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Magrum B, Smetana KS, Thompson M, Elefritz JL, Phelps M, Trolli E, Murphy CV. Characterization of Medication Discrepancies and Interventions Resulting From Pharmacy-Led Medication Reconciliation in the Critical Care Setting. J Pharm Pract 2024; 37:587-592. [PMID: 36592435 DOI: 10.1177/08971900221149788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Medication reconciliation has been shown to reduce medication-related errors in hospitalized patients, but the impact of pharmacy-led medication reconciliation in the intensive care unit (ICU) has not been extensively studied. Methods: This was a retrospective chart review of patients with a pharmacy-led medication reconciliation on admission to an ICU between January 1st and March 31st, 2018. Pharmacy-led medication reconciliations were completed by pharmacists, pharmacy residents, and pharmacy students. The objective of this study was to describe medication discrepancies identified by pharmacy-led medication reconciliation and to evaluate the interventions following. Results: A total of 288 patients were screened and 247 met inclusion criteria. There were 1148 medication discrepancies identified resulting in an average of 4.65 discrepancies per patient. Medication addition (54.25%) and medication deletion (45.75%) were most common. Within 24 hours of medication reconciliation, 214 interventions were made to active orders. No differences were observed between discrepancies identified and type of pharmacy staff completing the medication reconciliation. Conclusions: This study identified a high rate of medication discrepancies on admission to the ICU. Furthermore, it describes the types of pharmacist interventions following pharmacy-led medication reconciliation. This process may be impactful to incorporate as a standard practice in ICUs and warrants further investigation into value, cost, and pharmacist workflow.
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Affiliation(s)
- BrookeAnne Magrum
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Keaton S Smetana
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Molly Thompson
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica L Elefritz
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan Phelps
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Elizabeth Trolli
- The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Claire V Murphy
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Bormann TM, Brower KI, Forshay CM. Implementation of pharmacy-led preoperative medication reconciliation in surgical oncology patients. J Am Pharm Assoc (2003) 2024; 64:582-587. [PMID: 38218584 DOI: 10.1016/j.japh.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Pharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical. OBJECTIVES The purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program. PRACTICE DESCRIPTION The service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks' time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students' findings. PRACTICE INNOVATION A standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients' procedures and upon potential postoperative admission. EVALUATION METHODS A retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program. RESULTS Forty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete. CONCLUSION Preoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.
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Ahmadimoghaddam D, Akbari P, Mehrpooya M, Entezari-Maleki T, Rangchian M, Zamanirafe M, Parvaneh E, Mohammadi Y. Comparison between proactive and retroactive models of medication reconciliation in patients hospitalized for acute decompensated heart failure. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:143-158. [PMID: 38457155 DOI: 10.3233/jrs-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. OBJECTIVE This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. METHODS This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran. Eligible patients were those hospitalized for acute decompensated heart failure using a minimum of five regular medications before admission. Medication reconciliation was performed in 81 cases using the proactive model and in 81 using the retroactive model. RESULTS 556 medications were reconciled using the retroactive model, and 581 were reconciled using the proactive model. In the retroactive cases, 341 discrepancies (both intentional and unintentional) were identified, compared to 231 in the proactive cases. The proportion of patients with at least one unintentional discrepancy was significantly lower in the proactive cases than in the retroactive cases (23.80% versus 74.03%). Moreover, the number of unintentional discrepancies was significantly lower in the proactive cases compared to the retroactive cases (22 out of 231 discrepancies versus 150 out of 341 discrepancies). In the retroactive cases, medication omission was the most frequent type of unintentional discrepancy (44.00). About, 42.70% of reconciliation errors detected in the retroactive cases were judged to have the potential to cause moderate to severe harm. While the average time spent obtaining medication history was similar in both models (00:27 [h: min] versus 00:30), the average time needed to complete the entire process was significantly shorter in the proactive model compared to the retroactive model (00:41 min versus 00:51). CONCLUSION This study highlighted that the proactive model is a timely and effective method of medication reconciliation, particularly in improving medication safety for high-risk patients.
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Affiliation(s)
- Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Paniz Akbari
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rangchian
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Medical Faculty, Hamadan University of Medical Science, Hamadan, Iran
| | - Erfan Parvaneh
- Department of Cardiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Ngo NUT, Tangpraphaphorn S, Kahaku D, Canamar CP, Young A. Clinical Pharmacist Transition of Care Model Improves Hospital System Practice by Reducing Readmissions. J Healthc Qual 2023; 45:272-279. [PMID: 37039811 DOI: 10.1097/jhq.0000000000000384] [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: 04/12/2023]
Abstract
PURPOSE A primary cause of hospital readmission is medication-related problems (MRPs). Polypharmacy patients taking multiple medications concurrently experience an increased likelihood of MRPs and high occurrence of readmissions to the hospital within 30 days. This study assessed the ability of a pharmacist-led transition of care program to decrease readmissions in polypharmacy patients by evaluating and rectifying MRPs. METHODS Over 16 months, patients admitted onto the medicine ward service with ≥10 home medications ( n = 536) received medication management interventions from a clinical pharmacist including admission interview, medication reconciliation and consultation, and postdischarge phone follow-up. Admitted patients taking fewer than 10 home medications during the same time served as the control group and received routine standard of care ( n = 2317). RESULTS The polypharmacy group who received the pharmacist-led intervention had a statistically significantly lower 30-day readmission rate (8.8%) compared with patients in the control group (12.4%; X 2 = 5.63, p = .01). Patients receiving pharmacist intervention were 33% less likely to be readmitted within 30 days of discharge compared with the control group (odds ratio = 0.67, 95% CI = 0.49-0.94). All patients had at least one medication-related discrepancy. CONCLUSION This pharmacy-led transition of care program can effectively reduce readmission rates through resolution of medication-related problems.
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Francis M, Francis P, Patanwala AE, Penm J. Obtaining medication histories via telepharmacy: an observational study. J Pharm Policy Pract 2023; 16:69. [PMID: 37291672 DOI: 10.1186/s40545-023-00573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Medication reconciliation is an effective strategy to reduce medication errors upon hospital admission. The process involves obtaining a best possible medication history (BPMH), which can be both time-consuming and resource-intensive. During the COVID-19 pandemic, telepharmacy was used to reduce the risk of viral transmission. Telepharmacy is the remote provision of pharmacy-led clinical services, such as obtaining BPMHs, using telecommunications. However, the accuracy of telephone-obtained BPMHs has not yet been evaluated. Therefore, the primary aim of this study was to evaluate the proportion of patients who have an accurate BPMH from the telephone-obtained BPMH compared to an in-person obtained BPMH. METHODS This prospective, observational study took place in a large tertiary hospital. Recruited patients or carers had their BPMH obtained by a pharmacist over the telephone. The same patients or carers then had their BPMH conducted in-person to identify any deviations between the telephone-obtained and in-person obtained BPMH. All telephone-obtained BPMHs were timed with a stopwatch. Any deviations were categorised according to their potential consequence. An accurate BPMH was defined as having no deviations. Descriptive statistics were used to report all quantitative variables. A multivariable logistic regression was conducted to identify risk factors for patients and medications for having medication deviations. RESULTS In total, 116 patients were recruited to receive both a telephone-obtained and in-person obtained BPMH. Of these, 91 patients (78%) had an accurate BPMH with no deviations. Of the 1104 medications documented across all the BPMHs, 1064 (96%) had no deviation. Of the 40 (4%) medication deviations, 38 were deemed low-risk (3%) and 2 high-risk (1%). A patient was more likely to have a deviation if they are taking more medications (aOR: 1.11; 95% CI: 1.01-1.22; p < 0.05). A medication was more likely to have a deviation if it was regular non-prescription medication (aOR: 4.82; 95% CI: 2.14-10.82; p < 0.001) or 'when required' non-prescription medication (aOR: 3.12; 95% CI: 1.20-8.11; p = 0.02) or a topical medication (aOR: 12.53; 95% CI: 4.34-42.17; p < 0.001). CONCLUSIONS Telepharmacy represents a reliable and time-efficient alternative to in-person BPMHs.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Peter Francis
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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Newsom LC, Dupree LH, Thurston MM, Vivian Liao T, Nwaesei AS. A Scoping Review of Student Pharmacist-Led Transitions-of-Care Initiatives. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100001. [PMID: 37316136 DOI: 10.1016/j.ajpe.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To identify and evaluate the current literature pertaining to student pharmacist-led transitions-of-care (TOC) initiatives and to inform pharmacy educators regarding the current and future roles of pharmacy learners in TOC. FINDINGS A total of 14 articles were identified describing student-led initiatives in care transitions to the inpatient setting and from the inpatient to the outpatient setting. In most studies, student pharmacists involved in delivering TOC services were completing either an advanced pharmacy practice experience or an introductory pharmacy practice experience and were most commonly performing services such as admission medication history and reconciliation. The studies evaluated the impact of student-led TOC services through the identification or resolution of medication-related problems, interventions, and/or discrepancies and included limited and conflicting results pertaining to patient care-based outcomes. SUMMARY Student pharmacists are involved in delivering and leading a variety of TOC services in the inpatient setting and postdischarge period. These student-led TOC initiatives not only provide added value to patient care and the health system but also enhance students' preparation and readiness for pharmacy practice. Colleges and schools of pharmacy should incorporate learning experiences into the curriculum that equip students to contribute to TOC efforts and promote continuity of care across the health system.
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Affiliation(s)
| | - Lori H Dupree
- Mercer University College of Pharmacy, Atlanta, GA, USA
| | | | - T Vivian Liao
- Mercer University College of Pharmacy, Atlanta, GA, USA
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Francis M, Deep L, Schneider CR, Moles RJ, Patanwala AE, Do LL, Levy R, Soo G, Burke R, Penm J. Accuracy of best possible medication histories by pharmacy students: an observational study. Int J Clin Pharm 2023; 45:414-420. [PMID: 36515780 PMCID: PMC9749631 DOI: 10.1007/s11096-022-01516-2] [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: 06/30/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication reconciliation is an effective strategy to prevent medication errors upon hospital admission and requires obtaining a patient's best possible mediation history (BPMH). However, obtaining a BPMH is time-consuming and pharmacy students may assist pharmacists in this task. AIM To evaluate the proportion of patients who have an accurate BPMH from the pharmacy student-obtained BPMH compared to the pharmacist-obtained BPMH. METHOD Twelve final-year pharmacy students were trained to obtain BPMHs upon admission at 2 tertiary hospitals and worked in pairs. Each student pair completed one 8-h shift each week for 8 weeks. Students obtained BPMHs for patients taking 5 or more medications. A pharmacist then independently obtained and checked the student BPMH from the same patient for accuracy. Deviations were determined between student-obtained and pharmacist-obtained BMPH. An accurate BPMH was defined as only having no-or-low risk medication deviations. RESULTS The pharmacy students took BPMHs for 91 patients. Of these, 65 patients (71.4%) had an accurate BPMH. Of the 1170 medications included in patients' BPMH, 1118 (95.6%) were deemed accurate. For the student-obtained BPMHs, they were more likely to be accurate for patients who were older (OR 1.04; 95% CI 1.03-1.06; p < 0.001), had fewer medications (OR 0.85; 95% CI 0.75-0.97; p = 0.02), and if students used two source types (administration and supplier) to obtain the BPMH (OR 1.65; 95% CI 1.09-2.50; p = 0.02). CONCLUSION It is suitable for final-year pharmacy students to be incorporated into the BPMHs process and for their BPMHs to be verified for accuracy by a pharmacist.
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Affiliation(s)
- Martina Francis
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
| | - Louise Deep
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Rebekah J Moles
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Linda L Do
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Russell Levy
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Garry Soo
- Department of Pharmacy, Concord Repatriation Geriatric Hospital, Concord, NSW, Australia
| | - Rosemary Burke
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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Interception of chronic medication discrepancies by the clinical pharmacist in the emergency department. Eur J Emerg Med 2023; 30:7-14. [PMID: 35861664 DOI: 10.1097/mej.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The emergency department (ED) is a high-risk setting for the occurrence of medication discrepancies (MDs) due to inconsistencies between real and documented chronic medication therapies. A clinical pharmacist (CP) improves medication safety by performing a structured medication reconciliation on ED admission. The main objective was to identify the frequency and type of MDs in the chronic medication therapy by comparing the medication displayed in the home medication module of the electronic medical record and in the genereal practitioner's (GP) referral letter with the best possible medication history by performing a structured medication reconciliation on ED admission. This prospective, monocentric, interventional study was carried out in the ED of a tertiary care university hospital in Brussels, Belgium. Inclusion criteria were patients of at least 65 years, polypharmacy, ED admission between 8 a.m. and 4 p.m. on weekdays, hospitalization and signed informed consent. During 24 days, a CP performed a structured medication reconciliation in order to obtain the best possible medication history and registered all MDs. The CP compared the best possible medication history with the home medication module and the GP's referral letter and registered the different types of MDs. Eighty-three patients were included. The median number of medications in the home medication module and the best possible medication history was significantly different {7.0 [interquartile range (IQR), 5.0-11.0] vs. 8.0 (IQR, 6.0-11.0)/patient; P < 0.0001} with a median of 5.0 (IQR, 3.0-8.0) MDs per patient. Main MDs were omission (38.8%), addition (18.4%) and a deviant administration time (15.2%). Only 22.9% of patients ( N = 19) had a GP's referral letter containing their chronic medication therapy. The median number of medications in the GP's referral letter and the best possible medication history were significantly different [6.0 (IQR, 4.0-9.0) vs. 8.0 (IQR, 7.0-11.0)/patient; P < 0.0001] with a median of 6.0 (IQR, 5.0-11.0) MDs per patient. Main MDs were omissions (39.9%), deviant frequencies (35.3%) and doses (16.7%). A CP, integrated in a multidisciplinary ED team, enhances medication safety by intercepting MDs on ED admission. Few patients possess a GP's referral letter containing their chronic medication therapy and when they do, the accuracy and completeness are poor.
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Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection. J Clin Med 2023; 12:jcm12010376. [PMID: 36615176 PMCID: PMC9821377 DOI: 10.3390/jcm12010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists' interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians' medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians' medication histories.
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Thompson T. Student pharmacists are an underutilized resource in transitions of care. J Am Pharm Assoc (2003) 2022; 62:1755. [PMID: 36153269 DOI: 10.1016/j.japh.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Taylor Thompson
- Pharmacy Resident & Faculty Development Fellow, UPMC St. Margaret, Pittsburgh, PA.
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Marshall J, Hayes BD, Koehl J, Hillmann W, Bravard M, Jacob S, Gil R, Mitchell E, Ferrante F, Giulietti J, Tull A, Liu X, Lucier D. Effects of a pharmacy-driven medication history program on patient outcomes. Am J Health Syst Pharm 2022; 79:1652-1662. [PMID: 35596269 DOI: 10.1093/ajhp/zxac143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Obtaining an accurate medication history is a vital component of medication reconciliation upon admission to the hospital. Despite the importance of this task, medication histories are often inaccurate and/or incomplete. We evaluated the association of a pharmacy-driven medication history initiative on clinical outcomes of patients admitted to the general medicine service of an academic medical center. METHODS Comparing patients who received a pharmacy-driven medication history to those who did not, a retrospective stabilized inverse probability treatment weighting propensity score analysis was used to estimate the average treatment effect of the intervention on general medical patients. Fifty-two patient baseline characteristics including demographic, operational, and clinical variables were controlled in the propensity score model. Hospital length of stay, 7-day and 30-day unplanned readmissions, and in-hospital mortality were evaluated. RESULTS Among 11,576 eligible general medical patients, 2,234 (19.30%) received a pharmacy-driven medication history and 9,342 (80.70%) patients did not. The estimated average treatment effect of receiving a pharmacy-driven medication history was a shorter length of stay (mean, 5.88 days vs 6.53 days; P = 0.0002) and a lower in-hospital mortality rate (2.34% vs 3.72%, P = 0.001), after adjustment for differences in patient baseline characteristics. No significant difference was found for 7-day or 30-day all-cause readmission rates. CONCLUSION Pharmacy-driven medication histories reduced length of stay and in-hospital mortality in patients admitted to the general medical service at an academic medical center but did not change 7-day and 30-day all-cause readmission rates. Further research via a large, multisite randomized controlled trial is needed to confirm our findings.
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Affiliation(s)
- John Marshall
- Beth Israel Lahey Health Pharmacy, Westwood, MA, USA
| | - Bryan D Hayes
- Beth Israel Lahey Health Pharmacy, Westwood, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Koehl
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - William Hillmann
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
| | - Marjory Bravard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
| | - Susan Jacob
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Rosy Gil
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Andrea Tull
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | - Xiu Liu
- Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | - David Lucier
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA, USA
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Ziaie S, Mehralian G, Talebi Z. Evaluation of medication reconciliation process in internal medicine wards of an academic medical center by a pharmacist: errors and risk factors. Intern Emerg Med 2022; 17:377-386. [PMID: 34342787 DOI: 10.1007/s11739-021-02811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient's insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients' gender, physicians' gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs' potential interactions and harmful errors can improve this process and prevent such errors in the future.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, 500 12th 13 avenue, Columbus, OH, 43210, USA.
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Farag M, Hoti K, Hughes J, Chalmers L. Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis. Int J Clin Pharm 2022; 44:947-955. [PMID: 35438472 PMCID: PMC9016122 DOI: 10.1007/s11096-022-01409-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make. AIM To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators. METHOD Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015. SITE 1: was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team. SITE 2: was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines. RESULTS Key performance indicators from Site 1 (n = 75 records), which incorporated a clinical pharmacist, demonstrated significantly (p < 0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n = 59). CONCLUSION Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.
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Affiliation(s)
- Mechaiel Farag
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,North Metropolitan Health Service-Mental Health Pharmacy, Brockway Road, Mount Claremont, WA, 6010, Australia.
| | - Kreshnik Hoti
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia ,grid.449627.a0000 0000 9804 9646Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Jeff Hughes
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
| | - Leanne Chalmers
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
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14
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Laureau M, Vuillot O, Gourhant V, Perier D, Pinzani V, Lohan L, Faucanie M, Macioce V, Marin G, Giraud I, Jalabert A, Villiet M, Castet-Nicolas A, Sebbane M, Breuker C. Adverse Drug Events Detected by Clinical Pharmacists in an Emergency Department: A Prospective Monocentric Observational Study. J Patient Saf 2021; 17:e1040-e1049. [PMID: 32175969 DOI: 10.1097/pts.0000000000000679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adverse drug events (ADEs) are a major public health issue in hospitals. They are difficult to detect because of incomplete or unavailable medication history. In this study, we aimed to assess the rate and characteristics of ADEs identified by pharmacists in an emergency department (ED) to identify factors associated with ADEs. METHODS In this prospective observational study, we included consecutive adult patients presenting to the ED of a French 2600-bed tertiary care university hospital from November 2011 to April 2015. Clinical pharmacists conducted structured interviews and collected the medication history to detect ADEs (i.e., injuries resulting directly or indirectly from adverse drug reactions and noncompliance to medication prescriptions). Unsure ADE cases were reviewed by an expert committee. Relations between patient characteristics, type of ED visit, and ADE risk were analyzed using logistic regression. RESULTS Among the 8275 included patients, 1299 (15.7%) presented to the ED with an ADE. The major ADE symptoms were bleeding, endocrine problems, and neurologic disorders. Moreover, ADEs led to the ED visit, hospitalization, and death in 87%, 49.3%, and 2.2% of cases, respectively. Adverse drug event risk was independently associated with male sex, ED visit for neurological symptoms, visit to the ED critical care unit, or ED short stay hospitalization unit, use of blood, anti-infective, antineoplastic, and immunomodulating drugs. CONCLUSIONS This study improves the knowledge about ADE characteristics and on the patients at risk of ADE. This could help ED teams to better identify and manage ADEs and to improve treatment quality and safety.
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15
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Deep L, Schneider CR, Moles R, Patanwala AE, Do LL, Burke R, Penm J. Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students. Pharm Pract (Granada) 2021; 19:2471. [PMID: 34621455 PMCID: PMC8456341 DOI: 10.18549/pharmpract.2021.3.2471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/12/2021] [Indexed: 11/14/2022] Open
Abstract
Background Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution. Objective To evaluate the number and type of medication discrepancies identified by pharmacy students. Methods Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies. Results There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system. Conclusions Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.
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Affiliation(s)
- Louise Deep
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW (Australia).
| | - Carl R Schneider
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Linda L Do
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | | | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
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16
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Breuker C, Macioce V, Mura T, Castet-Nicolas A, Audurier Y, Boegner C, Jalabert A, Villiet M, Avignon A, Sultan A. Medication Errors at Hospital Admission and Discharge: Risk Factors and Impact of Medication Reconciliation Process to Improve Healthcare. J Patient Saf 2021; 17:e645-e652. [PMID: 28877049 DOI: 10.1097/pts.0000000000000420] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE First, the aim of the study was to assess the prevalence, characteristics, and severity of unintended medication discrepancies (UMDs) and medication errors (MEs) at admission and discharge of hospitalization. Second, the aim of the study was to identify clinical and hospitalization factors associated with risk of UMDs as well as characteristics of the medication reconciliation process associated with UMDs detection. METHODS This prospective observational study included all adult patients admitted from 2013 to 2015 in the Endocrinology-Diabetology-Nutrition Department of Montpellier Hospital, France. Clinical pharmacists conducted medication reconciliation by collecting the best possible medication history from different sources and comparing it with admission and discharge prescriptions to identify discrepancies. Unintended medication discrepancies corrected by the physician were considered as MEs. Risk factors of UMDs were identified with logistic regression. RESULTS Of 904 patients included, 266 (29.4%) had at least one UMD, at admission or at discharge. In total, 378 (98.2%) of 385 UMDs were considered to be MEs. Most MEs were omissions (59.3%). Medication errors were serious or very serious in 36% of patients and had potentially moderate severity in almost 40% of patients. The risk of UMDs increased constantly with the number of treatments (P < 0.001). Thyroid (adjusted odds ratio [OR] = 1.79, 95% CI = 1.12-2.86) and infectious diseases (adjusted OR = 1.80, 95% CI = 1.17-2.78) were associated with UMDs risk at admission. The best type of source for the detection of UMDs was the general practitioner or nurse (OR = 2.64, 95% CI = 1.51-4.63). CONCLUSIONS Unintended medication discrepancies are frequent at hospital and depend on intrinsic clinical parameters but also on practice of medication reconciliation process, such as number and type of sources used.
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Affiliation(s)
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier
| | | | - Yohan Audurier
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Catherine Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- From the Clinical Pharmacy Department, University Hospital of Montpellier
| | - Maxime Villiet
- From the Clinical Pharmacy Department, University Hospital of Montpellier
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17
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Audurier Y, Roubille C, Manna F, Zerkowski L, Faucanie M, Macioce V, Castet-Nicolas A, Jalabert A, Villiet M, Fesler P, Lohan-Descamps L, Breuker C. Development and validation of a score to assess risk of medication errors detected during medication reconciliation process at admission in internal medicine unit: SCOREM study. Int J Clin Pract 2021; 75:e13663. [PMID: 32770845 DOI: 10.1111/ijcp.13663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medication errors (ME) can be reduced through preventive strategies such as medication reconciliation. Such strategies are often limited by human resources and need targeting high risk patients. AIMS To develop a score to identify patients at risk of ME detected during medication reconciliation in a specific population from internal medicine unit. METHODS Prospective observational study conducted in an internal medicine unit of a French University Hospital from 2012 to 2016. Adult hospitalised patients were eligible for inclusion. Medication reconciliation was conducted by a pharmacist and consisted in comparing medication history with admission prescription to identify MEs. Risk factors of MEs were analysed using multivariate stepwise logistic regression model. A risk score was constructed using the split-sample approach. The split was done at random (using a fixed seed) to define a development data set (N = 1256) and a validation sample (N = 628). A regression coefficient-base scoring system was used adopting the beta-Sullivan approach (Sullivan's scoring). RESULTS Pharmacists detected 740 MEs in 368/1884 (19.5%) patients related to medication reconciliation. Female gender, number of treatments >7, admission from emergency department and during night or weekend were significantly associated with a higher risk of MEs. Risk score was constructed by attributing 1 or 2 points to these variables. Patients with a score ≥3 (OR [95% CI] 3.10 [1.15-8.37]) out of 5 (OR [95% CI] 8.11 [2.89-22.78]) were considered at high risk of MEs. CONCLUSIONS Risk factors identified in our study may help prioritising patients admitted in internal medicine units who may benefit the most from medication reconciliation (ClinicalTrials.gov number NCT03422484).
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Affiliation(s)
- Yohan Audurier
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Federico Manna
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- IRCM-INSERM U1194, University of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Laura Lohan-Descamps
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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18
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Farha RKA, Rashad M, Hasen E, Mukattash TL, Al-Hashar A, Basheti IA. Evaluation of the effect of video tutorial training on improving pharmacy students' knowledge and skills about medication reconciliation. Pharm Pract (Granada) 2020; 18:1711. [PMID: 32206142 PMCID: PMC7075426 DOI: 10.18549/pharmpract.2020.1.1711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/16/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives: This study aimed to describe the effect of using an innovative teaching strategy using a video tutorial on enhancing students’ knowledge about medication reconciliation, and skills in identifying medication discrepancies. Methods: This is a one group pre-post interventional study that was conducted at the School of Pharmacy at Applied Science Private University. Sixty pharmacy students were invited to attend an educational sessions that involve watching a 6-minutes video tutorial. The first two levels of the Kirkpatrick’s Model were used to evaluate the effectiveness of this training tool. Level 1 (Reaction) was assessed using a satisfaction questionnaire, while level 2 (Learning) was assessed using two criteria: 1) student acquired knowledge about medication reconciliation using a questionnaire and a knowledge score out of 13 was calculated for each student, and 2) student acquired skills in identifying medication discrepancies using a virtual case scenario. If the student was able to identify any of the four impeded discrepancies he/she rewarded 1 point for each identified discrepancy, but if they identified any incorrect discrepancy they scored a negative point. Results: Among the 60 students who registered to participate in the study, 49 attended the educational training (response rate 81.6%). The majority of them (n=44, 89.8%) were satisfied with the training process. Before the video tutorial, students showed an overall low knowledge score [4.08/13.0, SD 1.81], and low ability to identify discrepancies [0.72 identified discrepancies out of 4.0, SD 1.1]. Following the video tutorial, the overall knowledge score was improved (p<0.001), and students were able to identify more discrepancies after watching the video (p<0.001). Conclusion: In conclusion, video education has shown itself to be an effective method to educate pharmacy students.. This visualized method can be applied to other areas within pharmacy education. We encourage the integration of videos within the learning process to enhance students’ learning experience and to support the traditional learning provided by the teaching staff.
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Affiliation(s)
- Rana K Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Mays Rashad
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Eliza Hasen
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Tareq L Mukattash
- Department Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Amna Al-Hashar
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat (Oman)
| | - Iman A Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
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19
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Komperda K, Lempicki K. Effectiveness of a Medication Reconciliation Simulation in an Introductory Pharmacy Practice Experience Course. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:6628. [PMID: 31223148 PMCID: PMC6581359 DOI: 10.5688/ajpe6628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/17/2018] [Indexed: 05/22/2023]
Abstract
Objective. To evaluate the effectiveness of a simulated learning exercise on pharmacy students' ability and perception of their ability to perform medication reconciliation. Methods. Third-year pharmacy students were divided into three groups. Group A attended a 30-minute lecture; group B attended the lecture and participated in a 90-minute workshop; and group C received no training. After groups A and B completed their assigned learning activities, all students participated in a simulated medication reconciliation activity with a standardized patient (SP). Students also completed a pre- and post-intervention survey. Results. One hundred eighty-three students participated. Students in group B scored the highest (74.5%) on the SP activity compared to those in group A (68.9%) and group C (66.1%). Students in group B reported high levels of agreement with all statements describing the lecture, workshop, and SP activity, including that more of these activities should be integrated into the curriculum. Conclusion. A simulated learning exercise significantly improved students' ability to perform medication reconciliation, including obtaining an accurate medication list, correctly identifying medication discrepancies, and proposing appropriate resolutions. Simulated learning exercises should continue to be incorporated in pharmacy education, especially exercises for learning pharmacy practice skills such as medication reconciliation.
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Affiliation(s)
- Kathy Komperda
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois
| | - Kelly Lempicki
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois
- Midwestern University Clinical Skills and Simulation Center, Downers Grove, Illinois
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20
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Petrov K, Varadarajan R, Healy M, Darvish E, Cowden C. Improving Medication History at Admission Utilizing Pharmacy Students and Technicians: A Pharmacy-Driven Improvement Initiative. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2018; 43:676-684. [PMID: 30410283 PMCID: PMC6205119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Because of the frequency of medication errors related to care transitions, patient-safety initiatives have recently focused on improving the patient medication list. Pharmacy student and technician participation in the medication-history process has been shown to improve the quality of medication histories. To improve patient care, a pharmacy-driven medication-history service utilizing a unique hybrid team of pharmacy students and technicians was launched at Inova Loudoun Hospital (ILH). OBJECTIVE The objective of the service was to improve patient safety and therapy by providing the Best Possible Medication History (BPMH) for admitted acute-care patients. METHODS Data for the medication-history service was collected for six months from July 2015 to January 2016. The service included pharmacy technicians and fourth-year pharmacy students using the BPMH approach to verify patients' allergies, medications, doses, and frequencies, and to ensure optimal documentation in the Electronic Health Record (EHR). Data on types and numbers of discrepancies and interventions were collected during the process. Readmission rates for the study group were calculated and compared to readmission rates for all patients. RESULTS Out of 4,070 patients interviewed, 77.7% (3,162) had at least one discrepancy in their medication list. Per patient, the average number of medications was 7.47, with an average of 1.8 discrepancies. Pharmacy students identified more discrepancies per patient than pharmacy technicians, 2.3 versus 1.5, respectively. Readmission rates for patients interviewed by the medication-history team was lower than for all patients during the same period, as well as for all patients during the same period in the previous year. CONCLUSION This pharmacy-driven medication-history service, staffed with pharmacy technicians and students using a structured BPMH approach, increased the accuracy of home-medication lists on patient admission. The service demonstrated a difference in the types of interventions provided by pharmacy students and technicians. Readmission rates were also lower for patients with completed BPMH.
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21
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Louie JM, Hong LT, Garavaglia LR, Pinal DI, O'Brien CE. Evaluation of Home Medication Reconciliation by Clinical Pharmacists for Adult and Pediatric Cystic Fibrosis Patients. PHARMACY 2018; 6:pharmacy6030091. [PMID: 30142920 PMCID: PMC6163164 DOI: 10.3390/pharmacy6030091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
Medication reconciliation is an important aspect of a patient’s care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered, non-controlled, cross-sectional study at four CF Foundation-accredited centers in the United States to evaluate the medication reconciliation process for adult and pediatric CF patients by documenting the number of home medications reconciled by clinical pharmacists and the number of patients with home medications that did not align with the current CF guidelines published in 2013. There were 105 adult patients and 72 pediatric patients included in the study analysis with a mean number of medications reconciled by clinical pharmacists of 17.4 (standard deviation (SD) 6.7) for adults and 13 (SD 4.6) for pediatric patients. The mean number of discrepancies from guidelines per patient was 1.61 (SD 1.2) for adult patients and 0.63 (SD 0.9) for pediatric patients. Pharmacists play an essential role in identifying and managing medication interactions and further research is necessary to investigate pharmacist impact on medication reconciliation.
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Affiliation(s)
- Jessica M Louie
- Department of Pharmacy, University of Utah Health, Salt Lake City, UT 84132, USA.
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 90004, USA.
| | - Lisa T Hong
- Department of Pharmacy, University of Utah Health, Salt Lake City, UT 84132, USA.
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA 92354, USA.
| | - Lisa R Garavaglia
- Department of Pharmacy, West Virginia University Heathcare, Morgantown, WV 26501, USA.
| | - Denise I Pinal
- Department of Pharmacy, Cook Children's Medical Center, Fort Worth, TX 76104, USA.
- Department of Pharmacy Practice, University of Texas El Paso School of Pharmacy, El Paso, TX 79968, USA.
| | - Catherine E O'Brien
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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22
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Gorman EM, Brown GW, Costello JN, Woodruff AE. Impact of a pharmacist-driven transition of care program for patients with acute coronary syndromes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emma M. Gorman
- Department of Pharmacy; Buffalo General Medical Center; Buffalo New York
| | - Geoffrey W. Brown
- School of Pharmacy and Pharmaceutical Sciences; University at Buffalo; Buffalo New York
| | - Jessica N. Costello
- School of Pharmacy and Pharmaceutical Sciences; University at Buffalo; Buffalo New York
| | - Ashley E. Woodruff
- Department of Pharmacy; Buffalo General Medical Center; Buffalo New York
- School of Pharmacy and Pharmaceutical Sciences; University at Buffalo; Buffalo New York
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23
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Sproul A, Goodine C, Moore D, McLeod A, Gordon J, Digby J, Stoica G. Quality of Best Possible Medication History upon Admission to Hospital: Comparison of Nurses and Pharmacy Students and Consideration of National Quality Indicators. Can J Hosp Pharm 2018; 71:128-134. [PMID: 29736046 PMCID: PMC5931072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Medication reconciliation at transitions of care increases patient safety. Collection of an accurate best possible medication history (BPMH) on admission is a key step. National quality indicators are used as surrogate markers for BPMH quality, but no literature on their accuracy exists. Obtaining a high-quality BPMH is often labour- and resource-intensive. Pharmacy students are now being assigned to obtain BPMHs, as a cost-effective means to increase BPMH completion, despite limited information to support the quality of BPMHs obtained by students relative to other health care professionals. OBJECTIVES To determine whether the national quality indicator of using more than one source to complete a BPMH is a true marker of quality and to assess whether BPMHs obtained by pharmacy students were of quality equal to those obtained by nurses. METHODS This prospective trial compared BPMHs for the same group of patients collected by nurses and by trained pharmacy students in the emergency departments of 2 sites within a large health network over a 2-month period (July and August 2016). Discrepancies between the 2 versions were identified by a pharmacist, who determined which party (nurse, pharmacy student, or both) had made an error. A panel of experts reviewed the errors and ranked their severity. RESULTS BPMHs were prepared for a total of 40 patients. Those prepared by nurses were more likely to contain an error than those prepared by pharmacy students (171 versus 43 errors, p = 0.006). There was a nonsignificant trend toward less severe errors in BPMHs completed by pharmacy students. There was no significant difference in the mean number of errors in relation to the specified quality indicator (mean of 2.7 errors for BPMHs prepared from 1 source versus 4.8 errors for BPMHs prepared from ≥ 2 sources, p = 0.08). CONCLUSIONS The surrogate marker (number of BPMH sources) may not reflect BPMH quality. However, it appears that BPMHs prepared by pharmacy students had fewer errors and were of similar quality (in terms of clinically significant errors) relative to those prepared by nurses.
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Affiliation(s)
- Ashley Sproul
- , BSc(Pharm), CDE, PharmD, is with Horizon Health Network, Saint John, New Brunswick, and Dalhousie University, Halifax, Nova Scotia. Since the time when this study was conducted, she has also joined the University of New Brunswick, Fredericton, New Brunswick
| | - Carole Goodine
- , BSc(Pharm), ACPR, PharmD, is with the Horizon Health Network, Fredericton, New Brunswick, and Dalhousie University, Halifax, Nova Scotia. Since the time when this study was conducted, she has also joined the University of New Brunswick, Fredericton, New Brunswick
| | - David Moore
- , MMedSc, ART, is with the Horizon Health Network, Waterville, New Brunswick
| | - Amy McLeod
- , RN, BN, ENCC, is with the Horizon Health Network, Waterville, New Brunswick
| | - Jacqueline Gordon
- , RN MN, is with the Horizon Health Network, Fredericton, New Brunswick
| | - Jennifer Digby
- , MD, is with the Horizon Health Network, Fredericton, New Brunswick
| | - George Stoica
- , PhD, is with the Horizon Health Network, Saint John, New Brunswick
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24
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Gortney JS, Moser LR, Patel P, Raub JN. Clinical Outcomes of Student Pharmacist-Driven Medication Histories at an Academic Medical Center. J Pharm Pract 2018; 32:404-411. [PMID: 29463169 DOI: 10.1177/0897190018759224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many studies have shown the positive impact that student pharmacists have on patients' health; however, no studies have been published evaluating student pharmacists' impact on direct patient outcomes (ie, readmission, emergency department [ED] visits, length of stay) related to the medication history process. OBJECTIVE To evaluate the impact of student pharmacist-obtained medication histories on identification of medication discrepancies and clinical outcomes. METHODS Student pharmacists obtained medication histories and then compared the history to that obtained by other health-care providers. Students documented discrepancies and interventions were completed. Control patients were identified and discharge medication list and 30-day readmissions were compared. RESULTS Seventeen students conducted 215 patient interviews, and 1848 modifications were made to documented home medications in the electronic medical record. Compared to controls (n = 148 student pharmacist, 149 controls), a nonsignificant improvement was found in discharge medication list completeness scores in patients seen by student pharmacists (3.94 vs 3.63; P = .06); but no difference was found in accuracy scores (0.92 vs 0.93; P = .41). Fewer ED visits at 30 days were found in the student pharmacist group (8 vs 18; P = .045), with no difference in readmissions. CONCLUSIONS Student pharmacist-obtained medication histories improved the information available for identifying drug-related problems for inpatients, completeness of the discharge medication list, and ED visits within 30 days.
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Affiliation(s)
- Justine S Gortney
- 1 Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Lynette R Moser
- 1 Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Joshua N Raub
- 3 Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
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Sanders KA, McLaughlin JE, Waldron KM, Willoughby I, Pinelli NR. Educational outcomes associated with early immersion of second-year student pharmacists into direct patient care roles in health-system practice. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:211-219. [PMID: 29706278 DOI: 10.1016/j.cptl.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/30/2017] [Accepted: 10/13/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND PURPOSE To assess the educational impact of engaging second professional year student pharmacists in active, direct patient care experiences in health system practice. EDUCATIONAL ACTIVITY AND SETTING Student pharmacists in their second professional year completed a redesigned, skill-based four-week introductory pharmacy practice experience in health system practice. The immersion consisted of experiences in both operational and clinical pharmacy environments. Students were assessed with skill development checklist assessments. Pre-post surveys were also collected. Data were analyzed using a mixed methods approach. FINDINGS Twenty-eight student pharmacists were included; of those, 26 completed both surveys (92.9% response rate). Survey results revealed significant increases in 81.8% of operational and 100% of clinical self-efficacy statements (p<0.05) and positive perceptions of the program overall. Overall, findings suggested that student pharmacists developed skills in health system practice while identifying additional areas for emphasized learning. SUMMARY Student pharmacists engaged in early, hands-on, direct patient care experiences enhanced their skill development in operational and clinical pharmacy practice.
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Affiliation(s)
- Kimberly A Sanders
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 2201 Kerr Hall, CB#7574, Chapel Hill, NC 27599, United States.
| | - Jacqueline E McLaughlin
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 301 Pharmacy Lane, CB#7574, Chapel Hill, NC 27599, United States.
| | - Kayla M Waldron
- Department of Pharmacy, University of North Carolina Hospitals, 101 Manning Drive, CB #7600, Chapel Hill, NC 27514, United States.
| | - Ian Willoughby
- Department of Pharmacy, University of North Carolina Hospitals, 101 Manning Drive, CB #7600, Chapel Hill, NC 27514, United States.
| | - Nicole R Pinelli
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 115F Beard Hall CB#7574, Chapel Hill, NC 27599, United States.
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Champion HM, Loosen JA, Kennelty KA. Pharmacy Students and Pharmacy Technicians in Medication Reconciliation: A Review of the Current Literature. J Pharm Pract 2017; 32:207-218. [DOI: 10.1177/0897190017738916] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A literature review was conducted to examine how pharmacy students and technicians have been utilized in medication reconciliation processes in an effort to evaluate expanded roles for pharmacy students and technicians. Data were summarized on accuracy of obtaining medication histories, time requirements, discrepancy identification, and cost savings. Limitations and areas for future research also were identified. Data Sources: A search of PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO and a manual searching of bibliographies were performed. Study Selection: Articles were included in this literature review if they focused on medication reconciliation with pharmacy student or technician outcomes independent of pharmacist involvement, they are available in English from any country, and the outcomes were empirical. Data Synthesis: Of 2112 identified studies, 32 met the inclusion criteria. The literature review revealed pharmacy technicians or students were involved in several medication reconciliation activities. Trained pharmacy students and technicians were able to obtain thorough medication histories as well as identify medication history discrepancies and take appropriate action to correct these discrepancies. Through the use of pharmacy students and technicians in the medication reconciliation process, hospitals experienced cost savings and other health-care professionals had more time for other patient care activities as well as an increased trust in the accuracy of medication histories. Conclusion: These findings suggest that pharmacy students and technicians are accurate, time efficient, decrease costs, and provide support to other health-care professionals when they are included in the medication reconciliation process.
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Affiliation(s)
| | - Julia A. Loosen
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Korey A. Kennelty
- School of Pharmacy, University of Wisconsin–Madison, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin–Madison, Madison, WI, USA
- College of Pharmacy and Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Organizational readiness for change: Preceptor perceptions regarding early immersion of student pharmacists in health-system practice. Res Social Adm Pharm 2017; 13:1028-1035. [DOI: 10.1016/j.sapharm.2017.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/20/2022]
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Miranda AC, Cole JD, Ruble MJ, Serag-Bolos ES. Development of a Student-Led Ambulatory Medication Reconciliation Program at an Academic Institution. J Pharm Pract 2017; 31:342-346. [PMID: 28569128 DOI: 10.1177/0897190017712175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To integrate fourth-year student pharmacists on advanced pharmacy practice experience (APPE) rotations within several different ambulatory clinics to perform medication reconciliations and enhance interdisciplinary practice. METHODS The study design was a descriptive, prospective multisite study among a variety of ambulatory care outpatient clinics. Student pharmacists were partnered with physicians to conduct medication reconciliations during clinic visits for 4 hours per week, with data collection from January 2016 to September 2016. This program originated from physician requests for additional pharmacy involvement and led to the development of a successful implementation strategy to involve student pharmacists in the medication reconciliation process. RESULTS Student pharmacists identified 537 medication discrepancies among 491 patients, including commission of medications (36%), documentation of previously omitted medications (27%), and incomplete patient allergy information (11%). Students spent an average of 10 minutes on each encounter. CONCLUSION Documentation from this innovative program suggests improvement in medication reconciliation and enhanced patient care with limited time required of student pharmacists. A similar program could be developed and utilized at other clinical sites.
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Affiliation(s)
- Aimon C Miranda
- 1 Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Jaclyn D Cole
- 1 Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Melissa J Ruble
- 1 Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Erini S Serag-Bolos
- 1 Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
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Conciliation médicamenteuse en psychiatrie générale adulte : résultats de 3 années d’expérience. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.phclin.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trained student pharmacists' telephonic collection of patient medication information: Evaluation of a structured interview tool. J Am Pharm Assoc (2003) 2017; 56:153-60. [PMID: 27000165 DOI: 10.1016/j.japh.2015.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the feasibility and fidelity of student pharmacists collecting patient medication list information using a structured interview tool and the accuracy of documenting the information. The medication lists were used by a community pharmacist to provide a targeted medication therapy management (MTM) intervention. DESIGN Descriptive analysis of patient medication lists collected with telephone interviews. PARTICIPANTS Ten trained student pharmacists collected the medication lists. INTERVENTION Trained student pharmacists conducted audio-recorded telephone interviews with 80 English-speaking, community-dwelling older adults using a structured interview tool to collect and document medication lists. MAIN OUTCOME MEASURES Feasibility was measured using the number of completed interviews, the time student pharmacists took to collect the information, and pharmacist feedback. Fidelity to the interview tool was measured by assessing student pharmacists' adherence to asking all scripted questions and probes. Accuracy was measured by comparing the audio-recorded interviews to the medication list information documented in an electronic medical record. RESULTS On average, it took student pharmacists 26.7 minutes to collect the medication lists. The community pharmacist said the medication lists were complete and that having the medication lists saved time and allowed him to focus on assessment, recommendations, and education during the targeted MTM session. Fidelity was high, with an overall proportion of asked scripted probes of 83.75% (95% confidence interval [CI], 80.62-86.88%). Accuracy was also high for both prescription (95.1%; 95% CI, 94.3-95.8%) and nonprescription (90.5%; 95% CI, 89.4-91.4%) medications. CONCLUSION Trained student pharmacists were able to use an interview tool to collect and document medication lists with a high degree of fidelity and accuracy. This study suggests that student pharmacists or trained technicians may be able to collect patient medication lists to facilitate MTM sessions in the community pharmacy setting. Evaluating the sustainability of using student pharmacists or trained technicians to collect medication lists is needed.
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Breuker C, Abraham O, di Trapanie L, Mura T, Macioce V, Boegner C, Jalabert A, Villiet M, Castet-Nicolas A, Avignon A, Sultan A. Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare. Eur J Intern Med 2017; 38:38-45. [PMID: 28007439 DOI: 10.1016/j.ejim.2016.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact. METHOD This prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician. RESULTS Clinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME. CONCLUSIONS The intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.
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Affiliation(s)
- Cyril Breuker
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France.
| | - Océane Abraham
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Laura di Trapanie
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France
| | - Catherine Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Antoine Avignon
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Ariane Sultan
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
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32
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Rogers J, Pai V, Merandi J, Catt C, Cole J, Yarosz S, Wehr A, Durkin K, Kaczor C. Impact of a pharmacy student–driven medication delivery service at hospital discharge. Am J Health Syst Pharm 2017; 74:S24-S29. [DOI: 10.2146/ajhp150613] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Vinita Pai
- Nationwide Children’s Hospital, Columbus, OH
| | | | - Char Catt
- Nationwide Children’s Hospital, Columbus, OH
| | - Justin Cole
- Cedarville University School of Pharmacy, Cedarville, OH
| | | | | | | | - Chet Kaczor
- Nationwide Children’s Hospital, Columbus, OH
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Marinović I, Marušić S, Mucalo I, Mesarić J, Bačić Vrca V. Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia. Croat Med J 2017; 57:572-581. [PMID: 28051282 PMCID: PMC5209936 DOI: 10.3325/cmj.2016.57.572] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists' Best Possible Medication History (BPMH) and physicians' admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings.
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Affiliation(s)
- Ivana Marinović
- Ivana Marinović, Hospital Pharmacy, University Hospital Dubrava, Av. G. Šuška 6, Zagreb, Croatia,
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Dennis VC, May DW, Kanmaz TJ, Reidt SL, Serres ML, Edwards HD. Pharmacy Student Learning During Advanced Pharmacy Practice Experiences in Relation to the CAPE 2013 Outcomes. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:127. [PMID: 27756935 PMCID: PMC5066930 DOI: 10.5688/ajpe807127] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/06/2015] [Indexed: 05/21/2023]
Abstract
Outcomes from The Center for Advancement of Pharmacy Education (CAPE) are intended to represent the terminal knowledge, skills, and attitudes pharmacy students should possess and have guided delivery of pharmacy education for more than two decades. Advanced pharmacy practice experiences (APPEs) are the endpoint of pharmacy curricula where demonstration and assessment of terminal learning occurs. This review examines published literature in relation to the most recent CAPE outcomes to determine the extent to which they have been addressed during APPEs since 1996. Details related to the APPE focus, intervention(s)/learning setting(s), and assessments are summarized according to the 15 CAPE outcomes. Further, the assessments are categorized according to the level of learning achieved using an available method. Common CAPE outcomes are highlighted, as well as those for which published reports are lacking for APPEs. The range and quality of assessments are discussed and emphasize the need for continuous improvement of scholarly design and assessment.
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Affiliation(s)
| | - Dianne W. May
- University of Georgia College of Pharmacy, Athens, Georgia
| | - Tina J. Kanmaz
- St. John’s University College of Pharmacy and Health Sciences, Queens, New York
| | - Shannon L. Reidt
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Michelle L. Serres
- The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio
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Almanasreh E, Moles R, Chen TF. The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol 2016; 82:645-58. [PMID: 27198753 PMCID: PMC5338112 DOI: 10.1111/bcp.13017] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified. METHODS We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors. RESULTS Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n = 35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n = 57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists. CONCLUSIONS We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice.
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Affiliation(s)
- Enas Almanasreh
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Rebekah Moles
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
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Pinelli NR, McLaughlin JE, Chen SL, Luter DN, Arnall J, Smith S, Roth MT, Rodgers PT, Williams DM, Amerine LB. Improved Organizational Outcomes Associated With Incorporation of Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center. J Pharm Pract 2016; 30:99-108. [DOI: 10.1177/0897190015585765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To assess the feasibility of engaging second professional year student pharmacists in the medication reconciliation process on hospital and health system pharmacy practice outcomes. Methods: Student pharmacists in their second professional year in the Doctor of Pharmacy degree program at our institution were randomly selected from volunteers to participate. Each participant completed training prior to completing three 5-hour evening shifts. Organizational metrics, student pharmacist perception regarding quality of interactions with health care professionals, and pharmacist perceptions were collected. Results: A total of 83 medication histories were performed on complex medical patients (57.0 ± 19.2 years, 51% female, 65% Caucasian, 12 ± 6 medications); of those, 93% were completed within 24 hours of hospital admission. Second professional student pharmacists completed on average 1.9 ± 0.6 medication histories per shift (range 1-3). Student pharmacists identified 0.9 medication-related problems per patient in collaboration with a pharmacist preceptor. Student pharmacists believed the quality of their interactions with health care professionals in the Student Medication and Reconciliation Team (SMART) program was good or excellent. The program has been well received by clinical pharmacists involved in its design and implementation. Conclusion: This study provides evidence that second professional year student pharmacists can assist pharmacy departments in the care of medically complex patients upon hospital admission.
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Affiliation(s)
- Nicole R. Pinelli
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | - Sheh-Li Chen
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - David N. Luter
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Justin Arnall
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Shayna Smith
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Mary T. Roth
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Philip T. Rodgers
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Dennis M. Williams
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Lindsey B. Amerine
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
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Wills BM, Darko W, Seabury R, Probst LA, Miller CD, Cwikla GM. Pharmacy impact on medication reconciliation in the medical intensive care unit. J Res Pharm Pract 2016; 5:142-5. [PMID: 27162810 PMCID: PMC4843585 DOI: 10.4103/2279-042x.179584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Pharmacy-driven medication history (MH) programs have been shown to reduce the number of serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs). Methods: MHs were repeated over a 6-week period. Demographics, number, and nature of MDs were documented. Discrepancy severity was graded using a previously published method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs. Findings: Sixty-three MHs were repeated. Pharmacy MHs were less likely to contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001). Conclusion: Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT MDs on admission and home medication lists were common in patients admitted to the medical ICU. Pharmacy-driven medication reconciliation (MR) reduced the number and frequency of these discrepancies. Further research is required to improve current MR procedures.
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Affiliation(s)
- Brittany M Wills
- Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA
| | - William Darko
- Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA
| | - Robert Seabury
- Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA
| | - Luke A Probst
- Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA
| | | | - Gregory M Cwikla
- Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA
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Ashjian E, Salamin LB, Eschenburg K, Kraft S, Mackler E. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center. J Am Pharm Assoc (2003) 2016; 55:540-5. [PMID: 26359964 DOI: 10.1331/japha.2015.14214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the number of discrepancies and medication-related problems found as a result of pharmacy-led medication reconciliation involving introductory pharmacy practice experience (IPPE) students at a comprehensive cancer center. SETTING Outpatient infusion center of a National Cancer Institute (NCI)-designated and National Comprehensive Cancer Network (NCCN) cancer center. PRACTICE DESCRIPTION AND INNOVATION Third-year IPPE students contacted and completed medication reconciliation for 510 hematology/oncology patients scheduled for infusion center appointments without a coupled provider visit. IPPE students discussed the findings of the medication reconciliations with their pharmacist preceptors, who updated the medication histories in the electronic medical record (EMR) and communicated with prescribers directly about identified medication-related problems. All medication reconciliation was documented using a standardized note template in the EMR. MAIN OUTCOME MEASURES Number of medication discrepancies found, including medication additions, medication deletions, dose changes, and herbal product additions; medication-related problems-including drug-drug interactions, untreated indications (e.g., nausea, vomiting, pain, need for prophylactic medications), failure of patients to receive prescribed medications, and adverse drug reactions-were also documented. RESULTS Medication reconciliation was completed for 510 patients through the student pharmacist/pharmacist preceptor-led intervention during a 1-year period between January 1, 2013, and December 31, 2013. A total of 88% of patients had at least one discrepancy identified in their medication history and corrected in the EMR. In addition, 11.4% of patients had a medication-related problem identified. CONCLUSIONS Pharmacy-led medication reconciliation identified a large number of discrepancies among our hematology/oncology patients. This intervention allowed for correction of discrepancies in the EMR leading to improved accuracy of patient medication lists. In addition, it provided a valuable learning experience for student pharmacists.
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Rouzaud-Laborde C, Damery L, Cestac P, Sallerin B, Calvet P. Mentoring and supervising clinical pharmacist students at patients' bedside: which benefits? J Eval Clin Pract 2016; 22:4-9. [PMID: 26400689 DOI: 10.1111/jep.12444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Hospital clinical pharmacists are involved in teaching students during professional internship. Organization between the unit care and the pharmacy place is complicated. This study evaluated the effectiveness of two pharmaceutical teams: an experienced pharmacist in the pharmacy place, reachable by phone (team 1) or an experienced pharmacist in the ward, near patients and students (team 2). METHODS Pharmaceutical interventions were collected during two successive time periods, each of 6 months in a 15-bed unit (neurology). During the first time period, prescriptions were analyzed by the student (resident) in the ward and experienced pharmacist in the pharmacy place. During the second time period, prescriptions were analyzed by both experienced pharmacist and the resident in the ward. We compared the number, the type, the approval of pharmaceutical interventions and the medication reconciliation activities. Proportions were compared by a chisquared test (or Fisher exact test) as well as the quantitative value was calculated by a Student test. RESULTS 'Mentoring and supervising' students in the ward increased significantly the number of pharmaceutical interventions (PI; 104 interventions for 1408 analyzed prescriptions (7.4%) by the students in the ward and 317 interventions for 1391 (22.8%) by both the experienced pharmacist and the students in the ward (P = 0.002). Furthermore, specific interventions from medication reconciliation were significantly increased by the presence of experienced pharmacist in the ward (0.96% vs. 8.83% P = 0.018). CONCLUSION Effectiveness of clinical pharmacists can be improved by the presence of experienced pharmacist at patients' bedside, near students.
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Affiliation(s)
- Charlotte Rouzaud-Laborde
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Metabolic and Cardiovascular Diseases I2MC, Team 6: Cardiac Remodeling and New Therapies, National Institute of Health and Medical, INSERM, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France
| | - Léa Damery
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France
| | - Philippe Cestac
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France.,Team 1: Ageing and Alzheimer Disease: From Observation to Intervention, National Institute of Health and Medical Research, INSERM, Toulouse, France
| | - Brigitte Sallerin
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Metabolic and Cardiovascular Diseases I2MC, Team 6: Cardiac Remodeling and New Therapies, National Institute of Health and Medical, INSERM, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France
| | - Pauline Calvet
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France
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Smith L, Mosley J, Lott S, Cyr E, Amin R, Everton E, Islami A, Phan L, Komolafe O. Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting. Pharm Pract (Granada) 2016; 13:634. [PMID: 26759617 PMCID: PMC4696120 DOI: 10.18549/pharmpract.2015.04.634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Objective: To assess if the pharmacy department should be more involved in the medication reconciliation process to assist in the reduction of medication errors that occur during transition of care points in the hospital setting. Methods: This was an observational prospective cohort study at a 531-bed hospital in Pensacola, FL from June 1, 2014 to August 31, 2014. Patients were included in the study if they had health insurance and were taking five or more medications. Patients with congestive heart failure were excluded from the study. Student pharmacists collected and evaluated medication histories obtained from patients’ community pharmacies, and directed patient interviews. Primary care providers were only contacted on an as needed basis. The information collected was presented to the clinical pharmacist, where interventions were made utilizing clinical judgment. Results: During the three month study, 1045 home medications were reviewed by student pharmacist. Of these, 290 discrepancies were discovered (27.8%; p=0.02). The most common medication discrepancy found was dose optimization (45.5%). The remaining discrepancies included: added therapy (27.6%), other (15.2%), and discontinued therapy (11.7%). Pharmacists made 143 interventions based on clinical judgment (49.3%; p=0.04). Conclusion: Involvement of pharmacy personnel during the medication reconciliation process can be an essential component in reducing medical errors. With the addition of the pharmacy department during the admission process, accuracy, cost savings, and patient safety across all phases and transition points of care were achieved.
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Affiliation(s)
- Lillian Smith
- Assistant Professor of Pharmacy Practice. Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
| | - Juan Mosley
- Assistant Professor of Pharmacy Practice. Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
| | - Sonia Lott
- Director of Pharmacy and Co-Ethics & Compliance Officer. West Florida Hospital Pharmacy. Pensacola, FL ( United States ).
| | - Ernie Cyr
- Clinical Coordinator and Residency Program Director. West Florida Hospital. Pensacola, FL ( United States ).
| | - Raid Amin
- Department of Mathematics and Statistics Professor. University of West Florida . Pensacola, FL ( United States ).
| | - Emily Everton
- Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
| | - Abdullah Islami
- Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
| | - Linh Phan
- Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
| | - Opeyemi Komolafe
- Florida Agricultural & Mechanical University . Tallahassee, FL ( United States ).
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Haji Aghajani M, Ghazaeian M, Mehrazin HR, Sistanizad M, Miri M. Errors Related to Medication Reconciliation: A Prospective Study in Patients Admitted to the Post CCU. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:599-604. [PMID: 27642331 PMCID: PMC5018288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medication errors are one of the important factors that increase fatal injuries to the patients and burden significant economic costs to the health care. An appropriate medical history could reduce errors related to omission of the previous drugs at the time of hospitalization. The aim of this study, as first one in Iran, was evaluating the discrepancies between medication histories obtained by pharmacists and physicians/nurses and first order of physician. From September 2012 until March 2013, patients admitted to the post CCU of a 550 bed university hospital, were recruited in the study. As a part of medication reconciliation on admission, the physicians/nurses obtained medication history from all admitted patients. For patients included in the study, medication history was obtained by both physician/nurse and a pharmacy student (after training by a faculty clinical pharmacist) during the first 24 h of admission. 250 patients met inclusion criteria. The mean age of patients was 61.19 ± 14.41 years. Comparing pharmacy student drug history with medication lists obtained by nurses/physicians revealed 3036 discrepancies. On average, 12.14 discrepancies, ranged from 0 to 68, were identified per patient. Only in 20 patients (8%) there was 100 % agreement among medication lists obtained by pharmacist and physician/nurse. Comparing the medications by list of drugs ordered by physician at first visit showed 12.1 discrepancies on average ranging 0 to 72. According to the results, omission errors in our setting are higher than other countries. Pharmacy-based medication reconciliation could be recommended to decrease this type of error.
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Affiliation(s)
- Mohammad Haji Aghajani
- Department of Cardiology, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Monireh Ghazaeian
- Department of Clinical Pharmacy, Facultyof pharmacy, ShahidBeheshtiUniversityofMedicalSciences, Tehran, Iran.
| | - Hamid Reza Mehrazin
- Department of Clinical Pharmacy, Facultyof pharmacy, ShahidBeheshtiUniversityofMedicalSciences, Tehran, Iran.
| | - Mohammad Sistanizad
- Department of Clinical Pharmacy, Facultyof pharmacy, ShahidBeheshtiUniversityofMedicalSciences, Tehran, Iran. ,Department of Critical Care Medicine, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mirmohammad Miri
- Department of Critical Care Medicine, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: E-mail:
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L'Hommedieu T, DeCoske M, El Lababidi R, Ladell N. Utilizing pharmacy students in transitions-of-care services. Am J Health Syst Pharm 2015. [PMID: 26195650 DOI: 10.2146/ajhp140561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bishop BM. Involving pharmacy technicians and students in the emergency department to expand care provided by clinical pharmacists. Am J Health Syst Pharm 2015; 72:993-4. [PMID: 26025987 DOI: 10.2146/ajhp150054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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