Drug-Related Problems on Hospital Admission: Relationship to Medication Information Transfer

Ong, Stephanie W; Fernandes, Olavo; Cesta, Annemarie; Bajcar, Jana

doi:10.1345/aph.1g482

Cited by 49 publications

(39 citation statements)

References 9 publications

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“…Unlike other mobile applications, we believe that this is the only mobile application for outpatient use that supports patient-driven medication reconciliation with a feedback loop to correct errors (10,21,22). Communication of medication-related information is particularly crucial for this patient population, because patients frequently experience medication errors as a result of fragmented communication between multiple prescribers (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ong

Jassal

Miller

et al. 2016

CJASN

109

150

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Background and objectives Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.Design, setting, participants, & measurements We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. ResultsIn total, 47 patients (26 men; mean age =59 years old; 33% were $65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (.80% performed $80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, 23.4 mmHg; 95% confidence interval, 25.0 to 21.8 and diastolic BP, 22.1 mmHg; 95% confidence interval, 22.9 to 21.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.Conclusions Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.

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Section: Discussionmentioning

confidence: 99%

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ong

Jassal

Miller

et al. 2016

CJASN

109

150

View full text Add to dashboard Cite

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“…33 Our choice of medication groups for this study represents different theorized approaches to medication-prescribing, medication-taking, and medication-dispensing practice. 34,35 They include medications for the treatment of symptomatic diseases and for preventing complications of acute illness. They represent different medication delivery systems (e.g.…”

Section: Discussionmentioning

confidence: 99%

Unintentional Continuation of Medications Intended for Acute Illness After Hospital Discharge: A Population-Based Cohort Study

Scales

Fischer

et al. 2015

J GEN INTERN MED

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BACKGROUND:Patients are vulnerable to medicationrelated errors during transitions in care. Patients discharged from acute care hospitals may be at an elevated risk for the unintentional continuation of medications prescribed to prevent or treat complications that are associated with acute illness but are no longer indicated. We sought to evaluate rates of (primary objective) and risk factors for (secondary objective) potentially unintentional medication continuation following hospitalization. METHODS: A population-based cohort study of more than one million patients 66 years of age or older who were hospitalized in Ontario, Canada, between 2003 and 2011 and followed for 1 year (2004 to 2012). We created distinct cohorts by identifying seniors not previously receiving four classes of medications typically used to treat or prevent complications of acute illness: (1) antipsychotic medications, (2) gastric acid suppressants (histamine-2 blockers and proton pump inhibitors), (3) benzodiazepines, and (4) inhaled bronchodilators and steroids. After excluding documented indications, we followed patients to ascertain whether these medications were continued after hospital discharge, and assessed risk factors for their continuation using generalized estimating equations. The primary outcome was the new dispensation of any of the selected medications within 7 days of hospital discharge. RESULTS: Prescription without documented indication occurred across all medication classes, from 12,209 patients (1.4 %) for antipsychotic medications to 34,140 patients (6.1 %) for gastric acid suppressants. Risk factors for unintentional continuation varied across medication groups, but rates were consistently higher for older patients, those with multiple comorbidities, and emergency hospitalizations. The largest absolute risk factor across all medications was a hospitalization>7 days [OR 2.03 (95 % CI 1.94-2.11) for respiratory inhalers, 6.35 (95 % CI 5.91-6.82) for antipsychotic medications]. These medications were often continued at 1 year of follow-up, and accounted for a total additional medication cost of over CAD$18 million for the study population. CONCLUSION: Discharged patients are at risk of being prescribed and dispensed medications that are typically intended to prevent or treat complications of acute illness, despite having no documented indication for chronic use.

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“…In one study, 65% of medication-related problems experienced by patients with end-stage renal disease during hospital admissions occurred as a result of gaps in the transfer of medication information between health care settings and the patients. 13 As a consequence of these factors, medication-related problems continue to be abundant among patients undergoing hemodialysis.…”

Section: Résumémentioning

confidence: 99%

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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Background: Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients. Objectives: To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service. Methods: This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepancies identified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation. Results: Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients. Conclusions: This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies.

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Drug-Related Problems on Hospital Admission: Relationship to Medication Information Transfer

Cited by 49 publications

References 9 publications

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Unintentional Continuation of Medications Intended for Acute Illness After Hospital Discharge: A Population-Based Cohort Study

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

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