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Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Arrojo Suárez J, Jimenez Lozano I, Fernandez-Llamazares CM, Tristancho-Perez A, Yunquera Romero L, Martínez Roca C, Otero Villalustre C, García Robles A, Garrido Corro B, Rodríguez Marrodán B. Medication reconciliation on admission in paediatric chronic patients: A multicentre study. An Pediatr (Barc) 2023; 99:376-384. [PMID: 38036314 DOI: 10.1016/j.anpede.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. OBJECTIVES To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. METHODOLOGY Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. RESULTS 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. CONCLUSIONS The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana García Robles
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Villaronga Flaque M, Cabañas Poy MJ, Fernández-Llamazares CM, Álvarez Del Vayo C, Gallego Fernández C, Martínez Roca C, Hernández Gago Y, García Robles A, Garrido Corro B. Multicentre study of medication reconciliation in paediatric onco-hematology. Farm Hosp 2023; 47:261-267. [PMID: 37422402 DOI: 10.1016/j.farma.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them. METHODS A 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur. RESULTS Medication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE. CONCLUSIONS In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana García Robles
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
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Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Villaronga Flaque M, Cabañas Poy MJ, Fernández-Llamazares CM, Álvarez Del Vayo C, Gallego Fernández C, Martínez Roca C, Hernández Gago Y, García Robles A, Garrido Corro B. [Translated article] Medication reconciliation in pediatric hemato-oncologic patients: A multicenter study. Farm Hosp 2023; 47:T261-T267. [PMID: 37716875 DOI: 10.1016/j.farma.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVE To determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them. METHODS A 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients. RESULTS Medication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error. CONCLUSIONS In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors.
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. Farm Hosp 2023; 47:106-112. [PMID: 36842862 DOI: 10.1016/j.farma.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019-June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge. 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.
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Affiliation(s)
| | | | | | | | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. Farm Hosp 2023; 47:T106-T112. [PMID: 37032197 DOI: 10.1016/j.farma.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.
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Affiliation(s)
| | | | | | - Alfonso García Aranda
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
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Guisado-Gil AB, López-Hermoso C, Ramírez-Duque N, Fernández-Rubio G, Munoz R, Santos-Rubio MD, Sánchez-Hidalgo M. Cross-cultural adaptation to the Spanish version of the "Structured HIstory of Medication Use" questionnaire for medication reconciliation at admission. Med Clin (Barc) 2021:S0025-7753(20)30873-3. [PMID: 33612284 DOI: 10.1016/j.medcli.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The "Structured HIstory of Medication use" (SHIM) questionnaire is a tool developed to obtain an accurate pre-admission overview of medications, involving a structured interview with patients, and has demonstrated its potential to prevent reconciliation errors. The objective of this study was to cross-culturally adapt the SHIM questionnaire to Spanish. PATIENTS AND METHODS Forward and blind-back translations followed by a synthesis and adaptation, with the participation of an expert panel, to guarantee the equivalence between the original questionnaire and the Spanish version. Subsequently, pilot testing of the Spanish version was carried out through cognitive interviews in a sample of polymedicated patients under follow-up by the Department of Internal Medicine. RESULTS The Spanish version of the SHIM questionnaire (SHIM-e) was obtained. Scores for difficulty assigned by translators involved in forward and back translations were low. During the synthesis and adaptation phase, three discrepancies were resolved, and the expert panel decided to include some terms commonly used for clinical interviews in the Spanish version of the questionnaire. The pilot testing, which was performed in a sample of 10 polymedicated patients admitted to the Department of General and Digestive Surgery, showed 100% comprehensibility for all items, except for number 13, which was 90%. CONCLUSIONS This work presents the first cross-cultural adaptation to Spanish of the SHIM questionnaire. The forward and blind-back translations presented low difficulty and the results of the pilot testing showed a high level of comprehensibility for the Spanish version of this tool.
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González C, González G, Plaza-Plaza JC, Godoy MI, Cárcamo M, Rojas C. [Reduction of reconciliation errors in chronic pediatric patients through an educational strategy]. An Pediatr (Barc) 2020; 94:238-244. [PMID: 32917544 DOI: 10.1016/j.anpedi.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medication reconciliation errors, also known as unintentional discrepancies, are frequent during admission, especially in chronic patients, and have an impact on safety. Educational interventions can be a reduction strategy. MATERIAL AND METHODS Quasi-experimental study, before-after design. Participants were chronic patients admitted into hospitalization services. Medication reconciliation was conducted at admission. The intervention consisted of a training to each prescribing physician with study contents and printed educational material. To study the association between intervention and change of frequency of unintentional discrepancies was made a logistic regression model, adjusting for selected variables. RESULTS A sample of 54 patients was studied in each stage. In the first stage it was observed that 42.6% of patients had at least one unintentional discrepancy. After intervention the proportion of patients with at least one unintentional discrepancy decreased to 24.1% (p = 0.041). In both stages, omission was the main category of unintentional discrepancy. The significant reduction after the intervention is maintained by controlling for variables such as emergency admission and pre-admission service. CONCLUSIONS Incidence of unintentional discrepancies in admission is high in chronic hospitalized patients and can be reduced through an educative strategy.
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Affiliation(s)
- Claudio González
- Hospital de niños Dr. Exequiel González Cortés, San Miguel, Santiago, Chile; Depto. Salud Pública y Epidemiología, Universidad de los Andes, Santiago, Chile.
| | - Gabriela González
- Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - María Inés Godoy
- Unidad de Desarrollo, Análisis e Investigación, Departamento de Evaluación, Medición y Registro Educacional, Universidad de Chile, Santiago, Chile
| | - Marcela Cárcamo
- Depto. Salud Pública y Epidemiología, Universidad de los Andes, Santiago, Chile
| | - Cecilia Rojas
- Hospital de niños Dr. Exequiel González Cortés, San Miguel, Santiago, Chile
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Bilbao Gómez-Martino C, Nieto Sánchez Á, Fernández Pérez C, Borrego Hernando MI, Martín-Sánchez FJ. [Medication reconciliation errors according to patient risk and type of physician prescriber identified by prescribing tool used]. Emergencias 2018; 29:384-390. [PMID: 29188912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. MATERIAL AND METHODS Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). RESULTS A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). CONCLUSION The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions.
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Affiliation(s)
| | - Ángel Nieto Sánchez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid. Universidad Complutense de Madrid, España
| | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid. Unidad Transversal del IdISSC. Universidad Complutense de Madrid, España
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Abstract
OBJECTIVES To describe the risk factors and the effect of medication use on the risk of falls in a population of 65 years or older. MATERIAL AND METHODS Descriptive study of falls in the elderly population. The risk factors and consequences of the fall were recorded. Hypnotic and sedative risk drugs, opioids, and the simultaneous consumption of six or more drugs were considered. Diuretics were also included. The cumulative incidence for each group and the corresponding relative risks of falls were analysed from the cases registered between June and November 2016. RESULTS During the study period, 60 falls were reported, of which 66% were by women and 34% by men. The cumulative incidence of falls was 3 per thousand women (95% CI: 2.22-4.08), and 2 per thousand men (95% CI: 1.44-3.41). The majority (71%) had consumed risk medication. Six or more medications were taken by 40% of the men and 62.5% of the women, and 97.6% was risk medication. The relative risk of falls in people using hypnotics, sedatives and opioids compared to non-users was 8.7 in men and 7.1 in women. In people who took diuretics, the relative risk was 4.6 for both genders. In women on multiple medications the relative risk was 3.7 compared to 1.7 in men. CONCLUSIONS Polypharmacy and the use of hypnotic and sedative drugs and opioids and diuretics are an important public health problem, due to being risk factors for falls in this population, with a greater impact for women.
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Affiliation(s)
- M Fernández
- Centro de Salud de Sotrondio, Área sanitaria VIII, Servicio de Salud del Principado de Asturias, Sotondrio, Asturias, España
| | - C Valbuena
- Centro de Salud de Sotrondio, Área sanitaria VIII, Servicio de Salud del Principado de Asturias, Sotondrio, Asturias, España
| | - C Natal
- Gerencia del Área sanitaria VIII, Servicio de Salud del Principado de Asturias, La Felguera, Asturias, España.
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Jiménez-Buñuales MT, Martínez-Sáenz MS, González-Diego P, Vallejo-García M, Gallardo-Anciano J, Cestafe-Martínez A. [Prospective study in 2 hospitals]. ACTA ACUST UNITED AC 2016; 31 Suppl 1:4-10. [PMID: 27216576 DOI: 10.1016/j.cali.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study is to know the incidence rate of medication reconciliation at admission and discharge in patients of La Rioja and to improve the patient safety on medication reconciliation. MATERIAL AND METHODS An observational prospective study, part of the Joint Action PaSQ, Work Package 5, European Union Network for Patient Safety and Quality of Care. The study has taken into account the definitions of the Institute for Safe Medication Practices. Any unintended discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a reconciliation error. RESULTS A total of 750 patients were included, 9 (1.2%) of whom showed at least one discrepancy. The patients had a total of 3,156 mediations registered: 2,313 prescriptions (73.4%) showed no differences, while 821 prescriptions (26%) were intended discrepancies and 21 prescriptions (0.6%) unintended discrepancies were considered by the physician as reconciliation errors. A percentage of 1.2 of the patients, which represents 0.6% of the medicines (one in 166 medications registered) had reconciliation errors during their hospital stay. CONCLUSIONS A proceeding has been implemented by means of the physician doing the medication reconciliation and reviewing it with the help of a medication reconciliation form. The medication reconciliation is a priority strategic objective to improve the safety of patients.
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Affiliation(s)
- M T Jiménez-Buñuales
- Unidad de Medicina Preventiva, Fundación Hospital Calahorra, Calahorra, La Rioja, España.
| | | | - P González-Diego
- Servicio de Medicina Preventiva y Gestión de la Calidad, Hospital Reina Sofía, Servicio Navarro de Salud-Osasunbidea, Tudela, Navarra, España
| | - M Vallejo-García
- Unidad de Medicina Interna, Fundación Hospital Calahorra, Calahorra, La Rioja, España
| | - J Gallardo-Anciano
- Unidad de Farmacia, Fundación Hospital Calahorra, Calahorra, La Rioja, España
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Saavedra-Quirós V, Montero-Hernández E, Menchén-Viso B, Santiago-Prieto E, Bermejo-Boixareu C, Hernán-Sanz J, Sánchez-Guerrero A, Campo Loarte J. [Medication reconciliation at admission and discharge. A consolidated experience]. ACTA ACUST UNITED AC 2016; 31 Suppl 1:45-54. [PMID: 27157795 DOI: 10.1016/j.cali.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/13/2016] [Accepted: 02/17/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.
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Affiliation(s)
- V Saavedra-Quirós
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | - E Montero-Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - B Menchén-Viso
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - E Santiago-Prieto
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - C Bermejo-Boixareu
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J Hernán-Sanz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - A Sánchez-Guerrero
- Servicio de Farmacia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J Campo Loarte
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
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San José Ruiz B, Serrano De Lucas L, López-Giménez LR, Baza Martínez B, Sautua Larreategi S, Bustinza Txertudi A, Sebastián Leza Á, Chirivella Ramón MT, Fonseca Legrand JL, de Miguel Cascon M. [Medication reconciliation at hospital admission: Results and identification of target patients]. ACTA ACUST UNITED AC 2016; 31 Suppl 1:36-44. [PMID: 27156158 DOI: 10.1016/j.cali.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/08/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To quantify and to classify the discrepancies between the admission treatment and the usual patient treatment. To determine the variables that predict those patients that will have more benefit from medication reconciliation. MATERIAL AND METHODS A prospective medication reconciliation study was conducted in the Vascular Surgery Unit from March 2014 to December 2014. When the patients were admitted to the Vascular Surgery Unit, they were informed about the study and asked to prepare information about their chronic treatment. The pharmacist then checked their clinical records, outpatient prescriptions, and also interviewed the patient, obtaining the best pharmacotherapeutic history available. The discrepancies with the admission treatment were written into the patient electronic clinical records. Finally, the physician classified the discrepancies, and changed the treatment, if needed. The statistical analysis included a comparison between patients with and without a non-justified discrepancy (NJD). The statistically different characteristics were used to plot Receiver Operating Characteristic curves, in order to determine the sensitivity and the specificity of these variables to select patients with discrepancies. RESULTS A total of 380 patients were included. There were 845 non-justified, 600 justified non-documented, and 439 justified documented discrepancies. At least one NJD was identified in 293 patients (77%), with 65 patients (17%) having only justified discrepancies, and 22 patients (6%) having no discrepancies. NJD were: different dose, route or schedule (51%), omission (39%), wrong drug (8%) and commission (2%). The variables associated with discrepancies were number of chronic medications drugs and provider of information. CONCLUSIONS In most studies, omission is the most frequent error. In contrast, in our study the most frequent error is different dose, route, or schedule. The variable that allows selecting patients at higher risk of discrepancies is the number of chronic drugs. This risk is also increased if the patients are not the manager of their own medication.
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Affiliation(s)
- B San José Ruiz
- Servicio de Farmacia, Hospital Universitario Cruces, Barakaldo, España.
| | | | - L R López-Giménez
- Servicio de Farmacia, Hospital Universitario Cruces, Barakaldo, España
| | - B Baza Martínez
- Servicio de Farmacia, Hospital Universitario Cruces, Barakaldo, España
| | | | | | - Á Sebastián Leza
- Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, España
| | - M T Chirivella Ramón
- Servicio de Cirugía Vascular y Angiología, Hospital Universitario Cruces, Barakaldo, España
| | - J L Fonseca Legrand
- Servicio de Cirugía Vascular y Angiología, Hospital Universitario Cruces, Barakaldo, España
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13
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Valverde-Bilbao E, Mendizabal-Olaizola A, Idoiaga-Hoyos I, Arriaga-Goirizelai L, Carracedo-Arrastio JD, Arranz-Lázaro C. [Medication reconciliation in primary care after hospital discharge]. ACTA ACUST UNITED AC 2014; 29:158-64. [PMID: 24589233 DOI: 10.1016/j.cali.2014.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. MATERIAL AND METHODS This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. RESULTS Two hundred sixty-one patients (n=261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. CONCLUSIONS The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital.
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Affiliation(s)
- E Valverde-Bilbao
- Servicio de Farmacia, OSI Bidasoa, Hospital Bidasoa, Hondarribi, Guipúzcoa, España.
| | | | | | | | | | - C Arranz-Lázaro
- Unidad de Continuidad Asistencial, OSI Bidasoa, Hospital Bidasoa, Hondarribi, Guipúzcoa, España
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14
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Alfaro-Lara ER, Vega-Coca MD, Galván-Banqueri M, Nieto-Martín MD, Pérez-Guerrero C, Santos-Ramos B. [Pharmacological treatment conciliation methodology in patients with multiple conditions]. Aten Primaria 2013; 46:89-99. [PMID: 24035767 PMCID: PMC6985596 DOI: 10.1016/j.aprim.2013.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 06/17/2013] [Accepted: 07/05/2013] [Indexed: 11/13/2022] Open
Abstract
Objetivo Realizar una revisión bibliográfica para identificar las diferentes metodologías empleadas en el proceso de conciliación de los tratamientos farmacológicos que sean aplicables a pacientes pluripatológicos. Diseño Revisión sistemática. Fuentes de datos Se realizó una revisión bibliográfica (febrero de 2012) en las bases de datos Pubmed, EMBASE, CINAHL, PsycINFO e Índice Médico Español de métodos de conciliación del tratamiento en pacientes pluripatológicos, o en su defecto, ancianos o polimedicados. Selección de estudios Se recuperaron 273 artículos, de los que se seleccionaron 25. Extracción de datos Se extrajo información relativa a la metodología empleada: nivel asistencial en el que se realiza, fuentes de información, uso de formulario, tiempo establecido, profesional responsable, información recogida y variables registradas como errores de conciliación. Resultados La mayoría de estudios fueron al ingreso y al alta hospitalarios Como principales fuentes de información destacan la entrevista y la historia clínica. En la mayoría de trabajos no se especifica un tiempo preestablecido, ni se usa formulario, y el principal responsable es el farmacéutico clínico. Además de la medicación domiciliaria, los hábitos de automedicación y la fitoterapia también son registrados. Se recogen como errores de conciliación desde omisiones de fármacos hasta interacciones medicamentosas. Conclusiones Existe gran heterogeneidad en la metodología empleada para la actividad de la conciliación. No existe ningún trabajo realizado específicamente en el paciente pluripatológico, que por su complejidad y susceptibilidad a errores de conciliación requiere una metodología estandarizada.
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Affiliation(s)
- Eva Rocío Alfaro-Lara
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | | | - María Dolores Nieto-Martín
- Unidad de Gestión Clínica - Atención Médica Integral de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Bernardo Santos-Ramos
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España
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