Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge

Murphy, Eileen; Oxencis, Carolyn; Klauck, James A.; Meyer, Douglas A.; Zimmerman, Jill

doi:10.2146/ajhp080552

Cited by 108 publications

(86 citation statements)

References 7 publications

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“…Medical reconciliation requires collaboration between healthcare providers, nurses and pharmacists. In various studies, pharmacist involvement in medication reconciliation showed decreased medication errors and improved patient outcome [12,13]. Another study revealed nurse-pharmacy communication can significantly reduce medication errors [14].…”

Section: Discussionmentioning

confidence: 99%

Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions

Tahir¹,

Vinod²,

Daruwalla³

et al. 2017

AJPHR

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Background: Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. Unfortunately, medication errors are common in our health system accounting for significant proportion of patient harm. The main objective of our study was to explore the effect of self-designed intervention in improving the accuracy of patient current medication list in the outpatient settings. Methods: The study designed entailed collection of data from October 2013 to March 2014. The data collected in October (The pre-intervention) was compared to the post-intervention data in March 2014. Following interventions were performed: Education of residents, nurses and patients, frequent reminders to the residents to perform medication reconciliation, sending notifications to the residents who failed to perform medication reconciliation, reminding the patients get all refills at the time of appointment and reminding the patients to bring pill bottles at each appointment. The pre-intervention data was compared with the post-intervention data for different types of medication errors. Normality of the variables was pre assessed. Non-parametric analysis using Fisher's exact test was performed for comparison of categorical variables. Conclusion: In conclusion, our intervention improved the accuracy of patient current medication list in the electronic records as accurate as possible. For clinics and hospitals, medication reconciliation can enhance delivery of high value cost conscious care to the patients by reducing medication errors.

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Section: Discussionmentioning

confidence: 99%

Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions

Tahir¹,

Vinod²,

Daruwalla³

et al. 2017

AJPHR

View full text Add to dashboard Cite

show abstract

“…14, 15 The need to maintain and communicate accurate patient medication information via medication reconciliation is included in The Joint Commission National Patient Safety Goals 2014. 16 This helps ensure that future medications are prescribed safely, such as new orders for the FTS.…”

Section: Figure 3 Percentage Of Inpatient Fentanyl Transdermal Systementioning

confidence: 99%

Inpatient Prescribing and Monitoring of Fentanyl Transdermal Systems: Adherence to Safety Regulations

2014

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T he fentanyl transdermal system (FTS) is designed to deliver a continuous dose of fentanyl, a potent opioid analgesic. Adverse events related to toxicity include sedation and respiratory depression, particularly in the opioid-naïve patient and when the FTS is abused or misused. To minimize the risk of severe and potentially fatal adverse drug events (ADEs), national warnings and guidelines outlining the safe use of the FTS have been released, including a boxed warning restricting its use to moderate to severe chronic pain conditions in the opioidtolerant patient.1 The US Food and Drug Administration (FDA) also released statements in 2005 and 2007 outlining appropriate prescribing, dose selection, and safe use of the FTS.2 In 2012, the FDA approved the extended-release (ER) and long-acting (LA) opioid analgesics risk evaluation mitigation strategy (REMS), and The Joint Commission published a sentinel event alert related to the safe use of opioid analgesics, including the FTS, in the hospital setting. ABSTRACTBackground: National safety guidelines were developed to minimize the occurrence of serious adverse drug events (ADEs) associated with the use of the fentanyl transdermal system (FTS), however, reports of use in opioid-naïve patients for treatment of acute pain and associated ADEs continue to occur. Objective: To evaluate the prescribing patterns of the FTS for adherence to recent US regulatory recommendations and identify the impact of health information technology (HIT) on adherence rates. Methods: A retrospective pre-and postintervention analysis was performed in hospitalized adult patients receiving FTS. Electronic medication order instructions and text questions were incorporated into FTS electronic medication orders. The primary outcome measure was adherence of FTS medication orders to regulatory guidelines defi ned as (a) a new order in an opioid-tolerant patient for use in moderate to severe chronic pain or (b) continuation of the documented home dose in use for at least 7 days. Safety measures included respiratory rate and documented ADEs. Results: Adherence rates were signifi cantly increased in the postintervention cohort as compared to the preintervention cohort (48.7% vs 85.0%; P < .0001). Incidence of ADEs was signifi cantly lower post intervention (34.7% vs 23.3%; P = .043), including a lower incidence of respiratory depression (16.7% vs 8.3%; P = .043). Documentation was increased in the postintervention cohort (76% vs 100%). However, supporting documentation confi rmed responses in only 59.2% of records reviewed. Conclusions: Incorporation of HIT via electronic order text questions increased overall adherence rates to regulatory recommendations, increased documentation, and decreased the rate of associated ADEs.

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“…[9,10,11,12], az eltérő ellátórendszerekbe [9,10,11,12,13] és különböző profi lú osztályok gyakorlatába átültethető módszer [9,10,11,12]. A gyakorlat megvalósítását a betegbiztonság javítását célzó kampányokban aktív szerepet vállaló szervezetek is támogatják.…”

Section: Táblázatunclassified

Feasibility of the implementation of medication reconciliation in Hungary

et al. 2014

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Bevezetés: A gyógyszerelé s biztonságát javító stratégiák közül a gyógyszeres terápia egyeztetése bizonyítottan eredményes, az eltérő ellátórendszerekbe és különböző profi lú osztályok gyakorlatába átültethető módszer. Célkitűzés: A gyógyszeres terápia egyeztetési folyamatának alaposabb megismerése, a gyakorlathoz kapcsolódó korlátok és hajtó-erők feltérképezése. Módszer: A szerzők irodalomkutatást végeztek. 19 adatbázisban kerestek 7 keresőmotor segítsé-gével. Két független szakértő értékelése után a releváns közleményeket előre meghatározott szempontrendszer alapján dolgozták fel. Eredmények: 230 absztraktot értékeltek. A gyakorlat bevezetésével kapcsolatban talált korlátokat és támogató erőket rendszerezték. Gyakran említett akadályként találták a kommunikációs kérdéseket, a vezetés elhivatottságának hiányát, az előre nem látható forrásigényt és a kompetenciák szabályozatlanságát. A bevezetést támogató ajánlások főként a folyamatok újratervezését, a költséghatékonysági adatok bemutatását, kapcsolódó oktatások szervezését javasolják. Következtetések: A gyógyszerelési folyamat biztonságának javítása érdekében a szerzők hazai kór-házakban is javasolják a gyakorlat bevezetési lehetőségeinek vizsgálatát az azonosított korlátok és sikertényezők alapján, a hazai intézményekben jelenleg is zajló terepgyakorlatokra alapozva. Orv. Hetil., 2014, 155(35), 1395-1405. Kulcsszavak: gyógyszerelési hibák, nemkívánatos események, gyógyszeres terápia egyeztetése, betegátadás Feasibility of the implementation of medication reconciliation in HungaryIntroduction: For medication safety improvement medication reconciliation was proven to be an effective method transferable between differe nt healthcare providers and ward profi les. Aim: Gaining a better underst anding of the process of reconciling medicines. Mapping the driving and restraining forces of introducing medication reconciliation. Method: A search of the literature was conducted. 19 databases were searched using 7 different search engines. The relevance of the papers was rated by two independent experts. Data were extracted based on a pre viously compiled extraction tool. Results: 230 articles were evaluated. Limits and driving forces of implementing medication reconciliation were set out. Often mentioned implementation obstacles were: communication issues, disengagement of the l eaders, u npredictable resources and competence problems. Recommendations mainly consisted of process redesign techniques, presentation of cost-effectiveness data and arranging special training for staff. Conclusions: For improvement of medication safety in Hungarian hospitals implementing medication reconciliation should be considered. The conclusion of ongoing on-site trials as well as limits and success factor s identifi ed in this paper should taken into account.

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Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge

Abstract: A pharmacy-driven multidisciplinary admission history and medication reconciliation process has reduced medication errors in an academic medical center.

Cited by 108 publications

References 7 publications

Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions

Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions

Inpatient Prescribing and Monitoring of Fentanyl Transdermal Systems: Adherence to Safety Regulations

Feasibility of the implementation of medication reconciliation in Hungary

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