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Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E. A systematic review of older patients' experiences and perceptions of communication about managing medication across transitions of care. Res Social Adm Pharm 2020; 17:273-291. [PMID: 32299684 DOI: 10.1016/j.sapharm.2020.03.023] [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] [Received: 11/11/2019] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents. OBJECTIVE The aim of this systematic review was to explore older patients' experiences and perceptions of communication about managing medications across transitions of care. DESIGN A systematic review. METHODS A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article cross-checking and hand searching of reference lists of included papers were also undertaken. INCLUSION CRITERIA studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients' homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool. RESULTS The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients' experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period. CONCLUSIONS Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients' views of communication about medication management on admission, during hospitalisation, or transfer between settings.
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Affiliation(s)
- Guncag Ozavci
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Tracey Bucknall
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Deakin-Alfred Health Nursing Research Centre, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan Street Parkville, 3052, Victoria, Australia.
| | - Carmel Hughes
- Queen's University Belfast, School of Pharmacy, 97 Lisburn Road Belfast BT9 7BL, UK, Northern Ireland, UK.
| | - Christine Jorm
- NSW Regional Health Partners, Wisteria House, James Fletcher Hospital, 72 Watt St, Newcastle, 2300, NSW, Australia.
| | - Kathryn Joseph
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Elizabeth Manias
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The Role of Clinical Pharmacists in the Emergency Department. J Med Toxicol 2018; 14:114-116. [PMID: 29075954 PMCID: PMC6013729 DOI: 10.1007/s13181-017-0634-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brenna M Farmer
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Rama Rao
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Patient-, medication- and environment-related factors affecting medication discrepancies in older patients. Collegian 2017. [DOI: 10.1016/j.colegn.2016.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Manias E, Geddes F, Della P, Jones D, Watson B, Stewart-Wynne E. Inter-hospital ‘patient expect’ calls of clinical handovers for expected patients transferred from rural to metropolitan hospitals: A retrospective clinical audit. Collegian 2016. [DOI: 10.1016/j.colegn.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Manias E, Gerdtz M, Williams A, McGuiness J, Dooley M. Communicating about the management of medications as patients move across transition points of care: an observation and interview study. J Eval Clin Pract 2016; 22:635-43. [PMID: 26762967 DOI: 10.1111/jep.12507] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. METHOD A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. RESULTS Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. CONCLUSIONS Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia. .,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia. .,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - Marie Gerdtz
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Williams
- Monash Nursing Academy, Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Josephine McGuiness
- Pharmacy Department, The Alfred, Prahran, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Michael Dooley
- Pharmacy Department, The Alfred, Prahran, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int J Clin Pharm 2016; 38:1164-71. [PMID: 27558355 DOI: 10.1007/s11096-016-0348-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk factors were a larger number of previous medications, less physician years of experience, and more previous surgeries. Having a computerized order entry system in the hospital protected against some errors.
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Mekonnen AB, McLachlan AJ, Brien JAE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 2016; 6:e010003. [PMID: 26908524 PMCID: PMC4769405 DOI: 10.1136/bmjopen-2015-010003] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients' clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity. RESULTS 17 studies involving 21,342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results. CONCLUSION Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
| | - Jo-anne E Brien
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, Australia
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de Andrés-Lázaro AM, Sevilla-Sánchez D, Ortega-Romero MDM, Codina-Jané C, Calderón-Hernanz B, Sánchez-Sánchez M. Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias. Med Clin (Barc) 2015; 145:288-93. [DOI: 10.1016/j.medcli.2015.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
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Manias E, Gerdtz M, Williams A, Dooley M. Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards. J Clin Nurs 2014; 24:69-80. [DOI: 10.1111/jocn.12685] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery; Deakin University; Burwood Vic. Australia
- Department of Medicine; Royal Melbourne Hospital; The University of Melbourne; Parkville Vic. Australia
- Melbourne School of Health Sciences; The University of Melbourne; Parkville Vic. Australia
| | - Marie Gerdtz
- Melbourne School of Health Sciences; The University of Melbourne; Parkville Vic. Australia
- Emergency Department; The Royal Melbourne Hospital; Parkville Vic. Australia
| | - Allison Williams
- Monash Nursing Academy; School of Nursing and Midwifery; Clayton Campus; Monash University; Clayton Vic. Australia
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Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of Medication Reconciliation and Review on Clinical Outcomes. Ann Pharmacother 2014; 48:1298-312. [DOI: 10.1177/1060028014543485] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
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Affiliation(s)
- Elin C. Lehnbom
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Michael J. Stewart
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
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Weeks GR, Ciabotti L, Gorman E, Abbott L, Marriott JL, George J. Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals. Res Social Adm Pharm 2014; 10:679-92. [DOI: 10.1016/j.sapharm.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
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Manias E, Williams A, Liew D, Rixon S, Braaf S, Finch S. Effects of patient-, environment- and medication-related factors on high-alert medication incidents. Int J Qual Health Care 2014; 26:308-20. [DOI: 10.1093/intqhc/mzu037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Manias E. Detection of medication-related problems in hospital practice: a review. Br J Clin Pharmacol 2014. [PMID: 23194349 DOI: 10.1111/bcp.12049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods.
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Affiliation(s)
- Elizabeth Manias
- Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia.
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Kostas T, Paquin AM, Zimmerman K, Simone M, Skarf LM, Rudolph JL. Characterizing medication discrepancies among older adults during transitions of care: a systematic review focusing on discrepancy synonyms, data sources and classification terms. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Medication reconciliation is a Joint Commission National Patient Safety Goal prioritized at transitions of care. Medication discrepancies are the reason for, and result of, medication reconciliation. However, their characterization in the literature has not been systematically studied. Older adults are at particularly high risk for medication discrepancies given the prevalence of polypharmacy in this population. The aim was to determine how medication discrepancies among older adults are defined during transitions of care by analyzing synonyms, medication data sources and classification terms. A systematic search of PubMed and EMBASE for primary literature involving medication discrepancies among adults aged ≥50 years during hospital care transitions was carried out. Reviewers consolidated data into like categories and used descriptive statistics to summarize findings. Out of 746 records retrieved, 35 studies were included in this review. In total, 19 studies (54%) were exclusive to adults over 65 years of age. Study settings included hospital discharge (n = 16; 46%), admission (n = 13; 37%) and mixed or multiple transitions (n = 6; 17%). Synonyms for discrepancies included inconsistencies, incongruences, inaccuracies and disagreements, among others. Common data sources included inpatient medication records and medication histories. A comprehensive, best possible medication history utilizing all available medication data sources was recorded in 51% of studies (n = 18), most consistently at admission. Most studies (n = 32; 91%) classified discrepancies; common classification terms included drug dose (n = 28; 88%), omission (n = 26; 80%) and commission (n = 16; 50%). In this first systematic review of medication discrepancy definitions, we found inconsistency across studies. Standardization and common discrepancy nomenclature is necessary for medication reconciliation outcomes to be compared, and to identify best practices to enhance safety. Safety implications are most salient in older adults given the number of medications and transitions of care to which they are exposed, as well as their sensitivity to adverse consequences of medication discrepancies.
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Affiliation(s)
- Tia Kostas
- VA Boston Healthcare System, Geriatrics Research, Education & Clinical Center, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA
| | - Allison M Paquin
- VA Boston Healthcare System, Department of Pharmacy (119), 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Kristin Zimmerman
- Massachusetts College of Pharmacy & Health Sciences University, 179 Longwood Avenue, Boston, MA 02115, USA
| | - Mark Simone
- Mount Auburn Hospital, 300 Mount Auburn Street, DOB 517, Cambridge, MA 02138, USA
| | - Lara M Skarf
- VA Boston Healthcare System, Medical Staff Office 111, 1400 VFW Parkway, West Roxbury, MA 02132, USA
| | - James L Rudolph
- VA Boston Healthcare System, Geriatrics Research, Education & Clinical Center, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA
- Brigham & Women‘s Hospital, Division of Aging, 75 Francis Street, Boston, MA 02115, USA
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Climente-Martí M, García-Mañón ER, Artero-Mora A, Jiménez-Torres NV. Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service. Ann Pharmacother 2010; 44:1747-54. [PMID: 20923946 DOI: 10.1345/aph.1p184] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients. OBJECTIVE To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors for reconciliation errors and their potential clinical impact. METHODS An observational prospective study was conducted at a general teaching hospital. Patients who were admitted to the internal medicine service and were receiving chronic preadmission treatment were included in the study. Preadmission treatment was compared with the treatment prescribed on admission (first 48 hours) and at hospital discharge, and discrepancies and reconciliation errors were identified. The primary endpoint was the presence of reconciliation errors at admission and/or discharge. Potential risk factors (patient-, medication-, and system-related) for reconciliation errors were analyzed using a multivariate logistic regression model. RESULTS Of the 120 patients enrolled in the study between April and August 2009, 109 (90.8%) showed 513 discrepancies. The prevalence of patients with reconciliation errors was 20.8% (95% CI 13.6 to 28.1). Intended medication discrepancies were more frequent at admission (96.6%) than at discharge (75.5%), while reconciliation errors were more frequent at discharge (24.5%) than at admission (3.4%). The prevalence ratio (admission vs discharge) was 2.4 (95% CI 1.9 to 3.0) for discrepancies and 0.65 (95% CI 0.32 to 1.32) for reconciliation errors. The logistic regression analysis revealed an association between the number of discrepancies at admission (OR 1.21; 95% CI 1.01 to 1.44) and age (OR 1.05; 95% CI 0.99 to 1.10) and an increased risk of reconciliation errors. CONCLUSIONS Medication reconciliation strategies should focus primarily on avoiding errors at discharge. Since medication discrepancies at admission may predispose patients to reconciliation errors, early detection of such discrepancies would logically reduce the risk of reconciliation errors. Medication reconciliation programs must implement a process for gathering accurate preadmission drug histories and must submit this information to a critical assessment of patients' needs.
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Chan EW, Taylor SE, Marriott J, Barger B. An intervention to encourage ambulance paramedics to bring patients' own medications to the ED: Impact on medications brought in and prescribing errors. Emerg Med Australas 2010; 22:151-8. [DOI: 10.1111/j.1742-6723.2010.01273.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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