Medication Reconciliation by a Pharmacist in the Emergency Department: A Pilot Project

Kent, Andrea J; Harrington, Louise; Skinner, Jill

doi:10.4212/cjhp.v62i3.794

Cited by 16 publications

(30 citation statements)

References 17 publications

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“…Carrying out a medication reconciliation process after an interview with the patient has been shown to be a key tool for the resolution of potential drug-related problems, accounting for more than half of the resolutions. The prevalence of potential drug-related problems related to medication reconciliation found in our study was similar to the findings reported by Kent et al 23 and de Andrés-Lázaro et al 24…”

Section: Discussionsupporting

confidence: 92%

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

et al. 2017

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BackgroundThe resolution of potential drug-related problems is a priority of pharmaceutical care programmes.ObjectivesTo assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD).MethodsControlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality.Results118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647).ConclusionA pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables.Trial registration number NCT02368548.

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Section: Discussionsupporting

confidence: 92%

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

et al. 2017

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“…The mean number of home medications in the study population was found to be 6 ± 3 medications per medical record with a maximum of 13 and minimum of one. This finding is in accordance with the observations of studies done by Andrea J Kent, which reported of an average of 6 home medications per medical record 25,26 which reported of an average of 7 ± 4 drugs in their home treatment with a maximum of 20 and a minimum of zero.…”

Section: 22supporting

confidence: 82%

Medication Reconciliation and Medication Error Prevention in an Emergency Department of a Tertiary Care Hospital

Poornima¹,

Reshma²,

Tv³

et al. 2015

JYP

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Objective: The study was conducted to assess the effectiveness of the medication reconciliation and medication error prevention in an emergency department of a tertiary care hospital. Materials and Methods: Patients of either sex, aged above 18 years admitted for more than 24 hours irrespective of their medical diagnosis and for whom medication reconciliation was done were included. Patients' home medication charts were compared with their current admission medication charts to check the number of home medications that were being continued to be administered during their hospital stay. Each home medication that was not ordered or commented on was deemed to represent a discrepancy. The discrepancies were classified according to the criteria of the Safer Healthcare Now! Campaign and reasons for not continuing the drug were also documented. The interventions were brought to the notice of the concerned physician. Results: Of 80 patients (43 males and 37 females; mean age 61 ± 15 years), 74 patients had medication discrepancies categorised as documented intentional discrepancies, undocumented intentional discrepancies and unintentional discrepancies and 6 patients had no discrepancies. There was a statistically significant association between number of home medications and discrepancies, both undocumented intentional discrepancies (P=0.005) and unintentional discrepancies (P=0.049). Conclusion: This study recommends the need for additional resources and educational initiatives for the health care professionals to improve medication reconciliation. For effective medication reconciliation, patients or their care takers must help the physicians and other health care professionals involved in reconciliation by bringing all their home medications at the time of hospital admissions.

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“…Medication discrepancies are frequently documented in patients' medication lists upon admission to the ED. A study found that in 98 patients presenting to the ED, a total of 124 medication discrepancies were identified, with 40% requiring an intervention by the pharmacist . Due to staffing constraints and the fast‐paced environment of the ED, medication reconciliation may not be completed unless the patient is admitted to the hospital.…”

Section: Introductionmentioning

confidence: 99%

“…A study found that in 98 patients presenting to the ED, a total of 124 medication discrepancies were identified, with 40% requiring an intervention by the pharmacist. 10 Due to staffing constraints and the fast-paced environment of the ED, medication reconciliation may not be completed unless the patient is admitted to the hospital. Failing to update patients' medication lists and resolve possible discrepancies during these care transitions can increase the risk of medication-related adverse events and unnecessary prescribing.…”

mentioning

confidence: 99%

Implementation and evaluation of a pharmacy‐driven transitions of care program for patients discharged from the emergency department

Lacy

Bryant

Herring

et al. 2018

J Am Coll Clin Pharm

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Purpose To evaluate a pharmacy‐driven post‐emergency department (ED) transitions of care program. Methods Patients admitted to the ED who receive primary care at a network clinic were eligible for inclusion. Pharmacy team members contacted patients within 7 days of ED discharge to perform medication reconciliation and assess for appropriate follow‐up. Following the calling period, rates of repeat ED visits, urgent care visits, hospitalizations, and clinic visits within 30 days of ED discharge were evaluated. Results Seventy percent of eligible patients were successfully contacted via phone. At least one new medication was prescribed in the ED to 61% of contacted patients, 22% of which were not picked up at the time of the call. Medication reconciliation was successfully completed during 87% of the phone calls, with 64% resulting in at least one identified medication discrepancy. A total of 230 pharmacist interventions were completed. Contacted patients had an adjusted 44% (95% confidence interval [CI]: 9–65) lower risk of subsequent ED visits compared with patients unable to be reached. Four percent of patients successfully contacted were admitted to the hospital within 30 days of ED discharge compared with 8% of patients unable to be reached (adjusted relative risk [RR]: 0.39; 95% CI: 0.18–0.84). Conclusion Patients who received post‐ED transitions of care calls were less likely to be seen again in the ED or be admitted to the hospital within 30 days. Follow‐up phone calls provided by pharmacy team members may be an effective tool to improve transitions of care following ED visits.

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Medication Reconciliation by a Pharmacist in the Emergency Department: A Pilot Project

Cited by 16 publications

References 17 publications

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

Medication Reconciliation and Medication Error Prevention in an Emergency Department of a Tertiary Care Hospital

Implementation and evaluation of a pharmacy‐driven transitions of care program for patients discharged from the emergency department

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