Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER)

Damlien, L.; Davidsen, Nina; Nilsen, Merethe; Godø, Aasmund; Moger, Tron Anders; Viktil, Kirsten K.

doi:10.1097/mej.0000000000000355

Cited by 24 publications

(12 citation statements)

References 167 publications

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“…Despite the presence of some study reports showing the association [ 2 , 21 , 23 ], binary logistic regression analysis did not show any potential relationship of age or sex with medication discrepancy in this study. Indeed, demographics of patients revealed comparable characteristics for sex and age (Table 1 ).…”

Section: Main Textcontrasting

confidence: 99%

“…Various characteristics are highlighted to predict harmful discrepancies [ 21 ]. The number of medications received by a patient [ 18 , 22 ], older age, sex (woman), more frequent admission in the past 12 months and reason for patient admission were key predictors indicated in relation with potential harmful discrepancies [ 2 , 21 , 23 ]. In some studies, drug omission was reported as a frequent cause of unintended medication discrepancy [ 8 , 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia

et al. 2018

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ObjectiveThe aim of this study is to determine the magnitude of medication discrepancies and its associated factors at transitions in care of a Specialized University Hospital in eastern Ethiopia.ResultsThis study enrolled 411 patients having at least one prescription medication. For each of the patient enrolled, a medication reconciliation process was accomplished between medication use history before transition and medication orders at the transition. A total of 1027 medications were reconciled and 298 of them showed discrepancies. From such medication discrepancies, 96 (32.2%) of them were unintended discrepancies. Patients admitted to surgical ward (adjusted odds ratio {AOR} 0.27 [95% confidence interval 0.10–0.74]) and on malnutrition therapy (AOR 0.13 [0.03–0.52]) had reduced likelihoods of medication discrepancies. However, patients on cardiovascular drug therapy (AOR 5.69 [2.4–13.62]) and who were hospitalized for more than 5 days (AOR 5.69 [2.97–10.9] {5–10 days}) had significantly increased likelihoods of discrepancies. Accordingly, one-third of the medication discrepancies identified were unintentional and these discrepancies were more likely to occur with cardiovascular drugs, in medical or pediatric wards and patients hospitalized for prolonged time. Therefore, this pharmacist-led medication reconciliation indicates the potential of pharmacists in reducing drug-related adverse health outcomes that arise from medication discrepancy.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3668-z) contains supplementary material, which is available to authorized users.

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Section: Main Textcontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia

et al. 2018

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“…This version of the risk-scoring tool included similar variables, with point allocation assigned based on clinical experience and consensus of the pharmacy team, taking into consideration similar scoring system studies. 17,18 For each patient, this risk score is calculated and categorized as low risk (0-39) or high risk (40+) for medication discrepancies. The score threshold was also set rather arbitrarily based on the distribution of patient scores and available pharmacy resources for obtaining a medication history for high-risk patients.…”

Section: Settingmentioning

confidence: 99%

“…At the time of tool creation, only two small studies seeking to identify patients in need of medication reconciliation were identified. 17,18 Due to this lack of evidence, the variables included in the scoring tool were primarily decided upon based on clinical experience and consensus of the team with consideration of the aforementioned two studies.…”

Section: Introductionmentioning

confidence: 99%

Validation and evaluation of a prior‐to‐admission medication list discrepancy risk‐scoring tool

Fleenor,

McCluggage,

Schell

et al. 2023

J Am Coll Clin Pharm

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IntroductionMedication reconciliation is vital in preventing medication errors during transitions of care. Implementation of effective medication reconciliation, however, remains a challenge for healthcare systems due to cost and resource constraints. The objective of this study was to evaluate a risk‐scoring tool for identifying patients at high risk for medication discrepancies and, therefore, prioritize pharmacy intervention with obtaining an admission medication history.MethodsSingle‐center validation study at an academic medical center including adult patients with a medication history note written by a pharmacy staff member. The primary outcome was the number of changes made to the prior‐to‐admission (PTA) medication list by pharmacy staff. Secondary outcomes included changes in risk score after medication history was completed, the number of changes based on disease state and medication class, and the number of clinically relevant changes for a randomized subgroup of patients.ResultsThe study included 12 122 patient encounters. The median PTA risk score was 29 (low risk), and 41% of patients were aged 40–65 years. The median number of discrepancies was higher for the high‐risk group (6, interquartile range [IQR] 3–11) compared to the low‐risk group (3, IQR 1–7), p < 0.001. For the primary outcome, Pearson's correlation coefficient was 0.37, indicating a weak correlation between the PTA risk score and the number of changes to the medication list. The linear regression also indicated a weak correlation (R2 = 0.14). Parkinsonism, diabetes mellitus, chronic obstructive pulmonary disease, and cystic fibrosis were associated with a higher median count of medication discrepancies.ConclusionsThis study demonstrated that this PTA medication risk‐scoring tool could help identify patients at high risk of medication discrepancies, but the score did not correlate well with the number of medication list changes. Therefore, subgroup analyses and further studies are needed to determine the optimal medication list risk‐scoring tools.

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“…Furthermore, drug-related admissions due to non-compliance or potential prescribing omissions were not recognized. [69]. Only prescribed drugs taken regularly were considered in this study; hence, SADEs that might have been related to over-thecounter drugs and drugs used as needed were not recorded.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events?

Wang-Hansen

Wyller

Hvidsten

et al. 2019

Eur J Clin Pharmacol

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Purpose The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. Methods Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. Results We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5-9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. Conclusions We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.

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Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER)

Abstract: This innovative prioritizing model is designed to be practical in the fast-paced workflow at the ED and can identify what patients are at increased risk of having crMDs. The multidisciplinary working model was proven time efficient and could contribute towards increased patient safety.

Cited by 24 publications

References 167 publications

Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia

Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia

Validation and evaluation of a prior‐to‐admission medication list discrepancy risk‐scoring tool

Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events?

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