Clinical and economic impact of medication reconciliation by designated ward pharmacists in a hospitalist-managed acute medical unit

Park, Bogeum; Baek, Anna; Kim, Yoonhee; Suh, Young Ger; Lee, Jung Hwa; Lee, Eun-Sook; Lee, Ju‐Yeun; Lee, Euni; Lee, Jong-Chan; Park, Hee Sun; Kim, Eun Sun; Lim, Yejee; Kim, Nak Hyun; Ohn, Jung Hun; Kim, Hye Won

doi:10.1016/j.sapharm.2021.06.005

Cited by 15 publications

(12 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies indicate that medication reconciliation performed by a clinical pharmacist can significantly reduce medication discrepancies. 9 10 This is because their training and expertise make them better qualified to perform the reconciliation process. 11 Pharmacist-led medication reconciliation is considered the gold standard for ensuring accuracy in the medication history of patients.…”

Section: Discussionmentioning

confidence: 99%

Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review

Fatima,

Arshad,

Zafar

et al. 2024

BMJ Open Qual

View full text Add to dashboard Cite

ObjectiveThere were three main objectives of the study: to determine the overall compliance of medication reconciliation over 4 years in a tertiary care hospital, to compare the medication reconciliation compliance between paper entry (initial assessment forms) and computerised physician order entry (CPOE), and to identify the discrepancies between the medication history taken by the physician at the time of admission and those collected by the pharmacist within 24 hours of admission.MethodsThis study was conducted at a tertiary care hospital in a lower middle-income country. Data were gathered from two different sources. The first source involved retrospective data obtained from the Quality and Patient Safety Department (QPSD) of the hospital, consisting of records from 8776 patients between 2018 and 2021. The second data source was also retrospective from a quality project initiated by pharmacists at the hospital. Pharmacists collected data from 1105 patients between 2020 and 2021, specifically focusing on medication history and identifying any discrepancies compared with the history documented by physicians. The collected data were then analysed using SPSS V.26.ResultsThe QPSD noted an improvement in physician-led medication reconciliation, with a rise from 32.7% in 2018 to 69.4% in 2021 in CPOE. However, pharmacist-led medication reconciliation identified a 25.4% (n=281/1105) overall discrepancy in the medication history of patients admitted from 2020 to 2021, mainly due to incomplete medication records in the initial assessment forms and CPOE. Physicians missed critical drugs in 4.9% of records; pharmacists identified and updated them.ConclusionIn a lower middle-income nation where hiring pharmacists to conduct medication reconciliation would be an additional cost burden for hospitals, encouraging physicians to record medication history more precisely would be a more workable method. However, in situations where cost is not an issue, it is recommended to adopt evidence-based practices, such as integrating clinical pharmacists to lead medication reconciliation, which is the gold standard worldwide.

show abstract

Section: Discussionmentioning

confidence: 99%

Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review

Fatima,

Arshad,

Zafar

et al. 2024

BMJ Open Qual

View full text Add to dashboard Cite

show abstract

“…There were statistically significant differences between the two years, with an increase significantly that is expected because those items are essential for patients, which significantly impacts drugrelated mortality and morbidity in practice. [25][26][27][28] Emphasis on those items is highly recommended. The results showed that logistic regression was a non-significant relation of reasoning and association factors such as diagnosis, gender, and gender.…”

Section: Discussionmentioning

confidence: 99%

Performances and Activities of Virtual Pediatrics Medication Counselling Clinic in Riyadh City, Saudi Arabia

Alassadi,

Alzahrani,

Almutairi

et al. 2024

Int. J Pharmacol. Clin. Sci

View full text Add to dashboard Cite

Objectives: To explore the activities and performances of a virtual pediatrics medication counseling clinic in Riyadh City, Saudi Arabia. Methods: it was a retrospective analysis of activities and performances of a virtual pediatric medicine counseling clinic operated by the pharmacist at a public pediatric and maternity hospital. The pharmacist documented all the activities, including demographic information of patients visiting the clinic, the reason for the counseling, medication requirements to be counseled, and patient counseling items based on international guidelines. The data analysis was done through SPSS version 20 and Microsoft Excel version 2021; descriptive analysis and logistic regression of factors associated with the reason for counseling. Results: The total number of patients who visited the virtual pediatric medicine clinic through 20 months was 1955, with (97.75) per month. The majority of patients were female in the year 2021, 204 (63.55%) vs. female 900 (61.19%) in 2021, compared to male 117 (36.46%) vs. males in year 2022 628 (38.81%) with non-significant differences (p=0.149). The majority of patients were diagnosed as Diabetic Miletus in both years, 145 (45.17%) vs 884 (54.47%), with statistical significance differences between two 2021 and 2022 (p=0.000). The majority of patients counseled due to high alert medication was 230 (71.65%) in 2021 vs. 1198 (73.32%) in 2022, with non-statistically significant difference between them (p=0.539), and chronic diseases such as diabetes and asthma 224 (69.78%) vs. 901 (55.14%) in the year 2021 and 2022 respectively with statistical significance differences between both years (p=0.000). Most medication counseled was Insulin Aspart in both years, 121 (21.72%) vs. 909 (31.92%), insulin Glargine 104 (18.67%) in 2021 vs. 555 (19.49%) in 2022, and Enoxaparin in both years 40 (7.18%) vs. 205 (7.20%). Conclusion: The virtual pediatric medicine counseling clinic served many patients, emphasizing pediatric chronic diseases such as Diabetes and Asthma. Future studies are highly recommended to measure the clinical and economic outcomes and patient satisfaction.

show abstract

“…While formalized AMS education or certification is not standard during training for IM pharmacists, they regularly manage antimicrobials for urinary tract infections, lower respiratory tract infections, skin and skin structure infections, and bloodstream infections. While the overall utility of IM pharmacists as a part of the health care team is described within the literature, less is documented about their impact on AMS initiatives and any barriers they encounter to their interventions 16,21–24 . This study was conducted to characterize AMS interventions made by IM pharmacists and their trainees.…”

Section: Introductionmentioning

confidence: 99%

“…While the overall utility of IM pharmacists as a part of the health care team is described within the literature, less is documented about their impact on AMS initiatives and any barriers they encounter to their interventions. 16,[21][22][23][24] This study was conducted to characterize AMS interventions made by IM pharmacists and their trainees.…”

Section: Introductionmentioning

confidence: 99%

Impact of internal medicine pharmacists on antimicrobial stewardship

Rizzo,

Suchindran,

Albrecht

et al. 2024

J Am Coll Clin Pharm

View full text Add to dashboard Cite

IntroductionIncreased demands on infectious diseases (ID) pharmacists and providers may result in targeted antimicrobial stewardship (AMS) interventions. Internal medicine (IM) pharmacists frequently intervene on antimicrobials for their patients during general clinical care, although little is known regarding their overall impact on AMS.ObjectiveCharacterize AMS interventions made by IM pharmacists to identify areas of AMS that can be expanded to patients not covered by ID teams.MethodsThis was a prospective, dual‐center, cross‐sectional study where IM pharmacists, and their trainees were recruited to document routinely made AMS interventions that happened during daily patient care activities. These interventions were classified based on infection source, stewardship intervention type, whether recommendations were accepted or rejected by providers, and any barriers incurred during the implementation of interventions.ResultsFour IM pharmacists documented 386 interventions from February 2021 through May 2021. Physicians accepted pharmacist interventions 95.6% of the time. The most common interventions were for respiratory (n = 87, 22.5%), genitourinary (n = 80, 20.7%), and skin and skin structure infections (n = 65, 16.8%). The antimicrobials that IM pharmacists most frequently intervened on were vancomycin (n = 89, 23.1%) and ceftriaxone (n = 68, 17.6%). The most common interventions that were made were dose adjustment (n = 105, 27.2%), shortened duration of therapy (n = 86, 22.3%), and intravenous (IV) to oral (PO) conversions (n = 38, 9.8%). Of the 17 interventions not accepted, the most common barrier to implementation was physician concerns (n = 11, 52.4%), which were primarily associated with IV to PO recommendations (n = 7, 63.6%).ConclusionIM pharmacists participate in AMS for their patients and intervene frequently to adjust dosing for antimicrobials, shorten duration of therapy, and facilitate IV to PO conversions. IM pharmacists could serve as AMS extenders where additional AMS coverage is needed.

show abstract

Clinical and economic impact of medication reconciliation by designated ward pharmacists in a hospitalist-managed acute medical unit

Cited by 15 publications

References 36 publications

Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review

Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review

Performances and Activities of Virtual Pediatrics Medication Counselling Clinic in Riyadh City, Saudi Arabia

Impact of internal medicine pharmacists on antimicrobial stewardship

Contact Info

Product

Resources

About