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Cavalcante-Santos LM, Guarnieri AC, Conegundes FSDL, Giardini MH, Pereira LRL, Varallo FR. Clinical pharmacy in hospital palliative medicine: non-randomised clinical trial. BMJ Support Palliat Care 2023:spcare-2023-004620. [PMID: 38129106 DOI: 10.1136/spcare-2023-004620] [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: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the impact of pharmaceutical care on hospital indicators and clinical outcomes of palliative care (PC) patients admitted to a secondary hospital. METHODS A non-randomised clinical trial was carried out in the PC ward of a secondary hospital in São Paulo, Brazil. Pharmaceutical care for all patients aged 18 and above, admitted between October 2021 and March 2022, with stays exceeding 48 hours, was provided. The interventions required were performed in collaboration with healthcare teams, patients and caregivers. Assessments occurred at admission and discharge, using PC performance scales and pharmacotherapy tools, with Research Ethics Committee approval. RESULTS Over 6 months, 120 hospitalisations were analysed, primarily involving women (58.9%), averaging 71.0 years, with neoplasm diagnoses (20.5%). A total of 170 drug-related problems were identified in 68.3% of patients. Following assessment, 361 interventions were performed, with a 78.1% acceptance rate, including medication dose adjustments, additions and discontinuations. Addressing unintentional pharmacotherapy discrepancies at admission led to reduced hospital stays (p<0.05). Pharmaceutical interventions also decreased pharmacotherapy complexity (p<0.001), inappropriate medications for the older people (p<0.001) and improved symptom management, such as pain (p<0.05). CONCLUSIONS Pharmaceutical care services integrated within the multiprofessional health team contributed to reducing drug-related problems associated with polypharmacy as well as improved the management PC symptoms in end-of-life patients, which reduced hospitalisation time.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Ana Carolina Guarnieri
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Silva de Lima Conegundes
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Corvaisier M, Sanchez-Rodriguez D, Sautret K, Riou J, Spiesser-Robelet L, Annweiler C. Identifying older inpatients at high risk of unintentional medication discrepancies: a classification tree analysis. Aging Clin Exp Res 2023; 35:3227-3232. [PMID: 37943406 DOI: 10.1007/s40520-023-02598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Unintentional medication discrepancies at admission are differences between the best possible medication history and the prescribed treatment at admission, and are associated with adverse outcomes, particularly in older people. This study aimed to identify the clinical profiles of geriatric inpatients with unintentional medication discrepancies at hospital admission. A classification tree Chi-square Automatic Interaction Detector (CHAID) analysis was conducted to assess those patients' profiles and characteristics that were associated with a higher risk of unintentional medication discrepancies. One-hundred and thirty consecutive older patients admitted to acute care (87 ± 5 years old; 61.8% women) were assessed. The CHAID analysis retrieved 5 clinical profiles of older inpatients with a risk of up to 94.4% for unintentional medication discrepancies. These profiles were determined based on combinations of three characteristics: use of eye drops, frequent falls (≥ 1/year), and admission due to urgent hospitalization. These easily measurable clinical characteristics may be helpful as a supportive measure to improve pharmacological care.
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Affiliation(s)
- Mathieu Corvaisier
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
- Department of Pharmacy, Angers University Hospital, Angers, France
- Health Faculty, University of Angers, Angers, France
| | - Dolores Sanchez-Rodriguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Liège, Belgium
- Rehabilitation Research Group, Geriatrics Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Kevin Sautret
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
| | - Jérémie Riou
- Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | | | - Cédric Annweiler
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France.
- Health Faculty, University of Angers, Angers, France.
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
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Mengato D, Pivato L, Codato L, Faccioli FF, Camuffo L, Giron MC, Venturini F. Best Possible Medication History Collection by Clinical Pharmacist in a Preoperative Setting: An Observational Prospective Study. PHARMACY 2023; 11:142. [PMID: 37736914 PMCID: PMC10514880 DOI: 10.3390/pharmacy11050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND A Best Possible Medication History (BPMH) collected by clinical pharmacists is crucial for effective medication review, but, in Italy, it is often left to the nursing staff. This study aims to compare the quality and accuracy of a clinical pharmacist-documented BPMH with the current standard practice of ward staff-collected BPMH in an Italian preoperative surgical setting. METHODS A 20-week prospective observational non-profit study was conducted in a major university hospital. The study comprised three phases: a feasibility, an observational, and an interventional phase. During the feasibility phase, 10 items for obtaining a correct BPMH were identified. The control group consisted of retrospectively analyzed BPMHs collected by the ward staff during the observational phase, while interventions included BPMHs collected by the clinical pharmacist during the third phase. Omissions between the two groups were compared. RESULTS 14 (2.0%) omissions were found in the intervention group, compared with 400 (57.4%) found in the controls (p < 0.05); data collection was more complete when collected by pharmacists compared to the current modality (98.0% of completed information for the intervention versus 42.6%; p < 0.05). CONCLUSIONS The involvement of a pharmacist significantly reduced the number of omissions in preoperative surgical-collected BPMHs. This intervention holds the potential to decrease the risk of medication errors associated with inaccurate or incomplete BPMHs prior to surgical hospitalization.
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Affiliation(s)
- Daniele Mengato
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Lisa Pivato
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Lorenzo Codato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Pharmacology Building, Via Marzolo 5, 35131 Padova, Italy
| | - Fernanda Fabiola Faccioli
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Laura Camuffo
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Maria Cecilia Giron
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Pharmacology Building, Via Marzolo 5, 35131 Padova, Italy
| | - Francesca Venturini
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
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4
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Atey TM, Peterson GM, Salahudeen MS, Bereznicki LR, Simpson T, Boland CM, Anderson E, Burgess JR, Huckerby EJ, Tran V, Wimmer BC. Impact of Partnered Pharmacist Medication Charting (PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1452. [PMID: 36674208 PMCID: PMC9859430 DOI: 10.3390/ijerph20021452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies' clinical significance, with 'unintentional' discrepancies deemed 'errors'. Fewer patients in the PPMC group had at least one error (3.5%; 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4%; 95% CI: 42.5% to 56.3%) and usual care group (61.4%; 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.
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Affiliation(s)
- Tesfay Mehari Atey
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Luke R. Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Tom Simpson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Camille M. Boland
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Ed Anderson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - John R. Burgess
- Department of Endocrinology, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
| | - Emma J. Huckerby
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Viet Tran
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
| | - Barbara C. Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
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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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Ho JMW, Rofaiel R, Wang K, To E, Liu B, Antoniou T, Benjamin S, Bodkin RJ. Medication discrepancies in older adults receiving asynchronous virtual care. J Am Geriatr Soc 2022; 70:3633-3636. [PMID: 36089761 DOI: 10.1111/jgs.17971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Joanne Man-Wai Ho
- Department of Medicine, McMaster University, Kitchener, Ontario, Canada.,Schlegel Research Institute for Aging, Waterloo, Ontario, Canada.,GeriMedRisk, Waterloo, Ontario, Canada
| | - Rymon Rofaiel
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Division of General Internal Medicine & Geriatrics, Halton Healthcare, Oakville, Ontario, Canada
| | | | - Eric To
- Department of Medicine, McMaster University, Kitchener, Ontario, Canada
| | - Barbara Liu
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- GeriMedRisk, Waterloo, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Sophiya Benjamin
- GeriMedRisk, Waterloo, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Kitchener, Ontario, Canada.,Grand River Hospital, Kitchener, Ontario, Canada
| | - Robert Jack Bodkin
- GeriMedRisk, Waterloo, Ontario, Canada.,Grand River Hospital, Kitchener, Ontario, Canada
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Punj E, Collins A, Agravedi N, Marriott J, Sapey E. What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review. Pharmacol Res Perspect 2022; 10:e01007. [PMID: 36102210 PMCID: PMC9471999 DOI: 10.1002/prp2.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co-primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy-led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non-randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non-pharmacy control arm, with a Chi2 of 101.10 and I2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out-of-hours working.
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Affiliation(s)
- Ekta Punj
- Clinical Research NetworkUniversity of BirminghamBirminghamUK
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Abbie Collins
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Nirlep Agravedi
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - Elizabeth Sapey
- University of BirminghamBirminghamUK
- PIONEER, HDRUK Health Data Hub in Acute CareBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Acute MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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8
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Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11195731. [PMID: 36233599 PMCID: PMC9572040 DOI: 10.3390/jcm11195731] [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: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.
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9
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Zheng F, Wang D, Zhang X. The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China. BMC Health Serv Res 2022; 22:1157. [PMID: 36104805 PMCID: PMC9472438 DOI: 10.1186/s12913-022-08505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs. Methods A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication. Results The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001). Conclusion The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur. Trial registration This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020–087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn, number ChiCTR2000035321 date: 08/08/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08505-1.
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Brady JE, Simon SR, Yeksigian K, Zillich AJ, Moyer J, Linsky AM. Can nonclinicians classify medication discrepancies as accurately as clinical pharmacists? A validation study. Health Sci Rep 2022; 5:e824. [PMID: 36189414 PMCID: PMC9508616 DOI: 10.1002/hsr2.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Julianne E. Brady
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Steven R. Simon
- Center for the Study of Healthcare Innovation, Implementation and Policy VA Greater Los Angeles Healthcare System Los Angeles California USA
- Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles California USA
| | - Kate Yeksigian
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
| | - Alan J. Zillich
- Department of Pharmacy Practice, College of Pharmacy Purdue University West Lafayette Indiana USA
| | - Jonathan Moyer
- Office of Disease Prevention National Institutes of Health Bethesda Maryland USA
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine VA Boston Healthcare System Boston Massachusetts USA
- General Internal Medicine Boston University School of Medicine Boston Massachusetts USA
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11
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Stuijt CCM, van den Bemt BJF, Boerlage VE, Janssen MJA, Taxis K, Karapinar-Çarkit F. Differences in medication reconciliation interventions between six hospitals: a mixed method study. BMC Health Serv Res 2022; 22:722. [PMID: 35642033 PMCID: PMC9158255 DOI: 10.1186/s12913-022-08118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although medication reconciliation (MedRec) is mandated and effective in decreasing preventable medication errors during transition of care, hospitals implement MedRec differently. Objective Quantitatively compare the number and type of MedRec interventions between hospitals upon admission and discharge, followed by a qualitative analysis on potential reasons for differences. Methods This explanatory retrospective mixed-method study consisted of a quantitative and a qualitative part. Patients from six hospitals and six different wards i.e. orthopaedics, surgery, pulmonary diseases, internal medicine, cardiology and gastroenterology were included. At these wards, MedRec was implemented both on hospital admission and discharge. The number of pharmacy interventions was collected and classified in two subcategories. First, the number of interventions to resolve unintended discrepancies (elimination of differences between listed medication and the patient’s actual medication use). And second, the number of medication optimizations (optimization of pharmacotherapy e.g. eliminating double medication). Based on these quantitative results and interviews, a focus group was performed to give insight in local MedRec processes to address differences in context between hospitals. Descriptive analysis (quantitative) and content analysis (qualitative) was used. Results On admission 765 (85%) patients from six hospitals, received MedRec by trained nurses, pharmacy technicians, pharmaceutical consultants or pharmacists. Of those, 36–95% (mean per patient 2.2 (SD ± 2.4)) had at least one discrepancy. Upon discharge, these numbers were among 632 (70%) of patients, 5–28% (mean per patient 0.7 (SD 1.2)). Optimizations in pharmacotherapy were implemented for 2% (0.4–3.7 interventions per patient upon admission) to 95% (0.1–1.7 interventions per patient upon discharge) of patients. The main themes explaining differences in numbers of interventions were patient-mix, the type of healthcare professionals involved, where and when patient interviews for MedRec were performed and finally, embedding and extent of medication optimization. Conclusions Hospitals differed greatly in the number of interventions performed during MedRec. Differences in execution of MedRec and local context determines the number of interventions. This study can support hospitals who want to optimize MedRec processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08118-8.
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12
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Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF, Vasilevskis EE. Sources of medication omissions among hospitalized older adults with polypharmacy. J Am Geriatr Soc 2022; 70:1180-1189. [PMID: 34967444 PMCID: PMC8986578 DOI: 10.1111/jgs.17629] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies. METHODS Cross-sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post-acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies. RESULTS Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources-pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies. CONCLUSION A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.
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Affiliation(s)
- Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Amanda S Mixon
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
| | - Eduard Eric Vasilevskis
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Schmitz K, Lenssen R, Rückbeil M, Berning D, Thomeczek C, Brokmann JC, Jaehde U, Eisert A. The WHO High 5s project: medication reconciliation in a German university hospital. A prospective observational cohort study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:27-32. [PMID: 35148970 DOI: 10.1016/j.zefq.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ensuring medication accuracy during transitions in care is one of the five highly prevalent patient safety problems focused on within the World Health Organization High 5s Project. Medication reconciliation is a standardized patient care process that can be used to address this problem. The aim of the current study is to implement medication reconciliation in a German university hospital. METHODS The study was conducted at the Emergency Department of the University Hospital Aachen, Germany. All discrepancies between the Best Possible Medication History and the Admission Medication Order were documented and classified as documentation errors or medication errors. The type of error was also recorded. A negative binomial regression model was used to test several factors influencing the number of discrepancies. RESULTS The medications of 105 patients were reconciled. The mean number of discrepancies per patient was 4.6± 3.6, with a total of 298 medication errors and 189 documentation errors. The most common type of medication error was the omission of a drug (n=208; 69.8 %). In the negative binomial regression analysis, the care status (p=0.0015) as well as the number of preadmission drugs (p=0.0007) were significantly associated with medication errors. DISCUSSION A high number of discrepancies was detected and analysed. Patients admitted from nursing homes were less likely to have discrepancies in their medication reconciliation, perhaps because a structured documentation system for medications is already in place at nursing homes including error prone products (special dosage forms or food supplements). CONCLUSIONS In this study, medication reconciliation was implemented at a German full-care university hospital. The actual number of discrepancies observed strongly indicates the need for medication reconciliation at hospital admission.
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Affiliation(s)
- Katharina Schmitz
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany.
| | - Rebekka Lenssen
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany
| | - Marcia Rückbeil
- Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Berning
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | | | | | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Albrecht Eisert
- Pharmacy of the University Hospital RWTH Aachen, Aachen, Germany; Institute of Clinical Pharmacology of the University Hospital RWTH Aachen, Aachen, Germany
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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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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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16
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Breuker C, Faucanié M, Laureau M, Perier D, Pinzani V, Marin G, Sebbane M, Villiet M. Impact of a medico-pharmaceutical follow-up and an optimized communication between hospital and community on the readmission to the emergency department for an adverse drug event: URGEIM, study protocol for a randomized controlled trial. Trials 2021; 22:521. [PMID: 34362410 PMCID: PMC8349018 DOI: 10.1186/s13063-021-05501-4] [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: 04/06/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Adverse drug events (ADE) represent one of the main causes of admission to emergency department (ED). Their detection, documentation, and reporting are essential to avoid readmission. We hypothesize that a pharmacist-initiated multidisciplinary transition of care program combining ED pharmacist contribution and medications’ data transfer between inpatient and outpatient caregivers will reduce emergency visits related to ADE Method/design This is a prospective, open-label, randomized controlled trial. The primary aim of the study is 6-month ED readmission related to the same ADE. Three hundred forty-six adult patients with an ADE detected by a binomial pharmacist-physician will be recruited from the ED of an University Hospital and will be randomized in two groups: [1] experimental group (multidisciplinary transition of care program and medications’ data transfer between inpatient and outpatient caregivers) and [2] control group (usual care). Patients will be followed up over a period of 6 months. Endpoints will be carried out blindly of the randomization arm. The primary endpoint is the rate of patients who had at least one readmission in the ED for the same reason at 6 months (data collected during a phone call with the patient and the general practitioner). Trials registered NCT03725046. Discussion The trial results will have implications for the role of the clinical pharmacist in an emergency department. If successful, the intervention could be considered for implementation across other hospitals. Trial registration ClinicalTrials.govNCT03725046. Registered on 30 October 2018
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Affiliation(s)
- Cyril Breuker
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France. .,PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France.
| | - Marie Faucanié
- CHU Montpellier, Clinical Reasearch and Epidemiology Unit (Departement Information Médicale), Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Marion Laureau
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France.,CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Damien Perier
- CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Véronique Pinzani
- CHU Montpellier, Medical Pharmacology and Toxicology Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Grégory Marin
- CHU Montpellier, Clinical Reasearch and Epidemiology Unit (Departement Information Médicale), Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Mustapha Sebbane
- CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - M Villiet
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
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Lohan L, Marin G, Faucanie M, Laureau M, Macioce V, Perier D, Pinzani V, Giraud I, Castet-Nicolas A, Jalabert A, Villiet M, Sebbane M, Breuker C. Impact of medication characteristics and adverse drug events on hospital admission after an emergency department visit: Prospective cohort study. Int J Clin Pract 2021; 75:e14224. [PMID: 33866662 DOI: 10.1111/ijcp.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Emergency department (ED) overcrowding is a problem for the delivery of adequate and timely emergency care. To improve patient flow and the admission process, the quick prediction of a patient's need for admission is crucial. We aimed to investigate the variables associated with hospitalisation after an ED visit, with a particular focus on the variables related to medication. METHODS This prospective study was conducted from 2011 to 2018 in subacute medical ED of a French University Hospital. Specialised EDs (paediatric, gynaecologic, head and neck and psychiatric) and the outpatient unit of the ED were not included. Participation in this study was proposed to all adult patients who underwent a medication history interview with a pharmacist. Pharmacists conducted structured interviews for the completion of the medication history and the detection of adverse drug events (ADE). Relations between patient characteristics and hospitalisation were analysed using logistic regression. RESULTS Among the 14 511 included patients, 5972 (41.2%) were hospitalised including 69 deaths. In total, 7458 patients (51.4%) took more than 5 medications and 2846 patients (19.6%) had an ADE detected during the ED visit. In hospitalised patients, bleeding (32.2%) and metabolic disorders (16.8%) were the most observed ADE symptoms. Variables associated with increased hospital admission included 2 demographic variables (age, male gender), 4 clinical variables (renal and hepatic failures, alcohol addiction, ED visit for respiratory reason) and 6 medication-related variables (medications >5, use of blood, systemic anti-infective, metabolism and antineoplastic/immunomodulating medications and ADE). CONCLUSION We identified variables associated with hospitalisation including drug-related variables. These results point out the importance and the relevance of collecting medication data in a subacute medical ED (study registered on ClinicalTrials.gov, NCT03442010).
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Affiliation(s)
- Laura Lohan
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Gregory Marin
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marion Laureau
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Damien Perier
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Veronique Pinzani
- Medical Pharmacology and Toxicology Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Isabelle Giraud
- Economic Evaluation Unit, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Mustapha Sebbane
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
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18
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Baughman AW, Triantafylidis LK, O'Neil N, Norstrom J, Okpara K, Ruopp MD, Linsky A, Schnipper J, Mixon AS, Simon SR. Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility. Jt Comm J Qual Patient Saf 2021; 47:646-653. [PMID: 34244044 DOI: 10.1016/j.jcjq.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/19/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a quality improvement (QI) approach to improve medication reconciliation in an SNF setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). METHODS This study was conducted at a 112-bed US Department of Veterans Affairs SNF. The researchers used several QI methods, including data benchmarking, stakeholder surveys, process mapping, and a Healthcare Failure Mode and Effect Analysis (HFMEA) to complete comprehensive baseline assessments. RESULTS Baseline assessments revealed that medication reconciliation processes were error-prone, with high rates of medication discrepancies. Provider surveys and process mapping revealed extremely labor-intensive and highly complex processes lacking standardization. Factors contributing were polypharmacy, limited resources, electronic health record limitations, and patient exposure to multiple care transitions. HFMEA enabled a methodical approach to identify and address challenges. The team validated the best possible medication history (BPMH) process for hospital settings as outlined by MARQUIS2 for the SNF setting and found it necessary to use additional medication lists to account for multiple care transitions. CONCLUSION SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.
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Gadallah A, McGinnis B, Nguyen B, Olson J. Assessing the impact of virtual medication history technicians on medication reconciliation discrepancies. Int J Clin Pharm 2021; 43:1404-1411. [PMID: 33871769 DOI: 10.1007/s11096-021-01267-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Background To overcome resource limitations, Ascension hospitals have implemented a virtual pharmacy technician program to facilitate the completion of medication histories in select emergency departments. Objective This multicenter retrospective study aimed to assess the impact of taking a medication history virtually by pharmacy technicians on medication reconciliation accuracy in comparison to other clinicians. Setting Ascension Seton hospitals in Austin, Texas, United States. Method A retrospective chart review including patients above the age of 18, who were directly admitted from the emergency department between January 1, 2019 and August 31, 2019. Study investigators identified, quantified and categorized unintentional discrepancies by comparing medication histories to reconciled medication orders at admission. Descriptive analysis was applied to patient demographics. Mann-Whitney U and chi-square tests were applied to continuous and categorical outcomes, respectively. Main outcome measure The type and number of unintentional discrepancies at admission. Results In 208 patients, a total of 190 unintentional discrepancies were identified. The rate of unintentional discrepancies per medication was significantly lower for virtual pharmacy technicians than other clinicians (8.6% vs. 14.8% respectively, p < 0.0001). The most common type of unintentional discrepancies was omission in both groups. Length of stay, readmissions, and emergency department visits were similar in both groups. The rate of incomplete medication histories was significantly lower for virtual pharmacy technicians than other clinicians (6.7% vs. 62.5% respectively, p < 0.0001). Conclusion Implementing a virtual medication history technician program in the emergency department can revolutionize the medication history completion process and lower unintentional medication discrepancy rates.
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Affiliation(s)
| | - Brandy McGinnis
- Ascension Texas Department of Pharmacy, Austin, TX, USA
- University of Texas College of Pharmacy, Austin, TX, USA
| | - Brian Nguyen
- Ascension Texas Department of Pharmacy, Austin, TX, USA
| | - Jon Olson
- Ascension Texas Department of Pharmacy, Austin, TX, USA
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20
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Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. Res Social Adm Pharm 2021; 17:677-684. [DOI: 10.1016/j.sapharm.2020.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/10/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023]
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21
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Zhang K, Chia K, Hawley CE, Uricchio MJ, Driver JA, Salow M. A blueprint for success: Using an implementation framework to create a medication history technician pilot program. J Am Pharm Assoc (2003) 2021; 61:e301-e315. [PMID: 33583750 DOI: 10.1016/j.japh.2021.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication discrepancies at transitions of care may compromise patient safety. Trained pharmacy technicians can reduce harmful medication discrepancies at transitions of care by collecting medication histories. OBJECTIVE We describe how to create a program integrating medication history technicians (MHTs) into the hospital discharge process using implementation science. PRACTICE DESCRIPTION We created our MHT program at a Veterans Affairs (VA) hospital. PRACTICE INNOVATION We used an evidence-based framework and implementation science to tailor our MHT program to meet local stakeholder needs. EVALUATION METHODS We completed a literature review and review of current discharge practices. Then, we completed a workflow pilot, a needs assessment, and semistructured interviews with pharmacy technicians and pharmacists. We integrated these findings to identify barriers of MHT program implementation. Finally, we mapped these barriers to implementation strategies to create an MHT program implementation blueprint. RESULTS The literature review and review of current discharge practices revealed opportunities for our program to reduce medication discrepancies. We applied these findings to our proof-of-concept workflow pilot, which reduced medication discrepancy rates at discharge. When we explored barriers in the needs assessment, we learned that 4 of 6 pharmacy technicians had some training conducting medication histories, but 5 of 6 requested additional training for the new MHT role. We explored these and additional barriers in semistructured interviews. Four themes emerged: elements of pharmacy technician training, challenges to implementation, program logistics and workflow, and pharmacy technician self-efficacy. We mapped barriers to implementation strategies to create an MHT program implementation blueprint, including developing pharmacy technician training materials, modifying our workflow, creating program evaluation materials, and strategizing how to overcome anticipated and current implementation barriers. CONCLUSIONS We used implementation science to create a tailored MHT program. Others may adapt our implementation blueprint to fit local stakeholder needs.
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Debacq C, Bourgueil J, Aidoud A, Bleuet J, Mennecart M, Dardaine-Giraud V, Fougère B. Persistence of Effect of Medication Review on Potentially Inappropriate Prescriptions in Older Patients Following Hospital Discharge. Drugs Aging 2021; 38:243-252. [PMID: 33474671 DOI: 10.1007/s40266-020-00830-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Potentially inappropriate prescriptions (PIPs) can lead to adverse drug reactions and should be avoided whenever possible. OBJECTIVE Our objective was to assess the PIP resumption rate 6 months after discharge from our geriatric unit and to compare it with data in the literature. METHODS This single-center observational study included patients aged ≥ 70 years with at least one PIP that had been stopped during hospitalization (according to Screening Tool for Older Persons Prescriptions [STOPP] and Screening Tool to Alert doctors to Right Treatment [START] criteria, version 2) between May 2018 and October 2018. We collected sociodemographic data, medication reconciliation data, and descriptive data during a comprehensive geriatric assessment. Each patient's medication history after discharge was determined in collaboration with their usual community pharmacist. RESULTS A total of 125 patients (females 70%, mean age 87.1 years) were included. Data for the admission and discharge medication reconciliations were available for 44 patients (35%). On admission, 121 of the 125 patients (97%) were taking cardiovascular medication. Of the 336 treatments withdrawn, 61 (18.2%) had been re-prescribed at 6 months post-discharge-including half within the first month. The most frequent STOPP criterion was lack of indication (32%), and the overall PIP resumption rate was 22%. According to the anatomical therapeutic chemical (ATC) classification, the main organ system affected by PIPs was the cardiovascular system (47%, with a resumption rate of 17%). CONCLUSION Our results highlighted a low PIP resumption rate at 6 months and showed that a collaborative medication review is associated with persistent medium-term medication changes.
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Affiliation(s)
- Camille Debacq
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France.
| | - Julie Bourgueil
- Pharmacie, CHU Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Amal Aidoud
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Joëlle Bleuet
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Marc Mennecart
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | | | - Bertrand Fougère
- Gériatrie, CHU de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
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van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. A comparison between medication reconciliation by a pharmacy technician and the use of an online personal health record by patients for identifying medication discrepancies in patients' drug lists prior to elective admissions. Int J Med Inform 2020; 147:104370. [PMID: 33421688 DOI: 10.1016/j.ijmedinf.2020.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
AIM Medication discrepancies (MDs), defined as unexplained differences among medication regimens, cause important public health problems with clinical and economic consequences. Medication reconciliation (MR) reduces the risk of MDs, but is time consuming and its success relies on the quality of different information sources. Online personalized health records (PHRs) may overcome these drawbacks. Therefore, the aim of this study is to determine the level of agreement of identified MDs between traditional MR and an online PHR and the correctness of the identified MDs with a PHR. METHODS A prospective cohort study was conducted at the cardiology, neurology, internal medicine and pulmonary department of the Amphia Hospital, the Netherlands. Two weeks prior to a planned admission all patients received an invitation from a PHR to update their medication file derived from the Nationwide Medication Record System (NMRS). At admission MR was performed with all by a pharmacy technician, who created the best possible medication history (BPMH) based on the NMRS data and an interview. MDs were determined as discrepancies between the available information from the NMRS and the input and alterations patients or pharmacy technician made. The number, correctness of patients' alterations, type and severity of identified MDs were analysed. RESULTS Of 488 patients approached, 155 (31.8 %) patients who both used the PHR and had received MR were included. The mean number of MDs identified with MR and PHR was 6.2 (SD 4.3) and 4.7 (SD 3.7), respectively. 82.1 % of the drug information noted by the patient in the PHR was correct compared to the BPMH and 98.6 % had no clinically relevant differences between the lists. CONCLUSION Patients who used an online PHR can relatively accurately record a list of their medication. Further research is required to explore the level of agreement and the correctness of a PHR in other (larger) hospital(departments).
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Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E. A systematic review of older patients' experiences and perceptions of communication about managing medication across transitions of care. Res Social Adm Pharm 2020; 17:273-291. [PMID: 32299684 DOI: 10.1016/j.sapharm.2020.03.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents. OBJECTIVE The aim of this systematic review was to explore older patients' experiences and perceptions of communication about managing medications across transitions of care. DESIGN A systematic review. METHODS A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article cross-checking and hand searching of reference lists of included papers were also undertaken. INCLUSION CRITERIA studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients' homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool. RESULTS The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients' experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period. CONCLUSIONS Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients' views of communication about medication management on admission, during hospitalisation, or transfer between settings.
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Affiliation(s)
- Guncag Ozavci
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Tracey Bucknall
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Deakin-Alfred Health Nursing Research Centre, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan Street Parkville, 3052, Victoria, Australia.
| | - Carmel Hughes
- Queen's University Belfast, School of Pharmacy, 97 Lisburn Road Belfast BT9 7BL, UK, Northern Ireland, UK.
| | - Christine Jorm
- NSW Regional Health Partners, Wisteria House, James Fletcher Hospital, 72 Watt St, Newcastle, 2300, NSW, Australia.
| | - Kathryn Joseph
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Elizabeth Manias
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Herledan C, Baudouin A, Larbre V, Gahbiche A, Dufay E, Alquier I, Ranchon F, Rioufol C. Clinical and economic impact of medication reconciliation in cancer patients: a systematic review. Support Care Cancer 2020; 28:3557-3569. [PMID: 32189099 DOI: 10.1007/s00520-020-05400-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Medication reconciliation can reduce drug-related iatrogenesis by facilitating exhaustive information transmission at care transition points. Given the vulnerability of cancer patients to adverse drug events, medication reconciliation could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on medication reconciliation in cancer patients. METHODS A comprehensive search was performed in the PubMed/Medline, Scopus, and Web of Science databases, associating the keywords "medication reconciliation" and "cancer" or "oncology." RESULTS Fourteen studies met the selection criteria. Various medication reconciliation practices were reported: performed at admission or discharge, for hospitalized or ambulatory patients treated with oral or parenteral anticancer drugs. In one randomized controlled trial, medication reconciliation decreased clinically significant medication errors by 26%. Although most studies were non-comparative, they highlighted that medication reconciliation led to identification of discrepancies and other drug-related problems in up to 88% and 94.7% of patients, respectively. The impact on post-discharge healthcare utilization remains under-evaluated and mostly inconclusive, despite a trend toward reduction. No comparative economic evaluations were available but one study estimated the benefit:cost ratio of medication reconciliation to be 2.31:1, suggesting its benefits largely outweigh its costs. Several studies also underlined the extended pharmacist time required for the intervention, highlighting the need for further cost analysis. CONCLUSION Medication reconciliation can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Anas Gahbiche
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
| | - Edith Dufay
- Service Pharmacie, Centre Hospitalier de Lunéville, 6 Rue Jean Girardet, Lunéville, France
| | - Isabelle Alquier
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Service Evaluation et Outils pour la Qualité et la Sécurité des Soins, Haute Autorité de Santé, 5 avenue du Stade de France, Saint-Denis la Plaine, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France.
- EMR3738, Université de Lyon, Lyon, France.
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Stark HE, Graudins LV, McGuire TM, Lee CYY, Duguid MJ. Implementing a sustainable medication reconciliation process in Australian hospitals: The World Health Organization High 5s project. Res Social Adm Pharm 2020; 16:290-298. [DOI: 10.1016/j.sapharm.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/07/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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Presley CA, Wooldridge KT, Byerly SH, Aylor AR, Kaboli PJ, Roumie CL, Schnipper JL, Dittus RS, Mixon AS. The Rural VA Multi-Center Medication Reconciliation Quality Improvement Study (R-VA-MARQUIS). Am J Health Syst Pharm 2020; 77:128-137. [PMID: 31912884 DOI: 10.1093/ajhp/zxz275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE High-quality medication reconciliation reduces medication discrepancies, but smaller hospitals serving rural patients may have difficulty implementing this because of limited resources. We sought to adapt and implement an evidence-based toolkit of best practices for medication reconciliation in smaller hospitals, evaluate the effect on unintentional medication discrepancies, and assess facilitators and barriers to implementation. METHODS We conducted a 2-year mentored-implementation quality improvement feasibility study in 3 Veterans Affairs (VA) hospitals serving rural patients. The primary outcome was unintentional medication discrepancies per medication per patient, determined by comparing the "gold standard" preadmission medication history to the documented preadmission medication list and admission and discharge orders. RESULTS In total, 797 patients were included; their average age was 68.7 years, 94.4% were male, and they were prescribed an average of 9.6 medications. Sites 2 and 3 implemented toolkit interventions, including clarifying roles among clinical personnel, educating providers on taking a best possible medication history, and hiring pharmacy professionals to obtain a best possible medication history and perform discharge medication reconciliation. Site 1 did not implement an intervention. Discrepancies improved in intervention patients compared with controls at Site 3 (adjusted incidence rate ratio [IRR], 0.55; 95% confidence interval [CI], 0.45-0.67) but increased in intervention patients compared with controls at Site 2 (adjusted IRR, 1.22; 95% CI, 1.08-1.36). CONCLUSIONS An evidence-based toolkit for medication reconciliation adapted to the VA setting was adopted in 2 of 3 small, rural, resource-limited hospitals, resulting in both reduced and increased unintentional medication discrepancies. We highlight facilitators and barriers to implementing evidence-based medication reconciliation in smaller hospitals.
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Affiliation(s)
- Caroline A Presley
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kathleene T Wooldridge
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Susan H Byerly
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amy R Aylor
- Center for Applied Systems Engineering, VISN11-Veterans Engineering Resource Center, Indianapolis, IN
| | - Peter J Kaboli
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Christianne L Roumie
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, and Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Jeffrey L Schnipper
- BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA
| | - Robert S Dittus
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, and Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Amanda S Mixon
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, and Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
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An inventory of collaborative medication reviews for older adults - evolution of practices. BMC Geriatr 2019; 19:321. [PMID: 31752700 PMCID: PMC6873748 DOI: 10.1186/s12877-019-1317-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency’s website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al’s medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients’ medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
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Walsh EK, Kirby A, Kearney PM, Bradley CP, Fleming A, O'Connor KA, Halleran C, Cronin T, Calnan E, Sheehan P, Galvin L, Byrne D, Sahm LJ. Medication reconciliation: time to save? A cross-sectional study from one acute hospital. Eur J Clin Pharmacol 2019; 75:1713-1722. [PMID: 31463579 DOI: 10.1007/s00228-019-02750-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.
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Affiliation(s)
- Elaine K Walsh
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Ann Kirby
- School of Economics, University College Cork, Cork, Ireland
| | | | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Aoife Fleming
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran A O'Connor
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Ciaran Halleran
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Timothy Cronin
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Calnan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Patricia Sheehan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura Galvin
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Derina Byrne
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
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30
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Choi YJ, Kim H. Effect of pharmacy-led medication reconciliation in emergency departments: A systematic review and meta-analysis. J Clin Pharm Ther 2019; 44:932-945. [PMID: 31436877 DOI: 10.1111/jcpt.13019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/09/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Medication reconciliation is recommended to be performed at every transition of medical care to prevent medication errors or adverse drug events. This study investigated the impact of pharmacy-led medication reconciliation on medication discrepancies and potential adverse drug events in the ED to assess the benefits of pharmacy services. METHODS The systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The PubMed, Ovid Embase and Cochrane library databases were searched up from inception to 1 July 2018. Studies comparing the effectiveness of the medication reconciliation service performed by pharmacy personnel to usual care (nurses or physicians) in the ED were included. Duplicated studies, non-clinical studies, studies with ineligible comparators or study designs were excluded. RESULTS AND DISCUSSION Eleven studies were eligible for qualitative analysis, and 8 studies were included in meta-analysis. Pharmacy-led medication reconciliation substantially reduced medication discrepancies in the ED. The most common medication discrepancies included medication omission and incorrect/omitted dose or frequency. Unlike usual care, pharmacy-led medication reconciliation significantly reduced the proportion of patients with medication discrepancies by 68% (response rate 0.32; 95% confidence interval (CI): 0.19-0.53, P < .0001) and the number of medication discrepancy events by 88% (response rate 0.12; 95% CI 0.06-0.26, P < .00001). Intervention decreased the number of discrepancies per patient by 3.08 (mean difference -3.08; 95% CI: -4.76 to -1.39, P = .0003). Subgroup analysis revealed no differences between pharmacists and pharmacy technicians in medication reconciliation performance pertaining to medication discrepancies. The patients with several comorbidities or those administered numerous medications received marked benefits related to reduced medication discrepancies from pharmacy-led medication reconciliation. Moreover, a randomized controlled trial revealed decreased risk of potential adverse drug events by pharmacy-led medication reconciliation in patients receiving care in the ED. WHAT IS NEW AND CONCLUSION Pharmacy-led medication reconciliation significantly decreased the number of medication discrepancies. However, only one study investigated potential adverse drug events in patients receiving care in the ED. Therefore, further studies investigating the direct clinical impact of decreased medication discrepancies are required.
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Affiliation(s)
- Yeo Jin Choi
- Clinical Trial Center, Hallym University Sacred Heart Hospital, Anyang-si, Korea
| | - Hyunah Kim
- Drug Information Research Institute, College of Pharmacy, Sookmyung Women's University, Seoul, Korea
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Graabæk T, Terkildsen BG, Lauritsen KE, Almarsdóttir AB. Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study. Ther Adv Drug Saf 2019; 10:2042098619858049. [PMID: 31244989 PMCID: PMC6580721 DOI: 10.1177/2042098619858049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/27/2019] [Indexed: 11/21/2022] Open
Abstract
Transitions of care may result in medication errors, when information about a
patient’s medications is not communicated sufficiently. In this clinical record
review study, we aimed to evaluate the frequency of undocumented medication
discrepancies at discharge from hospital and evaluate which patient
characteristics could be associated with undocumented medication discrepancies.
Preadmission medication lists were compared against the medication list in the
discharge letters, taking into account medication changes documented in the
patient record throughout the inpatient stay and in the discharge summary. Out
of 200 patients, 174 (87%) were affected by at least one undocumented medication
discrepancy, mostly for regular medication. Of the 1972 medications used, 744
(38%) medications were changed without documentation in the patient record, the
majority being over-the-counter supplements and herbal medications. Polypharmacy
at admission and discharge was associated with increased undocumented medication
discrepancies. This study indicates a lack of medication reconciliation during
inpatient stay. Correct and complete medication lists at admission and discharge
may resolve many of these discrepancies, supporting patient safety at
transitions of care.
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Affiliation(s)
| | - Babette Gorm Terkildsen
- Research Unit of Clinical Pharmacology and
Pharmacy, University of Southern Denmark, Odense C, Denmark
| | - Kira Emilie Lauritsen
- Research Unit of Clinical Pharmacology and
Pharmacy, University of Southern Denmark, Odense C, Denmark
| | - Anna Birna Almarsdóttir
- WHO Collaborating Centre for Research and
Training in the Patient Perspective on Medicines Use, University of
Copenhagen, Copenhagen Ø, Denmark
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Rostami P, Heal C, Harrison A, Parry G, Ashcroft DM, Tully MP. Prevalence, nature and risk factors for medication administration omissions in English NHS hospital inpatients: a retrospective multicentre study using Medication Safety Thermometer data. BMJ Open 2019; 9:e028170. [PMID: 31182450 PMCID: PMC6561430 DOI: 10.1136/bmjopen-2018-028170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine the prevalence, nature and predictors of patients having medication administration omissions in hospitals. METHODS All medication administration omissions data collected using the standardised methodology of the Medication Safety Thermometer in January 2015 were examined. Hospital inpatients prescribed at least one medication were included in the analysis. Multilevel logistic regression models ascertained the effects of patients' gender, age, number of prescribed medicines, ward specialty and medicines reconciliation initiation status on the likelihood of having omissions. Valid clinical reasons (VCRs) were excluded from regression models. A sensitivity analysis, excluding patient refusal (PR) omissions, was also conducted. RESULTS The final study sample included 5708 patients from 320 wards in 37 hospitals. Excluding VCRs, 30% of patients had medication administration omissions (95% CI 29 to 30). Approximately half of patients with omissions had refused medicines (51%, 95% CI 49 to 53). Univariable analysis suggested that all variables were significantly associated with omissions. However, in the multivariable model, significant differences were only observed regarding the numbers of medicines patients were prescribed and their ward specialty. Patients prescribed more than 20 medications were approximately five times more likely to have had omissions than patients prescribed one to four medications (OR 4.99, 95% CI 3.22 to 7.73). Patients on surgical wards were also more likely to have had omissions than those on medical wards (OR 1.58, 95% CI 1.14 to 2.18, p=0.006), but there was no significant difference when PRs were excluded (OR 0.5, 95% CI 0.27 to 1.22, p=0.473). CONCLUSION Medication administration omissions are a substantial problem that affect many hospital patients, and certain patient groups are at higher risk. Specific interventions are required targeting the underlying reasons for medication omissions for different patient subgroups.
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Affiliation(s)
- Paryaneh Rostami
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Research and Innovation, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Gareth Parry
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Patient Safety Translational Research Centre, National Institute for Health Research (NIHR), Greater Manchester, UK
| | - Mary P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Giannini O, Rizza N, Pironi M, Parlato S, Waldispühl Suter B, Borella P, Pagnamenta A, Fishman L, Ceschi A. Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward. BMJ Open 2019; 9:e026259. [PMID: 31133583 PMCID: PMC6538074 DOI: 10.1136/bmjopen-2018-026259] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Medication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including a best possible medication history (BPMH) compared with a standard medication history in patients admitted to an internal medicine ward. DESIGN Prospective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model. SETTING Internal medicine ward in a secondary care hospital in Southern Switzerland. PARTICIPANTS The first 100 consecutive patients admitted in an internal medicine ward. PRIMARY AND SECONDARY OUTCOME MEASURES Medication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified. RESULTS The median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model. CONCLUSION Even in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.
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Affiliation(s)
- Olivier Giannini
- Department of Internal Medicine, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Ticino, Switzerland
| | - Nicole Rizza
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michela Pironi
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Saida Parlato
- Hospital Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Paola Borella
- Department of Internal Medicine, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Ticino, Switzerland
| | - Alberto Pagnamenta
- Unit of Clinical Epidemiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Pneumology, University of Geneva, Geneva, Switzerland
| | | | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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Daliri S, Hugtenburg JG, ter Riet G, van den Bemt BJF, Buurman BM, Scholte op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One 2019; 14:e0213593. [PMID: 30861042 PMCID: PMC6413946 DOI: 10.1371/journal.pone.0213593] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. METHODS A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. RESULTS We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79). CONCLUSIONS A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands
- Community Pharmacy Westwijk, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, the Netherlands
| | - Bianca M. Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
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Duwez M, Valette A, Foroni L, Allenet B. [Involvement of hospital pharmacy technician for expanding medication reconciliation process in France: Actors' willingness and opinions]. ANNALES PHARMACEUTIQUES FRANÇAISES 2019; 77:168-177. [PMID: 30678804 DOI: 10.1016/j.pharma.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/12/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Medication reconciliation is widely promoted by international health authorities. Its expansion requires human resources, which are limited and unequally distributed among health care facilities. Recent international studies support the involvement of pharmacy technician in the medication reconciliation process but his role remains unstructured in France. We aimed to assess pharmacy technicians' opinions and willingness to be involved in the medication reconciliation process expansion and to identify the levers and barriers of the project. METHODS A field study was conducted among health facilities of our territory hospital group. Semi-structured interviews were carried out with different pharmacy technicians. Data were analyzed using a qualitative thematic analysis approach. RESULTS Overall, 12 pharmacy technicians from 5 hospitals were interviewed and almost all assumed their rightful place in the medication reconciliation process (n=11), with a view to revaluating tasks. For all pharmacy technicians, the main barriers to participate in medication reconciliation were the lack of time and training. The spread of a "patient culture", the supervision by pharmacists, the desire to be part of the care team in the ward and additional training requests were major levers of change. CONCLUSIONS Pharmacy technicians' role in expanding medication reconciliation process is legitimate and must be standardized in France. The deployment of the project requires to be formalized within a territory and should consider and develop local organisations.
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Affiliation(s)
- M Duwez
- Pharmacie, CHU Grenoble Alpes, 38700 La Tronche, France; Université Grenoble Alpes/CNRS/TIMC - IMAG UMR5525/Themas, 38700 La Tronche, France
| | - A Valette
- Université Grenoble Alpes/CNRS/CERAG, 38000 Grenoble, France
| | - L Foroni
- Pharmacie, CHU Grenoble Alpes, 38700 La Tronche, France
| | - B Allenet
- Pharmacie, CHU Grenoble Alpes, 38700 La Tronche, France; Université Grenoble Alpes/CNRS/TIMC - IMAG UMR5525/Themas, 38700 La Tronche, France.
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Presley CA, Byerly SH, Aylor AR, Mixon AS. An environmental scan of medication history technician programs within the Veterans Health Administration. Am J Health Syst Pharm 2019; 76:44-49. [PMID: 31603983 DOI: 10.1093/ajhp/zxy005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Results of a study to identify medication history technician (MHT) programs within the Veterans Health Administration (VHA) and to evaluate the personnel, structure, and scope of such programs are reported. METHODS Specially trained pharmacy technicians can take accurate patient medication histories and contribute to the medication reconciliation process. An environmental scan of MHT programs within VHA was conducted via an email query of pharmacy personnel. Semistructured interviews of personnel at each responding site (an MHT, a pharmacist, or both) were conducted. RESULTS Ten VHA sites had existing MHT programs; the earliest was initiated in 2010. Sites employed from 1 to 4 MHTs, who most commonly worked in the inpatient setting (7 sites). At most sites (9), MHTs obtained a "best possible medication history" through systematic collection of medication information using 2 reliable sources, such as patients, caregivers, and medical records. Survey respondents at all sites reported benefits of MHT programs, including dedicated time to obtain medication histories, allowing for more effective use of pharmacists' time. Six sites were eager to increase the reach of their programs. MHT training, oversight, and quality assurance varied across the sites. The survey results indicated that there are opportunities nationally-within and outside VHA-to develop standardized training, competency assessments, and quality assurance measures for MHT programs. CONCLUSION Ten VHA sites with MHT programs were identified. MHTs most commonly worked in inpatient settings as part of admission medication reconciliation processes.
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Affiliation(s)
- Caroline A Presley
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Susan H Byerly
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amy R Aylor
- VA Office of Strategic Integration (OSI), Veterans Engineering Resource Center (VERC), Washington, DC
| | - Amanda S Mixon
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
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Gernant SA, Nguyen MO, Siddiqui S, Schneller M. Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review. Res Social Adm Pharm 2018; 14:883-890. [DOI: 10.1016/j.sapharm.2017.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
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Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre-post study from Ethiopia. Int J Clin Pharm 2018; 40:1209-1216. [PMID: 30155773 DOI: 10.1007/s11096-018-0722-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this strategy has not been well researched in low-and-middle-income countries, including Ethiopia. Objective The aim of this study was to investigate the impact of pharmacist-led MedRec intervention on the incidence of unintentional medication discrepancies in Ethiopia. Setting Emergency department in a tertiary care teaching hospital in Ethiopia. Method A single centre, prospective, pre-post study was conducted on adults (aged 18 years or over) that had been hospitalized for at least 24 h and were taking at least 2 home medications on admission. The intervention involved assignment of a pharmacist to an emergency care team so as to take the best possible medication history and reconcile this list with the current medications in use. Main outcome measure Incidence and potential clinical severity of unintentional medication discrepancies. Results 123 patients were included (pre-intervention, 49; post-intervention, 74). The proportion of patients with at least one unintended discrepancy was reduced from 59 to 10.5% after the intervention (p < 0.001). Similarly, the percentage of patients with potentially severe clinical impact medication discrepancies reduced significantly after the intervention (p < 0.01). Most importantly, the likelihood of occurrence of unintentional medication discrepancies was approximately 17 times more often in the absence of pharmacist intervention (OR 16.45, 95% CI 5.22, 51.85). Conclusion This study has found that pharmacist-led MedRec intervention was impactful, and it was able to minimize the incidence of unintentional medication discrepancies significantly.
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Tamiru A, Edessa D, Sisay M, Mengistu G. Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia. BMC Res Notes 2018; 11:554. [PMID: 30075803 PMCID: PMC6076390 DOI: 10.1186/s13104-018-3668-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study is to determine the magnitude of medication discrepancies and its associated factors at transitions in care of a Specialized University Hospital in eastern Ethiopia. Results This study enrolled 411 patients having at least one prescription medication. For each of the patient enrolled, a medication reconciliation process was accomplished between medication use history before transition and medication orders at the transition. A total of 1027 medications were reconciled and 298 of them showed discrepancies. From such medication discrepancies, 96 (32.2%) of them were unintended discrepancies. Patients admitted to surgical ward (adjusted odds ratio {AOR} 0.27 [95% confidence interval 0.10–0.74]) and on malnutrition therapy (AOR 0.13 [0.03–0.52]) had reduced likelihoods of medication discrepancies. However, patients on cardiovascular drug therapy (AOR 5.69 [2.4–13.62]) and who were hospitalized for more than 5 days (AOR 5.69 [2.97–10.9] {5–10 days}) had significantly increased likelihoods of discrepancies. Accordingly, one-third of the medication discrepancies identified were unintentional and these discrepancies were more likely to occur with cardiovascular drugs, in medical or pediatric wards and patients hospitalized for prolonged time. Therefore, this pharmacist-led medication reconciliation indicates the potential of pharmacists in reducing drug-related adverse health outcomes that arise from medication discrepancy. Electronic supplementary material The online version of this article (10.1186/s13104-018-3668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Addisu Tamiru
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia
| | - Dumessa Edessa
- Department of Pharmacy Practice, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia.
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Oromia, Ethiopia
| | - Getnet Mengistu
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
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Kiechle ES, McKenna CM, Carter H, Zeymo A, Gelfand BW, DeGeorge LM, Sauter DA, Mazer-Amirshahi M. Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department. J Med Toxicol 2018; 14:272-277. [PMID: 29968185 DOI: 10.1007/s13181-018-0671-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Medication histories, including knowledge of allergies and adverse drug reactions (ADRs), are a nationally recognized quality measure. Medication histories in the emergency department (ED) are often inaccurate or incomplete. Our objective was to determine the prevalence and nature of medication allergy and ADR discrepancies in an urban ED. METHODS This was a prospective observational descriptive study, enrolling a convenience sample of adults over 7 months at a single academic urban ED. Trained personnel recorded patient demographics and number of daily medications. Patients listed any prior drug allergies or non-allergic ADRs. Following the ED encounter, the patients' self-reported allergies and ADRs were compared to the electronic medical record (EMR) to identify and describe discrepancies. RESULTS A sample of 1014 patients, predominantly black (81%), female (60%), and in the 18- to 59-year-old range (69%), was recruited. Most patients were taking at least one daily medication (74%). Three hundred fifteen patients reported at least one allergy (31%), and 252 (25%) at least one ADR. Four hundred sixteen patients (41%) had a discrepancy between their self-report of allergy or ADR and the EMR. Omissions were the most frequent discrepancy. Full descriptions of allergies or ADR were present in 18.4% of charts. Fifty-seven patients (5.6%) were administered a medication which could have interacted with a documented allergy or ADR; none of the allergy EMR records were updated to reflected this. CONCLUSIONS In this cross-sectional ED study, drug allergies and ADRs were both highly prevalent. There were significant discrepancies in documentation of allergies and ADRs between patient self-report and the EMR.
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Affiliation(s)
- Eric S Kiechle
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Suite NA 1009, Washington, DC, 20010, USA.
| | - Colleen M McKenna
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Hannah Carter
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Alexander Zeymo
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, MD, 20782, USA
| | - Bradley W Gelfand
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Lindsey M DeGeorge
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Suite NA 1009, Washington, DC, 20010, USA
| | - Diane A Sauter
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Suite NA 1009, Washington, DC, 20010, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Suite NA 1009, Washington, DC, 20010, USA.,Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
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Breuker C, Macioce V, Mura T, Audurier Y, Boegner C, Jalabert A, Villiet M, Castet-Nicolas A, Avignon A, Sultan A. Medication errors at hospital admission and discharge in Type 1 and 2 diabetes. Diabet Med 2017; 34:1742-1746. [PMID: 29048753 DOI: 10.1111/dme.13531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
AIMS To assess the prevalence and characteristics of medication errors at hospital admission and discharge in people with Type 1 and Type 2 diabetes, and identify potential risk factors for these errors. METHODS This prospective observational study included all people with Type 1 (n = 163) and Type 2 diabetes (n = 508) admitted to the Diabetology-Department of the University Hospital of Montpellier, France, between 2013 and 2015. Pharmacists conducted medication reconciliation within 24 h of admission and at hospital discharge. Medication history collected from different sources (patient/family interviews, prescriptions/medical records, contact with community pharmacies/general practitioners/nurses) was compared with admission and discharge prescriptions to detect unintentional discrepancies in medication indicating involuntary medication changes. Medication errors were defined as unintentional medication discrepancies corrected by physicians. Risk factors for medication errors and serious errors (i.e. errors that may cause harm) were assessed using logistic regression. RESULTS A total of 322 medication errors were identified and were mainly omissions. Prevalence of medication errors in Type 1 and Type 2 diabetes was 21.5% and 22.2% respectively at admission, and 9.0% and 12.2% at discharge. After adjusting for age and number of treatments, people with Type 1 diabetes had nearly a twofold higher odds of having medication errors (odds ratio (OR) 1.72, 95% confidence interval (CI) 1.02-2.94) and serious errors (OR 2.17, 95% CI 1.02-4.76) at admission compared with those with Type 2 diabetes. CONCLUSIONS Medication reconciliation identified medication errors in one third of individuals. Clinical pharmacists should focus on poly-medicated individuals, but also on other high-risk people, for example, those with Type 1 diabetes.
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Affiliation(s)
- C Breuker
- Clinical Pharmacy Department, University Hospital of Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, France
| | - V Macioce
- Clinical Research and Epidemiology Unit, France
| | - T Mura
- Clinical Research and Epidemiology Unit, France
| | - Y Audurier
- Clinical Pharmacy Department, University Hospital of Montpellier, France
| | - C Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, France
| | - A Jalabert
- Clinical Pharmacy Department, University Hospital of Montpellier, France
| | - M Villiet
- Clinical Pharmacy Department, University Hospital of Montpellier, France
| | - A Castet-Nicolas
- Clinical Pharmacy Department, University Hospital of Montpellier, France
- IRCM, University of Montpellier, INSERM U1194, France
| | - A Avignon
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, France
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, France
| | - A Sultan
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, France
- Endocrinology-Diabetology-Nutrition Department, University Hospital of Montpellier, France
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Bowman C, McKenna J, Schneider P, Barnes B. Comparison of Medication History Accuracy Between Nurses and Pharmacy Personnel. J Pharm Pract 2017; 32:62-67. [PMID: 29108459 DOI: 10.1177/0897190017739982] [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
PURPOSE: To evaluate the differences in medication history errors made by pharmacy technicians, students, and pharmacists compared to nurses at a community hospital. METHODS: One hundred medication histories completed by either pharmacy or nursing staff were repeated and evaluated for errors by a fourth-year pharmacy student. The histories were analyzed for differences in the rate of errors per medication. Errors were categorized by their clinical significance, which was determined by a panel of pharmacists, pharmacy students, and nurses. Errors were further categorized by their origin as either prescription (Rx) or over the counter (OTC). The primary outcome was the difference in the rate of clinically significant errors per medication. Secondary outcomes included the differences in the rate of clinically insignificant errors, Rx errors, and OTC errors. Differences in the types of errors for Rx and OTC medications were also analyzed. Additionally, the number of patients with no errors was compared between both groups. RESULTS: The pharmacy group had a lower clinically significant error rate per medication (0.03 vs 0.09; relative risk [RR] = 0.66; 95% confidence interval [CI]: 0.020-0.093; P = .003). For secondary outcomes, the pharmacy group had a lower total error rate (0.21 vs 0.36, RR = 0.58; 95% CI: 0.041-0.255; P = .007), Rx error rate (0.09 vs 0.27, RR = 0.44; 95% CI: 0.071-0.292; P = .002), and OTC error rate (0.24 vs 0.46; RR = 0.52; 95% CI: 0.057-0.382; P = .009) per medication. The pharmacy group completed 20% more medication histories without Rx errors ( P = .045) and 25% more histories without OTC errors ( P = .041). CONCLUSION: This study demonstrated that expanded use of pharmacy technicians and students improves the accuracy of medication histories in a community hospital.
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Affiliation(s)
- Connor Bowman
- 1 Pharmacy Department, Olathe Medical Center, Olathe, KS, USA
| | | | - Phil Schneider
- 1 Pharmacy Department, Olathe Medical Center, Olathe, KS, USA
| | - Brian Barnes
- 2 University of Kansas School of Pharmacy, Lawrence, KS, USA
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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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Kiesel E, Hopf Y. Hospital pharmacists working with geriatric patients in Europe: a systematic literature review. Eur J Hosp Pharm 2017; 25:e74-e81. [PMID: 31157072 DOI: 10.1136/ejhpharm-2017-001239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives Multimorbidity of geriatric patients often leads to polypharmacy that increases the risk for drug interactions. Geriatric patients are also more sensitive to adverse drug reactions due to physiological changes resulting from ageing. Hence, the use of medicines should be considered thoroughly. This systematic literature review aimed at identifying and presenting available evidence on the effect of pharmaceutical interventions on geriatric patients, their medications or healthcare costs in a clinical setting in Europe. Methods We included all studies on research of pharmaceutical interventions on geriatric inpatients (≥65 years) in Europe since 2001. Database searches were conducted on PubMed, EMBASE, The Cochrane Library and AgeInfo. In addition, the following journals were searched manually: European Journal of Hospital Pharmacy, 'Krankenhauspharmazie', 'Medizinische Monatsschrift für Pharmazeuten' and 'Zeitschrift für Gerontologie und Geriatrie'. Results Database screening yielded 8058 hits. After deletion of duplicates, screening of title and abstract, 143 full-text articles were analysed and 17 papers were included. Manual searching added four more papers. Included studies were conducted in Belgium, Denmark, England, Ireland, the Netherlands, Sweden and Spain. They demonstrate that pharmaceutical care on wards leads to more appropriate medication use and might reduce outcomes like drug-related readmissions. Intensified pharmaceutical care showed additional effects, even in countries with established pharmaceutical care in hospitals. Conclusions This systematic literature review demonstrates that ward-based pharmacists may improve the appropriateness of medications, seamless care and drug safety for geriatric inpatients while being cost effective.
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Affiliation(s)
- Esther Kiesel
- Department of Pharmacy, University Hospital of Munich, Munich, Germany
| | - Yvonne Hopf
- Department of Pharmacy, University Hospital of Munich, Munich, Germany
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Hill JD, Anderegg SV, Couldry RJ. Development of a Pharmacy Technician-Driven Program to Improve Vaccination Rates at an Academic Medical Center. Hosp Pharm 2017; 52:617-622. [PMID: 29276298 DOI: 10.1177/0018578717722788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Influenza and pneumococcal disease contribute substantially to the burden of preventable disease in the United States. Despite quality measures tied to immunization rates, health systems have struggled to achieve these targets in the inpatient setting. Pharmacy departments have had success through implementation of pharmacist standing order programs (SOP); however, these initiatives are labor-intensive and have not resulted in 100% immunization rates. Objective: The objective of this study was to evaluate a pilot utilizing pharmacy technician interventions, in combination with a nursing SOP, to improve vaccination rates of hospitalized patients for influenza and pneumococcal disease. Methods: A process was developed for pharmacy technicians to identify patients who were not previously screened or immunized during the weekend days on the Cardiovascular Progressive Care unit at the University of Kansas Health-System. Targeted pharmacy technician interventions consisted of phone call reminders and face-to-face discussions with nursing staff. The primary study outcome was the change in immunization compliance rates between the control and intervention groups. Results: Influenza vaccine rates showed a statistically significant increase from 72.2% (52 of 72) of patients during the control group to 92.9% (65 of 70, P = .001) of patients during the intervention group. A pneumococcal vaccination rate of 81.3% (61 of 75) was observed in the control group, compared with 84.3% (59 of 70) of patients in the intervention group (P = .638). Conclusion: An improvement in inpatient influenza immunization rates can be achieved through targeted follow-up performed by pharmacy technicians, in combination with a nursing-driven SOP.
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Affiliation(s)
- John D Hill
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Rick J Couldry
- The University of Kansas Health-System, Kansas City, KS, USA
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Sardaneh AA, Burke R, Ritchie A, McLachlan AJ, Lehnbom EC. Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system. Int J Med Inform 2017; 101:41-49. [DOI: 10.1016/j.ijmedinf.2017.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 01/03/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
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Rhalimi F, Rhalimi M, Rauss A. Pharmacist's Comprehensive Geriatric Assessment: Introduction and Evaluation at Elderly Patient Admission. Drugs Real World Outcomes 2017; 4:43-51. [PMID: 27933555 PMCID: PMC5332309 DOI: 10.1007/s40801-016-0098-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The role of the clinical pharmacist within the healthcare system remains unclear. OBJECTIVE Our objective was to describe a pharmacist's comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs). METHODS We conducted a prospective interventional study over 29 months in a 34-bed medical/rehabilitation geriatric ward in a French geriatric hospital. At admission, patients received pharmaceutical care through a consistent three-step process: (1) pharmacists met with the patient to undertake cognitive screening and assess their medication adherence (using the Girerd score) and medication history; (2) medication reconciliation was conducted at admission to detect intentional and unintentional discrepancies in treatment; and (3) clinical medication review was carried out throughout the patient's stay. The pharmacist conveyed proposed interventions to optimise treatment to the physician through the electronic health record. The number and type of PIs and their rate of implementation were recorded. RESULTS In total, 539 patients aged >65 years were included; their mean age was 84 years. Cognitive screening showed that 45% of patients were confused at admission. Medication adherence assessment indicated that 50.2% had adherence problems. Medication reconciliation at admission detected discrepancies in 48%, with a mean of 1.09 unintended discrepancies per patient. Patients were taking an average of 7 ± 3 drugs. In total, 828 PIs were reported to physicians; 520 were accepted and implemented (62.8% acceptance rate). CONCLUSION This approach helps to avoid medication errors and enables the suggestion of relevant PIs, which were implemented by physicians in two-thirds of cases.
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Affiliation(s)
- Faiza Rhalimi
- Centre Hospitalier Bertinot Juël, 34 bis Rue Pierre Budin, 60240 Chaumont en Vexin, France
| | - Mounir Rhalimi
- Centre Hospitalier Bertinot Juël, 34 bis Rue Pierre Budin, 60240 Chaumont en Vexin, France
- INSERM U1088, University of Picardie Jules Verne, Amiens, France
| | - Alain Rauss
- ARCOSA Limeil-Brévannes, Val-de-Marne, Paris, France
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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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The effect of the TIM program (Transfer ICU Medication reconciliation) on medication transfer errors in two Dutch intensive care units: design of a prospective 8-month observational study with a before and after period. BMC Health Serv Res 2017; 17:124. [PMID: 28183302 PMCID: PMC5301448 DOI: 10.1186/s12913-017-2065-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/31/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The transfer of patients to and from the Intensive Care Unit (ICU) is prone to medication errors. The aim of the present study is to determine whether the number of medication errors at ICU admission and discharge and the associated potential harm and costs are reduced by using the Transfer ICU and Medication reconciliation (TIM) program. METHODS This prospective 8-month observational study with a pre- and post-design will assess the effects of the TIM program compared with usual care in two Dutch hospitals. Patients will be included if they are using at least one drug before hospital admission and will stay in the ICU for at least 24 h. They are excluded if they are transferred to another hospital, admitted and discharged in the same weekend or unable to communicate in Dutch or English. In the TIM program, a clinical pharmacist reconciles patient's medication history within 24 h after ICU admission, resulting in a "best possible" medication history and presents it to the ICU doctor. At ICU discharge the clinical pharmacist reconciles the prescribed ICU medication and the medication history with the ICU doctor, resulting in an ICU discharge medication list with medication prescription recommendations for the general ward doctor. Primary outcome measures are the proportions of patients with one or more medication transfer errors 24 h after ICU admission and 24 h after ICU discharge. Secondary outcome measures are the proportion of patients with potential adverse drug events, the severity of potential adverse drug events and the associated costs. For the primary outcome relative risks and 95% confidence intervals will be calculated. DISCUSSION Strengths of this study are the tailor-made design of the TIM program and two participating hospitals. This study also has some limitations: A potential selection bias since this program is not performed during the weekends, collecting of potential rather than actual adverse drug events and finally a relatively short study period. Nevertheless, the findings of this study will provide valuable information on a crucial safety intervention in the ICU. TRIAL REGISTRATION Dutch trial register: NTR4159 , 5 September 2013.
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Irwin AN, Ham Y, Gerrity TM. Expanded Roles for Pharmacy Technicians in the Medication Reconciliation Process: A Qualitative Review. Hosp Pharm 2017; 52:44-53. [PMID: 28179740 PMCID: PMC5278913 DOI: 10.1310/hpj5201-44] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Collection of a complete and accurate medication history is an essential component of the medication reconciliation process. The role of pharmacy technicians in supporting medication reconciliation has been the subject of recent interest. Purpose: The purpose of this article is to review the existing literature on pharmacy technician involvement in the medication reconciliation process and to summarize outcomes on the quality and accuracy of pharmacy technician-collected medication histories. Method: A literature review was conducted using MEDLINE and Academic Search Premier (1948 - April 2015). Results: Sixteen papers were identified, with 12 containing a formal evaluation of outcomes. Three were purely descriptive, and 9 compared the pharmacy technician's performance to pharmacists, nurses, physicians, and/or interdisciplinary teams. Studies used a variety of endpoints, but they demonstrated similar or improved outcomes by engaging pharmacy technicians. Evidence demonstrates that trained pharmacy technicians are able to gather medication histories with similar completeness and accuracy to other health care professionals. Conclusion: The use of pharmacy technicians may be a viable strategy for developing and expanding medication reconciliation processes with appropriate supervision. Future efforts should focus on evaluating the impact of expanded roles for pharmacy technicians in the health care system; assessing the need for standardization of pharmacy technician education, training, and certification; and obtaining clarification from state pharmacy boards regarding these expanded roles.
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