular medications, adherence, and self-medication behaviour. The ePR is essential for conducting a thorough MedRec.
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Affiliation(s)
- Camille Jurado
- Department of Pharmacy, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Violaine Calmels
- Department of Pharmacy, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emilie Lobinet
- Department of Endocrinology, Hôpital Larrey, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Elodie Divol
- Department of Pharmacy, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases, and Nutrition, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Medicine, University Toulouse III, Paul Sabatier, Toulouse, France
| | - David Metsu
- Department of Pharmacokinetics and Toxicology, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INTHERES, INRA, ENVT, Université de Toulouse, France
| | - Brigitte Sallerin
- Department of Pharmacy, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,I2MC, Team 6: Cardiac Remodeling and New Therapies, National Institute of Health and Medical, INSERM, Toulouse, France.,Department of Pharmacy, University Toulouse III, Paul Sabatier, Toulouse, France
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