An evaluation of medication reconciliation at an outpatient Internal Medicines clinic

Gaag, Suzanne van der; Janssen, Marjo J. A.; Wessemius, Hanneke; Siegert, C. E. H.; Karapinar-Çarkıt, Fatma

doi:10.1016/j.ejim.2017.07.015

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…Studies on the added value of MR in the outpatient setting are lacking. Until now, studies in the outpatient clinics have only examined the effect of MR on the identification and reduction of MDs, without taking into account the value of the additional information provided by the patient during MR [20,23,38,39]. According to the guidelines, it is necessary to perform MR prior to or during the prescribing of drugs [24,31].…”

Section: Discussionmentioning

confidence: 99%

“…Up to 100% of the patients admitted to a hospital have at least one medication discrepancy [13,14], of which half of these have the potential to harm patients [15][16][17][18]. In the outpatient setting, more than half of the patients visiting the outpatient clinic have at least one medication discrepancy [19][20][21]. Although the proportion of outpatients with a medication discrepancy is lower, the large number of patients visiting the outpatient clinics results in a high number of patients with at least one medication discrepancy.…”

Section: Introductionmentioning

confidence: 99%

“…Medication reconciliation (MR) has been proven as an effective method to reduce medication discrepancies. Most studies demonstrate that MR approximately halves the number of medication discrepancies both in the inpatient and outpatient setting [9,20,22,23]. Besides reducing medication discrepancies, MR has the ability to identify medication non-adherence, low medication literacy, and use of non-prescribed medications such as supplements and vitamins [24].…”

Section: Introductionmentioning

confidence: 99%

“…This is important because studies shows that Dutch inpatients have on average three medication discrepancies [27,29,30]. Also, in the outpatient setting about 83% of the patients have at least one medication discrepancy [20]. However, outpatient MR, such as for the outpatient rheumatology clinic, is not implemented at all Dutch hospitals.…”

Section: Introductionmentioning

confidence: 99%

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The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting

Nat

Huiskes

Maas

et al. 2022

BMC Health Serv Res

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Background Unintentional changes to patients’ medicine regimens and drug non-adherence are discovered by medication reconciliation. High numbers of outpatient visits and medication reconciliation being time-consuming, make it challenging to perform medication reconciliation for all outpatients. Therefore, we aimed to get insight into the proportion of outpatient visits in which information obtained with medication reconciliation led to additional drug-related actions. Methods In October and November 2018, we performed a cross-sectional observational study at the rheumatology outpatient clinic. Based on a standardized data collection form, outpatient visits were observed by a pharmacy technician trained to observe and report all drug-related actions made by the rheumatologist. Afterwards, the nine observed rheumatologists and an expert panel, consisting of two rheumatologists and two pharmacists, were individually asked which drug information reported on the drug list composed by medication reconciliation was required to perform the drug-related actions. The four members of the expert panel discussed until consensus was reached about their assessment of the required information. Subsequently, a researcher determined if the required information was available in digital sources: electronic medical record (electronic prescribing system plus physician’s medical notes) or Dutch Nationwide Medication Record System. Results Of the 114 selected patients, 83 (73%) patients were included. If both digital drug sources were available, patient’s input during medication reconciliation resulted in additional information to perform drug-related actions according to the rheumatologist in 0% of the visits and according to the expert panel in 14%. If there was only access to the electronic medical record, the proportions were 8 and 29%, respectively. Patient’s input was especially required for starting a new drug and discussing drug-related problems. Conclusions If rheumatologists only had access to the electronic medical record, in 1 out of 3 visits the patient provided additional information during medication reconciliation which was required to perform a drug-related action. When rheumatologists had access to two digital sources, patient’s additional input during medication reconciliation was at most 14%. As the added value of patient’s input was highest when rheumatologists prescribe a new drug and/or discuss a drug-related problem, it may be considered that rheumatologists only perform medication reconciliation during the visit when performing one of these actions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting

Nat

Huiskes

Maas

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Establishing and maintaining an accurate list of medications is difficult, especially when these lists are a result of varied processes and different sources (e.g., community clinics, hospital release forms, patient and family, etc. ; Magalhães, Santos, Rosa, & Noblat Lde, 2014; van der Gaag, Janssen, Wessemius, Siegert, & Karapinar-Çarkit, 2017). Medication lists are prone to gaps (Cook, Render, & Woods, 2000).…”

Section: Introductionmentioning

confidence: 99%

Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task

Bitan¹,

Parmet

Greenfield

et al. 2019

Hum Factors

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Objective:To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information.Background:Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients’ medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies.Method:130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information.Results:Four distinct cognitive strategies were identified (“Conditions first”: n = 76 clinicians, “Medications first”: n = 7, “Crossover”: n = 17, and “Alternating”: n = 10). The strategy clinicians applied was affected by their experience (p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions.Conclusion:Clinicians apply various cognitive strategies while reconciling medications and medical conditions.Application:Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.

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The clinical and educational outcomes of an inter-professional student-led medication review team, a pilot study

Reumerman

Richir

Nieuwenhuis

et al. 2020

Eur J Clin Pharmacol

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Aims The involvement of an inter-professional healthcare student team in the review of medications used by geriatric patients could not only provide patients with optimized therapy but also provide students with a valuable inter-professional learning experience. We describe and evaluate the clinical and learning outcomes of an inter-professional student-run mediation review program (ISP). Subject and method A variable team consisting of students in medicine, pharmacy, master advanced nursing practice, and master physician assistant reviewed the medication lists of patients attending a specialized geriatric outpatient clinic. Results During 32 outpatient visits, 188 medications were reviewed. The students identified 14 medication-related problems, of which 4 were not recognized by healthcare professionals. The ISP team advised 95 medication changes, of which 68 (71.6%) were directly implemented. Students evaluated this pilot program positively and considered it educational (median score 4 out of 5) and thought it would contribute to their future inter-professional relationships. Conclusion An inter-professional team of healthcare students is an innovative healthcare improvement for (academic) hospitals to increase medication safety. Most formulated advices were directly incorporated in daily practice and could prevent future medication-related harm. The ISP also offers students a first opportunity to work in an inter-professional manner and get insight into the perspectives and qualities of their future colleagues.

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An evaluation of medication reconciliation at an outpatient Internal Medicines clinic

Cited by 7 publications

References 9 publications

The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting

The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting

Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task

The clinical and educational outcomes of an inter-professional student-led medication review team, a pilot study

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