Differences in medication reconciliation interventions between six hospitals: a mixed method study

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.

The Effectiveness of Inpatient Rehabilitation in Parkinson’s Disease: A Systematic Review of Recent Studies

“…Suboptimal medication leads to impaired ADL and reduced QOL, and to unnecessary neuropsychiatric symptoms. Collaboration between pharmacists and physicians during all stages of the rehabilitation process therefore is required and beneficial [68,69].…”

“…The 6 moderate grade studies permit some conclusions, which might benefit the field. The only long-term controlled multidisciplinary study [47] clearly showed that a focused inpatient program including medication optimization [69], followed by an intensive outpatient program, was able to keep PwPD stable for 2 years, whereas a matched control group all stayed in the nursing home. This means that focused PD rehabilitation, including medication optimization with advanced therapies like L-dopa-and apomorphine infusions if indicated, is able to postpone definite nursing home admission with years, resulting in a huge improvement of ADL and with a significant cost reduction at the same time.…”