Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey

Wanbon, Richard; Lyder, Catherine; Villeneuve, Éric; Shalansky, Stephen; Manuel, Leslie; Harding, Melanie

doi:10.4212/cjhp.v68i3.1453

Cited by 8 publications

(11 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, Canadian hospitals are struggling to meet ROPs for admission MedRec with 57.4% overall compliance, are even further behind on discharge MedRec, and are not yet documenting MedRec on transfers 13 While studies have documented medication discrepancies based on MedRec, noted suboptimal communication strategies around medication management, or offered commonly held views as to why MedRec is not reaching its goals,4–9 no studies were identified in our literature review that carefully detailed current processes to understand barriers preventing success, or to document resource usage.…”

Section: Introductionmentioning

confidence: 99%

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

et al. 2016

View full text Add to dashboard Cite

BackgroundMedication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness.MethodsProcess engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions.ResultsAcross all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses.DiscussionMedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required.

show abstract

Section: Introductionmentioning

confidence: 99%

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In a recent survey of Canadian hospitals, 39% of respondents reported that pharmacy services were provided in the emergency department and that the emergency pharmacy teams prioritized patients who were to be admitted for obtaining a BPMH. 4,5 Only 23% of respondents reported having adequate staff to comply with the new Required Organizational Practice. 5 This finding implies that additional staff or improvements in current processes (or both) would be required to meet Accreditation Canada's standards, which also require that medication reconciliation be performed for admitted patients.…”

Section: 3mentioning

confidence: 99%

“…4,5 Only 23% of respondents reported having adequate staff to comply with the new Required Organizational Practice. 5 This finding implies that additional staff or improvements in current processes (or both) would be required to meet Accreditation Canada's standards, which also require that medication reconciliation be performed for admitted patients. 1 Up to 27% of all hospital prescribing errors can be attributed to medication histories being incomplete at the time of admission, with 27% to 83% of patients having at least 1 medication history error at the time of admission with the potential to adversely affect care over the long term.…”

Section: 3mentioning

confidence: 99%

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Macdonald

Manuel

Brennan

et al. 2017

CJHP

Self Cite

View full text Add to dashboard Cite

Background: Accreditation standards have outlined the need for staff in emergency departments to initiate the medication reconciliation process for patients who are at risk of adverse drug events. The authors hypothesized that a guided form could be used by non-admitted patients in the emergency department to assist with completion of a best possible medication history (BPMH). Objective: To determine the percentage of patients in the non-acute care area of the emergency department who could complete a guided BPMH form with no clinically significant discrepancies (defined as no major discrepancies and no more than 1 moderate discrepancy). Methods: This prospective exploratory study was conducted over 4 weeks in February and March 2016. Data were collected using the self-administered BPMH form, patient interviews, and a data collection form. After completion of the guided BPMH form, patients were randomly selected for interview by a pharmacy team member to ensure their self-completed BPMH forms were complete and accurate. Eligible patients were those with non-acute needs who had undergone triage to the waiting room. Patients who were already admitted and those with immediate triage to the acute care or trauma area of the emergency department were excluded. Results: Of the 160 patients who were interviewed, 146 (91.3%) completed the form with no more than 1 moderate discrepancy (but some number of minor discrepancies). There were no discrepancies in 31 (19.4%) of the BPMH forms, and 101 (63.1%) of the forms had only minor discrepancies. Conclusions: Most of the patients interviewed by the pharmacy team were able to complete the BPMH form with no clinically significant discrepancies. The self-administered BPMH form would be a useful tool to initiate medication reconciliation in the emergency department for this patient population, but used on its own, it would not be a reliable source of BPMH information, given the relatively low number of patients who completed the form with no discrepancies.

show abstract

“…Most Canadian hospitals have insufficient clinical pharmacists and rely on physicians, nurses and clinical trainees to complete medication reconciliation, even though these people often lack the time to take a thorough medication history. [15][16][17][18] To facilitate medication history-taking and eliminate transcribing errors, hospitals in jurisdictions with access to elecIncidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review tronic medication dispensing records have developed medication reconciliation forms that are prepopulated with outpatient medication dispensing data. Yet, such databases do not capture medications dispensed outside of community pharmacies (e.g., in long-term care facilities) and may list inaccurate dosages of medications titrated by patients or care providers (e.g., warfarin).…”

mentioning

confidence: 99%

Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review

et al. 2017

View full text Add to dashboard Cite

Background:To reduce medication discrepancies (unintended differences between a patient's outpatient and inpatient medication regimens), Canadian institutions have implemented medication reconciliation forms that are prepopulated with outpatient medication dispensing data. These may prompt prescribers to reorder discontinued medications or continue newly contraindicated medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of such forms.Methods: This retrospective chart review included patients previously enrolled in an observational study in which a research pharmacist prospectively collected best-possible medication histories in the emergency department. Research assistants uninvolved with the parent study compared medication orders written in the first 48 hours after admission with the research pharmacist's best-possible medication history to identify medication discrepancies and errors of commission, defined as inappropriate medication continuations and reordering of previously stopped medications. An independent panel adjudicated the clinical significance of the errors. Results:Of 151 patients, 71 (47.0% [95% confidence interval (CI) 39.2-54.9]) were exposed to 112 medication errors on admission. Of the 112 errors, 24 (21.4% [95% CI 14.9-29.9]) were clinically significant. Errors of commission accounted for 24.1% ]) of all errors; 10 (37.0% .2]) of the errors of commission were clinically significant.Interpretation: Medication errors were common after the implementation of electronically prepopulated medication reconciliation forms. Prospective research is required to examine the impact of prepopulated medication reconciliation forms and ensure they do not facilitate errors of commission. AbstractResearch Research CMAJ OPEN E346CMAJ OPEN, 5(2) tronic medication dispensing records have developed medication reconciliation forms that are prepopulated with outpatient medication dispensing data. Yet, such databases do not capture medications dispensed outside of community pharmacies (e.g., in long-term care facilities) and may list inaccurate dosages of medications titrated by patients or care providers (e.g., warfarin). 19,20 Prepopulated medication reconciliation forms may facilitate errors of commission by prompting health care providers to restart a discontinued medication that remains in the electronic medication dispensing history or to continue a medication in the setting of a new contraindication. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after implementation of an electronically prepopulated medication reconciliation form. A secondary objective was to evaluate factors associated with both types of error. Methods DesignWe conducted a structured 2-staged chart review at Vancouver General Hospital, a 955-bed academic tertiary care centre. This was an a priori planned substudy of a large prospective observational cohort study that aimed to validate previously derived cl...

show abstract

Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey

Cited by 8 publications

References 47 publications

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review

Contact Info

Product

Resources

About