Pharmacy impact on medication reconciliation in the medical intensive care unit

Wills, Brittany; Darko, William; Seabury, Robert W.; Probst, Luke A.; Miller, Christopher D.; Cwikla, Gregory M.

doi:10.4103/2279-042x.179584

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…When discrepancies develop between the medications that the provider intends for the patient to be taking and those actually being used, there is increased risk for loss of efficacy or adverse events. Discrepancies can be highly relevant, with a recent study finding that in intensive care units, 17.1% of discrepancies were serious or potentially life-threatening [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Medication discrepancies in late-stage chronic kidney disease

Ibrahim

Hazzan

Mathew

et al. 2017

Clinical Kidney Journal

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BackgroundLate-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0–30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD.MethodsWe analyzed all patients enrolled in Northwell Health’s Healthy Transitions in LS-CKD program. All patients had estimated GFR 0–30 mL/min, not on dialysis. Medications were reviewed by a nurse at a home visit. Patients’ medication usage and practice were compared with nephrologists’ medication lists, and discrepancies were characterized. Patients were categorized as having either no discrepancies or one or more. Associations between patient characteristics and number of medication discrepancies were evaluated by chi-square or Fisher’s exact test for categorical variables, and two-sample t-test or Wilcoxon text for continuous variables.ResultsSeven hundred and thirteen patients with a median age of 70 (interquartile range 58–79) years were studied. There were 392 patients (55.0% of the study population) with at least one medication discrepancy. The therapeutic classes of medications with most frequently occurring medication discrepancies were cardiovascular, vitamins, bone and mineral disease agents, diuretics, analgesics and diabetes medications. In multivariable analysis, factors associated with higher risk of discrepancies were congestive heart failure [odds ratio (OR) 2.13; 95% confidence interval (CI) 1.44–3.16; P = 0.0002] and number of medications (OR 1.29; 95% CI 1.21–1.37; P < 0.0001).ConclusionsMedication discrepancies are common in LS-CKD, affect the majority of patients and include high-risk medication classes. Congestive heart failure and total number of medications are independently associated with greater risk for multiple drug discrepancies. The frequency of medication discrepancies indicates a need for great care in medication management of these patients.

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Section: Discussionmentioning

confidence: 99%

Medication discrepancies in late-stage chronic kidney disease

Ibrahim

Hazzan

Mathew

et al. 2017

Clinical Kidney Journal

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“…A small, single-center quality improvement effort demonstrated a reduction in serious or potentially life-threatening medication discrepancies when patients’ caregivers, pharmacies, and past admission records were utilized as sources of information. 19…”

Section: Introductionmentioning

confidence: 99%

“…A small, single-center quality improvement effort demonstrated a reduction in serious or potentially life-threatening medication discrepancies when patients' caregivers, pharmacies, and past admission records were utilized as sources of information. 19 The purpose of this study is to assess the feasibility of performing medication histories in a diverse critically ill patient population and to establish and characterize the frequency of medication discrepancies.…”

Section: Introductionmentioning

confidence: 99%

Medication Histories in Critically Ill Patients Completed by Pharmacy Personnel

et al. 2019

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Background: Although critically ill adults often have extended hospital lengths of stay and are at high risk of having medication-related adverse events, the value of medication histories in these patients remains underreported. Objective: To assess the feasibility of performing medication histories in critically ill adults and to establish the frequency of and characterize identified discrepancies. Methods: This prospective study included patients admitted to 4 intensive care units (ICUs) in a large academic medical center and was conducted in 2 phases. In phase 1, medication histories were conducted over a 5-week period by clinical pharmacists to assess feasibility. In phase 2, medication histories were conducted over a 3-week period by a pharmacy technician. Medication discrepancies, defined as any difference between the documented and pharmacy personnel–identified home medication list, were aggregated in both phases and adjudicated for severity. Results: In phase 1, 127 medication histories were completed (42.3% of admitted patients). Impaired cognition was the most common barrier encountered; however, 76% of patients were able to have a history completed if an attempt was made. In phase 2, a medication history was completed for 176 patients (58.9% of admitted patients). In aggregate, 1155 discrepancies were identified, with 78.2% of patients having a discrepancy. The median number of discrepancies per patient was 3 (interquartile range = 1-5); 11 life-threatening, 101 serious, and 326 significant discrepancies were identified. Conclusion and Relevance: A pharmacy personnel–based medication history program in the ICU is feasible and assists in the discovery of medication discrepancies with the potential for patient harm.

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The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

Sakhiya

James

Jhaveri

et al. 2020

Kidney International Reports

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). M edication discrepancies are common in medicine, posing an ongoing threat to safe patient care. Discrepancies can be defined as any difference between the physician's records and the medications that the patient actually takes, including related dose and frequency. In clinical practice, medication discrepancies are common, occurring in 34% to 95% of patients newly admitted to hospitals. 1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy. 4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases. These patients are often treated with a large number of drugs 5 and are cared for by multiple physicians. This is certainly true in advanced CKD, in which care can become fragmented because of the large number of collaborating care providers and suboptimal communication.The relationship between medication discrepancies and subsequent hospitalizations has been rarely studied in advanced CKD. 6 There are clear reasons to believe that such a relationship would exist. Patients with advanced CKD probably have a high rate of hospitalizations. Improper use of medications could lead to hospitalizations through adverse effects of misused drugs, medical complications, and diminution of anticipated efficacy. In the current study we have analyzed the relationship between the number medication discrepancies in advanced CKD and the risk for hospitalizations over up to a year of follow-up. RESULTSWe enrolled 713 patients with stage 4 to 5 CKD into the baseline cohort, with characteristics displayed in Table 1. The population skewed toward older age, with 62.7% being >65 years. There was a minor underrepresentation of Hispanic patients; comprising only 9% of patients. The vast majority of patients were hypertensive and approximately 50% had diabetes mellitus. During the 1-year assessment period, 23 patients died and 33 patients reached end-stage renal disease. A further 5 patients were lost to follow-up.A total of 392 patients (55.0% of the study population) had at least 1 medication discrepancy. The median number of discrepancies per patient (in patients with at least 1 discrepancy) was 2, (interquartile range, 1-4). A total of 646 patients (90.6%) had 0-5 discrepancies, 56 (7.8%) had 6-10 discrepancies, and 11 (1.5%) had more than 10 discrepancies. Types of discrepancies included patients taking a medication not on the nephrologist's list, patients not taking a medication on the nephrologist's list, different doses, and different dose frequencies. Medication...

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Pharmacy impact on medication reconciliation in the medical intensive care unit

Cited by 9 publications

References 6 publications

Medication discrepancies in late-stage chronic kidney disease

Medication discrepancies in late-stage chronic kidney disease

Medication Histories in Critically Ill Patients Completed by Pharmacy Personnel

The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

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