1
|
Ebbens MM, Gombert-Handoko KB, Wesselink EJ, van den Bemt PMLA. The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study. J Am Med Dir Assoc 2021; 22:2553-2558.e1. [PMID: 33905738 DOI: 10.1016/j.jamda.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal. OBJECTIVES To explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician. DESIGN (INCLUDING INTERVENTION) Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care). SETTING AND PARTICIPANTS Patients scheduled for elective surgery using at least 1 chronic medication were included. MEASURES The primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%. RESULTS A total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 ± 2.5 in the patient portal group and 2.8 ± 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care. CONCLUSIONS AND IMPLICATIONS Medication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.
Collapse
Affiliation(s)
- Marieke M Ebbens
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands; Department of Hospital Pharmacy, St Jansdal Hospital, Harderwijk, the Netherlands; Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kim B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elsbeth J Wesselink
- Department of Clinical Pharmacy, Zaans Medical Centre, Zaandam, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
2
|
Ebbens MM, van Dorp ELA, Gombert-Handoko KB, van den Bemt PMLA. Pre-operative medication reconciliation by pharmacy technicians or anaesthesiologists. Eur J Anaesthesiol 2021; 38 Suppl 1:S71-S72. [PMID: 33645936 DOI: 10.1097/eja.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marieke M Ebbens
- From the Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden (MME, KBG-H), Department of Pharmacy, St Jansdal Hospital, Harderwijk (MME), Department of Anesthesiology, Leiden University Medical Center, Leiden (ELAvD), Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen (PMLAvdB), Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam. Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands (MME, PMLAvdB)
| | | | | | | |
Collapse
|
3
|
Ebbens MM, Errami H, Moes DJAR, van den Bemt PMLA, van der Boog PJM, Gombert-Handoko KB. Prevalence of medication transfer errors in nephrology patients and potential risk factors. Eur J Intern Med 2019; 70:50-53. [PMID: 31606307 DOI: 10.1016/j.ejim.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medication reconciliation in transitions of care can prevent medication transfer errors (MTE). MTE can cause patient harm. Since performing medication reconciliation for every patient is not always feasible, identification of potential risk factors of MTE could aid in targeting this intervention to the right patients. OBJECTIVE To establish the proportion of patients with one or more MTE in the outpatient nephrology setting. Secondary patient characteristics associated with MTE, type and potential harm, and medication groups were investigated. METHODS This retrospective observational cohort study was conducted in the Leiden University Medical Center, the Netherlands, between November 2017 and April 2018. The cohort involved patients in whom medication reconciliation was performed by a medical attendant using the electronic tool 'Medical Dashboard' prior to visiting the nephrologist. MTE were defined as unintended discrepancies between the medication in the hospital system and the result of the medication reconciliation. The proportion of patients with one or more MTE was calculated and the association of patient characteristics (age, sex, number of medications and kidney function (CKD-EPI)) with MTE was analyzed using multivariate logistic regression. RESULTS Of 380 patients, 235 patients (61.8%) had at least one MTE. On average patients used 10.3 medications. The number of medications per patient was significantly associated with MTE; OR 1.11 (95%CI 1.05-1.16). No association was found for age, sex, and kidney function. CONCLUSION In ambulatory nephrology patients 61.8% had at least one MTE. Nephrology patients using a higher number of drugs are more prone to MTE.
Collapse
Affiliation(s)
- M M Ebbens
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands; Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands; St Jansdal Hospital, Department of Pharmacy, Wethouder Jansenlaan 90, 3844, DG, Harderwijk, The Netherlands.
| | - H Errami
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - D J A R Moes
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - P M L A van den Bemt
- Erasmus University Medical Center Rotterdam, Department of Hospital Pharmacy, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - P J M van der Boog
- Leiden University Medical Center, Department of Nephrology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - K B Gombert-Handoko
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| |
Collapse
|
4
|
Van Der Luit CD, De Jong IR, Ebbens MM, Euser S, Verweij SL, Van Den Bemt PM, Luttikhuis HM, Becker ML. Frequency of occurrence of medication discrepancies and associated risk factors in cases of acute hospital admission. Pharm Pract (Granada) 2018; 16:1301. [PMID: 30637032 PMCID: PMC6322986 DOI: 10.18549/pharmpract.2018.04.1301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/01/2018] [Indexed: 11/14/2022] Open
Abstract
Background Medication discrepancies are a common occurrence following hospital admission and carry the potential for causing harm. However, little is known about the potential risk factors involved in medication discrepancies. Objective The objective of this study was to determine how frequently medication discrepancies occur and their associated risk factors, in patients hospitalized via the emergency department of the Spaarne Gasthuis Hospital, located in The Netherlands. Methods This retrospective observational study examines 832 hospital admissions which took place between April 1st and June 30th, 2015. Medication reconciliation was performed within 24 hours of admission and medication discrepancies were registered. The primary outcome recorded in the study was the proportion of patients experiencing one or more medication discrepancies, as verified by the physician. As a secondary outcome, the association between these discrepancies and pre-specified variables was analyzed using univariate and multivariate logistic regression. Results At least one medication discrepancy was found to have occurred with 97 of the 832 patients (11.7%), the most common discrepancies involving incorrect drug dose (44.9%) and omission of medication (36.4%). In the univariate analysis, age (OR=1.03 [95% CI 1.02:1.04] p<0.001) and number of pre-admission medications taken (OR=1.13 [95%CI 1.09:1.17] p<0.001) were revealed to be significantly associated with the risk of medication discrepancies. Sex, type of medical specialty, and surgical versus non-surgical specialty were found not to be significantly associated with discrepancies. In the multivariate analysis, both the number of pre-admission medications (OR=1.10 [95%CI 1.06:1.15] p<0.001) and age (OR=1.02 [95%CI 1.01:1.03] p=0.004) were independently associated with the risk of medication discrepancy. Conclusions Of the total number of patients, 11.7% experienced one or more medication discrepancies following admission to the hospital. Elderly patients taking multiple drugs were found to be particularly at risk.
Collapse
Affiliation(s)
| | - Iris R De Jong
- Pharmacy Foundation of Haarlem Hospitals. Haarlem; & University of Groningen, Faculty of Science and Engineering. Groningen (Netherlands).
| | - Marieke M Ebbens
- Clinical Pharmacist, Researcher. Department of Pharmacy, St Jansdal Hospital. Harderwijk; & Department of Hospital Pharmacy, Erasmus University Medical Centre. Rotterdam (Netherlands).
| | - Sjoerd Euser
- Spaarne Gasthuis Academy, Spaarne Gasthuis. Haarlem (Netherlands).
| | - Sjoerd L Verweij
- Clinical Pharmacist. Pharmacy Foundation of Haarlem Hospitals. Haarlem (Netherlands).
| | - Patricia M Van Den Bemt
- Clinical Pharmacist, Professor in Medication Safety. Department of Hospital Pharmacy, Erasmus University Medical Centre. Rotterdam (Netherlands).
| | - Hanneke M Luttikhuis
- Clinical Pharmacist. Pharmacy Foundation of Haarlem Hospitals. Haarlem (The Netherlands).
| | - Matthijs L Becker
- Clinical Pharmacist, Researcher. Pharmacy Foundation of Haarlem Hospitals. Haarlem (Netherlands).
| |
Collapse
|
5
|
Ebbens MM, Laar SAV, Wesselink EJ, Gombert-Handoko KB, van den Bemt PMLA. Prospective Validation of a Risk Prediction Model to Identify High-Risk Patients for Medication Errors at Hospital Admission. Ann Pharmacother 2018; 52:1211-1217. [DOI: 10.1177/1060028018784905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pharmacy-led medication reconciliation in elective surgery patients is often performed at the preoperative screening (POS). Because of the time lag between POS and admission, changes in medication may lead to medication errors at admission (MEAs). In a previous study, a risk prediction model for MEA was developed. Objective: To validate this risk prediction model to identify patients at risk for MEAs in a university hospital setting. Methods: The risk prediction model was derived from a cohort of a Dutch general hospital and validated within a comparable cohort from a Dutch University Medical Centre. MEAs were assessed by comparing the POS medication list with the reconciled medication list at hospital admission. This was considered the gold standard. For every patient, a risk score using the risk prediction model was calculated and compared with the gold standard. The risk prediction model was assessed with receiver operating characteristic (ROC) analysis. Results: Of 368 included patients, 167 (45.4%) had at least 1 MEA. ROC analysis revealed significant differences in the area under the curve of 0.535 ( P = 0.26; validation cohort) versus 0.752 ( P < 0.0001; derivation cohort). The sensitivity in this validating cohort was 66%, with a specificity of 40%. Conclusion and Relevance: The risk prediction model developed in a general hospital population is not suitable to identify patients at risk for MEA in a university hospital population. However, number of medications is a common risk factor in both patient populations and should, thus, form the basis of an adapted risk prediction model.
Collapse
Affiliation(s)
- Marieke M. Ebbens
- Leiden University Medical Center, Leiden, Netherlands
- St Jansdal Hospital, Harderwijk, Netherlands
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | | |
Collapse
|
6
|
H. Vinkers C, Penning R, M. Ebbens M, Hellhammer J, C. Verste J, J. Kalkman C, Olivier B. Stress-Induced Hyperthermia in Translational Stress Research. ACTA ACUST UNITED AC 2010. [DOI: 10.2174/1874143601004010030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The stress-induced hyperthermia (SIH) response is the transient change in body temperature in response to
acute stress. This body temperature response is part of the autonomic stress response which also results in tachycardia and
an increased blood pressure. So far, a SIH response has been found in a variety of species (including rodents, baboons,
turtles, pigs, impalas and chimpanzees), and there are indications that stress exposure alters body temperature in humans.
This review aims to assess the translational potential and the different aspects of the body temperature reaction in
response to stress. If stress-induced temperature changes are consistent across species, the SIH paradigm may be
employed in preclinical and clinical setups and provide a tool to examine the pharmacological, genetic and mechanistic
background of stress at both the preclinical and the clinical level.
Collapse
|
7
|
Abstract
Zaleplon is a pyrazolopyrimidine hypnotic used for the treatment of insomnia. Zaleplon binds preferentially at the α1β2γ2 subunit of gamma aminobutyric acid type A (GABAA) receptors in the central nervous system, and has a half-life of about one hour. Efficacy studies show that zaleplon is a suitable hypnotic for sleep initiation purposes. However, because of its short half-life, zaleplon is less effective in sleep maintenance when compared with other hypnotics. Nevertheless, zaleplon does increase total sleep time. No rebound effects are observed after treatment discontinuation. The use of zaleplon is relatively safe. Adverse effects are mild and of short duration. No important interactions have been reported, and there is no evidence of abuse potential. Relative to benzodiazepine hypnotics, the biggest advantage of zaleplon is that current evidence suggests it does not produce residual next-day effects. As early as four hours after intake of zaleplon, no effects on cognitive, memory, psychomotor performance, and the ability to drive a car have been reported. Future studies should confirm these findings, and comparisons with new nonbenzodiazepine hypnotics should determine the importance of zaleplon in the future treatment of insomnia.
Collapse
Affiliation(s)
- Marieke M Ebbens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, The Netherlands
| | | |
Collapse
|