Use of complete medication history to identify and correct transitions-of-care medication errors at psychiatric hospital admission

Abstract

Methods for categorizing the scale and severity of medication errors corrected by pharmacy staff during admission medication reconciliation using complete medication history continue to evolve. We established a rating scale that is effective for generating error reports to health system quality leadership. These reports are needed to quantify the value of investment in transitions-of-care pharmacy staff. All medication errors that were reported by pharmacy staff in the admission medication reconciliation process during a period of 6 months were eligible for inclusion. Complete medication history data source was utilized by admitting providers and all pharmacist staff and a novel medication error scoring methodology was developed. This methodology included: medication error category, medication error type, potential medication error severity, and medication non-adherence. We determined that 82 medication errors were detected from 72 patients and assessed that 74 of these errors may have harmed patients if they were not corrected through pharmacist intervention. Most of these errors were dosage discrepancies and omissions. With hospital system budgets continually becoming leaner, it is important to measure the effectiveness and value of staff resources to optimize patient care. Pharmacists performing admission medication reconciliation can detect subtle medication discrepancies that may be overlooked by other clinician types. This methodology can serve as a foundation for error reporting and predicting the severity of adverse drug events.

Med rec double check: Inpatient psychiatry medication errors identified on admission using Medicaid Web portals and electronic pharmaceutical claims data

“…The role of pharmacists in the MR process is well established, and an accruing number of reports have described psychiatric pharmacists in this regard. 2 , 5 , 6 , 10 , 13–15 Lizer and Brackbill 15 found pharmacy-performed MR following a previous nursing-performed MR identified an average of 2.9 discrepancies per patient. Accomando and colleagues 14 identified 89% of behavioral health patients in the emergency department had a median of 4 medication discrepancies, where approximately 70% of all patients had a MR previously completed by a nonpharmacist health care professional.…”

“…1 Medication errors during transitions of care are common during inpatient psychiatry admissions, which can lead to patient harm. 2–12 This problem has led to the successful incorporation of psychiatric pharmacists in the emergency department to perform MR, 13 , 14 comprehensive medication reviews by pharmacists or technicians, 6 , 12 , 15 and use of integrated electronic medication management systems to identify medication discrepancies during transitions of care. 9 Despite best efforts, MEs still occur following MR based on inaccurate subjective information obtained during patient interview, possibly due to mental decline, psychiatric instability, or increased quantity of medications taken.…”

Impact of a Nationwide Medication History Sharing Program on the Care Process and End-User Experience in a Tertiary Teaching Hospital: Cohort Study and Cross-Sectional Study

“…The physicians were able to collect the patients’ complete medication use histories in a friendly manner, even if the patients were unable to identify the exact medications they were taking. As access to a complete medication use history could help physicians make clinical decisions and collaborate care within the hospital [ 28 ], the HIS could help improve the patient’s outcomes. Thus, HISs can play a vital role in value-based health care by delivering comprehensive and up-to-date information, including medication use history, laboratory results, and other medical records.…”