Safe Medication Reconciliation: An Intervention to Improve Residents' Medication Reconciliation Skills

Arundel, Cherinne; Logan, Jessica; Ayana, Ribka; Gannuscio, Jacqueline; Kerns, Jennifer C.; Swenson, Rebecca R.

doi:10.4300/jgme-d-14-00565.1

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…A hospital-based educational program found an increase in knowledge and self-e cacy for proper medication reconciliation from pre-and post-surveys (16). Improving knowledge is important and may improve the quality of medication lists gathered through medication reconciliation, but the effect on outcomes is less clear (17)(18)(19). Similar to our ndings, others have found that providing education alone is not enough to guarantee consistently accurate medication reconciliation (17)(18)(19).…”

Section: Discussionsupporting

confidence: 66%

Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care

Jones¹,

Duboski

Romagnoli

et al. 2021

Preprint

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Introduction. Improper medication reconciliation can result in inaccurate medication lists which can lead to adverse events including hospitalizations. Interventions targeting medication reconciliation have had varying levels of success. To improve medication reconciliation practices in our ambulatory care clinics, we developed an educational program for clinic personnel. The objective of this study is to describe the educational program, its implementation in a healthcare system, pharmacist and clinic personnel perception of the program, and its impact on clinic personnel knowledge and practice. Methods. Guided by the Conceptual Model of Implementation Research, we conducted an evaluation of a pharmacist-led educational program on evidence-based practices for medication reconciliation by examining implementation outcomes. The implementation outcomes measured include penetration, fidelity, acceptability, appropriateness, feasibility, and adoption. Data was collected through direct observations, administrative data, pre- and post-surveys, and semi-structured interviews. Results. A total of 37/46 (80%) primary care sites implemented the pharmacist delivered medication reconciliation education from April to June 2021 with representation from each of Geisinger’s regions. Ten (27%) clinic sites completed the medication reconciliation educational program as originally designed, with the remainder adapting the program. A total of 296 clinic personnel completed the pre-survey, while 178 completed the post-survey. There were no statistically significant differences in baseline characteristics between clinic personnel who completed the pre- vs. post-survey. Interviews were completed with 11 clinic personnel who attended the educational program and 4 pharmacists who delivered the educational program. All clinic personnel interviewed felt satisfied with the educational program and felt it was appropriate since it directly impacted their job. While clinic personnel felt the educational program was acceptable and appropriate, two major concerns were discussed: lack of patient knowledge about their medications and lack of time to complete the medication reconciliation. We found the adherence rate to the elements of the medication reconciliation which were covered in the education program ranged from 0% to 95% in the 55 observations conducted.Conclusion. An educational program for medication reconciliation was found to be acceptable and appropriate but was often adapted to fit site specific needs. Additional barriers affected adoption of best practices and should be addressed in future studies. Trial registration. N/A

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Section: Discussionsupporting

confidence: 66%

Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care

Jones¹,

Duboski

Romagnoli

et al. 2021

Preprint

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“…Although educational interventions have been of limited effectiveness, 6 certain individual centres have had success in reducing medication discrepancies by increasing the education of medical residents. 7,8,18 At our institution, increasing resident education to include the full and ongoing process of medication reconciliation, rather than just the technical aspects of completing a BPMH on a preprinted order form, may be of benefit. Mandating access to provincial electronic drug information systems for prescribers, as well as partnering with clinical pharmacists and pharmacy technicians at the time of admission, to facilitate communication with patients' community pharmacies, would result in more complete medication histories.…”

Section: Discussionmentioning

confidence: 99%

“…Our literature review of medication reconciliation education initiatives targeted toward resident physicians found limited published data on the best way to approach this training. [6][7][8][9][10] Medication reconciliation data for pediatric asthma are limited, as are data assessing the accuracy of medication reconciliation performed by medical residents, given that most studies to date have evaluated pharmacy-led initiatives. 11 Therefore, this study aimed to assess the completeness of medication reconciliation forms prepared by resident physicians for pediatric inpatients with asthma.…”

Section: Introductionmentioning

confidence: 99%

Completeness of Medication Reconciliation by Pediatric Residents at Hospital Admission for Asthma

Martin

McDonald

Holland

2021

CJHP

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Background: Medication errors at hospital admission, though preventable, continue to be common. The process of medication reconciliation has been identified as an important tool in reducing medication errors. The first step in medication reconciliation involves documenting a patient’s best possible medication history (BPMH); at the authors’ tertiary pediatric hospital, this step is completed at time of admission by resident physicians. Objectives: To describe and quantify the completeness of admission BPMH by resident physicians for pediatric inpatients with asthma. Methods: This single-centre, retrospective chart review evaluated documentation of admission medication reconciliation for pediatric inpatients with asthma who were admitted between January 2016 and December 2017. Medication reconciliation forms were deemed incomplete if records for asthma medications were missing drug name, inhaler strength or oral drug dose, directions for use, or evidence of reconciliation. Results: A total of 241 charts were evaluated, of which 97 (40%) had incomplete documentation for at least 1 medication; in particular, 48 (37%) of the 130 inhaled corticosteroid orders were missing inhaler strength. For most of the charts with incomplete medication history (68% [66/97]), no reason was documented; however, review of the medication reconciliation forms and physician notes revealed that families might have been unsure of a patient’s home medications or physicians might have left it to the pharmacy to clarify medication doses. Conclusions: Documentation of inhaler medications on admission medication reconciliation forms completed by resident physicians for pediatric patients with asthma was often incomplete. Future quality improvement interventions, including resident and patient education, are required at the study institution. Collaboration with pharmacy services is also likely to improve completeness of the medication reconciliation process. RÉSUMÉ Contexte : Bien qu’elles soient évitables, les erreurs de médication au moment de l’admission à l’hôpital sont encore répandues. Le processus du bilan comparatif des médicaments a été reconnu comme étant un outil important pour réduire ces erreurs. La première étape du bilan comparatif des médicaments vise à décrire le meilleur schéma thérapeutique possible (MSTP) du patient; dans l’hôpital pédiatrique tertiaire des auteurs, les médecins résidents se chargent de cette étape au moment de l’admission. Objectifs : Décrire et quantifier le degré d’exhaustivité du MSTP réalisé par les médecins résidents pour les patients en pédiatrie souffrant d’asthme. Méthodes : Cet examen rétrospectif unicentrique des dossiers a permis d’évaluer l’élaboration du bilan comparatif des médicaments à l’admission en pédiatrie des patients souffrant d’asthme entre janvier 2016 et décembre 2017. Les formulaires de bilan comparatif des médicaments étaient jugés incomplets si les dossiers relatifs aux médicaments contre l’asthme n’indiquaient pas le nom du médicament, la force de l’inhalateur ou la dose orale du médicament, le mode d’emploi ou les preuves de conciliation médicamenteuse. Résultats : L’évaluation portait sur 241 tableaux; au moins 1 médicament manquait dans la description de 97 d’entre eux (40 %); en particulier la force de l’inhalateur ne figurait pas dans 48 (37 %) des 130 ordonnances relatives aux corticostéroïdes administrés par inhalation. La plupart des tableaux dont l’histoire pharmacothérapeutique était incomplète (68 % [66/97]) n’en indiquaient pas la raison; cependant, l’examen des formulaires du bilan comparatif des médicaments et les notes des médecins ont révélé que les familles n’étaient peut-être pas certaines des médicaments que le patient prenait à domicile ou que les médecins auraient pu laisser aux pharmaciens le soin de clarifier les doses. Conclusions : La description des médicaments administrés au moyen d’inhalateurs au moment de l’admission, figurant sur les formulaires du bilan comparatif des médicaments remplis par les médecins résidents pour les patients en pédiatrie souffrant d’asthme, était souvent incomplète. De futures interventions sur l’amélioration de la qualité, y compris les instructions données au patient et au résident, sont nécessaires dans l’institution où s’est déroulée l’étude. Il est probable que la collaboration avec les services de pharmacie améliorerait l’exhaustivité du processus du bilan comparatif des médicaments.

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“…As taking care of patients is the primary, and sometimes challenging, task for the physician, a permissive and open atmosphere with the opportunity to discuss reality-based experiences and thoughts was found to be important in the educational sessions. Indeed, although high-quality evidence is lacking regarding the effects of feedback [23,24], allowing time for such interaction has been shown to be favorable for job performance [25]. Further, occupational distress, which has been reported to be relatively frequent among junior physicians [26], may be alleviated through interactive feedback sessions.…”

Section: Discussionmentioning

confidence: 99%

“It’s helpful to get the time and opportunity to discuss drug treatment; that’s what I think is the most important thing.”—A qualitative study on prescribing education in junior physicians

Lönnbro

Wallerstedt

2019

Eur J Clin Pharmacol

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Background As prescribing skills are a prerequisite for rational use of medicines, and education and training are important in acquiring these skills, we aimed to explore what aspects junior physicians find important when being taught the art of prescribing. Methods Written feedback from 34 interns after participating in an educational session as part of a randomized controlled study at a university hospital formed the qualitative data in this study. Manifest content analysis was performed, guided by the research question "Educating junior physicians in the art of prescribing: what aspects do they find important?" Meaning units were extracted and categorized, and emergent themes were identified. Results Five themes emerged. The first, clinical relevance, was exemplified by the categories valuable for health care; perceived relevance for one's own work; and translating theory into practice while the second, applicable content, included categories such as clinical advice; practical tips on using the electronic medical record system; and tools that facilitate. The third and fourth themes, reality-based teaching and creative discussions, were exemplified by the categories patient cases and feedback; and discussion-based teaching; wide-ranging discussions and a permissive and open atmosphere, respectively. In the last theme, effective structure, we identified the categories clear structure; small group teaching; allocated time for discussion; wellorganized administration; and home assignment for practice. Conclusion Creative discussions, effectively structured in small group sessions, with clinically relevant, reality-based content built on case studies and feedback, are aspects which junior physicians find important when educated in the art of prescribing.

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Safe Medication Reconciliation: An Intervention to Improve Residents' Medication Reconciliation Skills

Abstract: Background Medication errors during hospitalization are a major patient safety concern. Medication reconciliation is an effective tool to reduce medication errors, yet internal medicine residents rarely receive formal education on the process.

Cited by 8 publications

References 14 publications

Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care

Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care

Completeness of Medication Reconciliation by Pediatric Residents at Hospital Admission for Asthma

“It’s helpful to get the time and opportunity to discuss drug treatment; that’s what I think is the most important thing.”—A qualitative study on prescribing education in junior physicians

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