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"medication reconciliation"

Jennifer E Prey, Fernanda Polubriaginof, Lisa V Grossman, Ruth Masterson Creber, Demetra Tsapepas, Rimma Perotte, Min Qian, Susan Restaino, Suzanne Bakken, George Hripcsak, Leigh Efird, Joseph Underwood, David K Vawdrey
Objective: Unintentional medication discrepancies contribute to preventable adverse drug events in patients. Patient engagement in medication safety beyond verbal participation in medication reconciliation is limited. We conducted a pilot study to determine whether patients' use of an electronic home medication review tool could improve medication safety during hospitalization. Materials and Methods: Patients were randomized to use a tool before or after hospital admission medication reconciliation to review and modify their home medication list...
September 4, 2018: Journal of the American Medical Informatics Association: JAMIA
Ian A Scott, Peter I Pillans, Michael Barras, Christopher Morris
Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care...
September 2018: Therapeutic Advances in Drug Safety
Ahmed Otokiti, Abdelhaleem Sideeg, Paulisa Ward, Merina Dongol, Mohamed Osman, Oloruntobi Rahaman, Syed Abid
Background : Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the 'July effect'. Objective : To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols...
2018: Journal of Community Hospital Internal Medicine Perspectives
P Bravo, L Martinez, S Metzger, E Da Costa Noble, R Meckenstock, A Greder-Belan, L Parnet, F Samdjee, S Azan
Since April 2015, medication reconciliation is performed in our Department. The objective of this study is to assess the impact of this activity on patients' care after one year of practice. METHODS: All patients who received medication reconciliation between April-October 2015 and June-December 2016 were included in this retrospective study. Undocumented unintentional discrepancies (DNIND) which result from the comparison between the patient's usual treatments and the medication prescribed at admission were collected...
August 29, 2018: La Revue de Médecine Interne
Victoria C Liu, Insaf Mohammad, Bibban B Deol, Ann Balarezo, Lili Deng, Candice L Garwood
OBJECTIVES: This study aimed to evaluate hospital utilization and characterize interventions of pharmacist-led telephonic post-discharge medication reconciliation. METHOD: A retrospective analysis was conducted, including 833 index events in 586 geriatric patients receiving the intervention. Medicare claims were used to capture 30-day hospital utilization (admission to the emergency department, observation unit, or inpatient hospitalization) following discharge from any of these locations...
August 30, 2018: Journal of Aging and Health
Lily L Ackermann, Emily A Stewart, Jeffrey M Riggio
The goal of this study is to evaluate change in residents' assessment of supervision and safety of the discharge process after formal discharge instruction education. An educational lecture and workshop addressing high-risk medications, medication reconciliation, follow-up, and handoffs were provided to internal medicine residents. Residents were given a longitudinal survey before and after the discharge education session. Significant improvement in perception was demonstrated in review of discharge instructions ( P < ...
August 30, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Alemayehu B Mekonnen, Andrew J McLachlan, Jo-Anne E Brien, Desalew Mekonnen, Zenahbezu Abay
Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this strategy has not been well researched in low-and-middle-income countries, including Ethiopia. Objective The aim of this study was to investigate the impact of pharmacist-led MedRec intervention on the incidence of unintentional medication discrepancies in Ethiopia. Setting Emergency department in a tertiary care teaching hospital in Ethiopia. Method A single centre, prospective, pre-post study was conducted on adults (aged 18 years or over) that had been hospitalized for at least 24 h and were taking at least 2 home medications on admission...
August 28, 2018: International Journal of Clinical Pharmacy
Rachel K Miller, Shimrit Keddem, Samuel Katz, Zachary Smith, Christina R Whitehouse, Karen Goldstein, Karen B Hirschman, Jerry C Johnson
Background : Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. Objective : We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. Methods : The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only)...
August 2018: Journal of Graduate Medical Education
Jessica M Louie, Lisa T Hong, Lisa R Garavaglia, Denise I Pinal, Catherine E O'Brien
Medication reconciliation is an important aspect of a patient's care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered, non-controlled, cross-sectional study at four CF Foundation-accredited centers in the United States to evaluate the medication reconciliation process for adult and pediatric CF patients by documenting the number of home medications reconciled by clinical pharmacists and the number of patients with home medications that did not align with the current CF guidelines published in 2013...
August 23, 2018: Pharmacy (Basel, Switzerland)
Sophie Marien, Delphine Legrand, Ravi Ramdoyal, Jimmy Nsenga, Gustavo Ospina, Valéry Ramon, Benoit Boland, Anne Spinewine
Objective: Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the "patient app" and the "MedRec app." This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app...
August 17, 2018: Journal of the American Medical Informatics Association: JAMIA
Patrick Redmond, Tamasine C Grimes, Ronan McDonnell, Fiona Boland, Carmel Hughes, Tom Fahey
BACKGROUND: Transitional care provides for the continuity of care as patients move between different stages and settings of care. Medication discrepancies arising at care transitions have been reported as prevalent and are linked with adverse drug events (ADEs) (e.g. rehospitalisation).Medication reconciliation is a process to prevent medication errors at transitions. Reconciliation involves building a complete list of a person's medications, checking them for accuracy, reconciling and documenting any changes...
August 23, 2018: Cochrane Database of Systematic Reviews
Gemmae M Fix, Justeen K Hyde, Rendelle E Bolton, Victoria A Parker, Kelly Dvorin, Juliet Wu, Avy A Skolnik, D Keith McInnes, Amanda M Midboe, Steven M Asch, Allen L Gifford, Barbara G Bokhour
OBJECTIVE: Providers make judgments to inform treatment planning, especially when adherence is crucial, as in HIV. We examined the extent these judgments may become intertwined with moral ones, extraneous to patient care, and how these in turn are situated within specific organizational contexts. METHODS: Our ethnographic case study included interviews and observations. Data were analyzed for linguistic markers indexing how providers conceptualized patients and clinic organizational structures and processes...
August 13, 2018: Patient Education and Counseling
Jeffrey L Schnipper, Amanda Mixon, Jason Stein, Tosha B Wetterneck, Peter J Kaboli, Stephanie Mueller, Stephanie Labonville, Jacquelyn A Minahan, Elisabeth Burdick, Endel John Orav, Jenna Goldstein, Nyryan V Nolido, Sunil Kripalani
BACKGROUND: Unintentional discrepancies across care settings are a common form of medication error and can contribute to patient harm. Medication reconciliation can reduce discrepancies; however, effective implementation in real-world settings is challenging. METHODS: We conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The intervention consisted of local implementation of medication reconciliation best practices, utilising an evidence-based toolkit with 11 intervention components...
August 20, 2018: BMJ Quality & Safety
Kok Wai Kee, Cheryl Wai Teng Char, Anthony Yew Fei Yip
Introduction: Transition of care from hospital to primary care has been associated with increased medication errors. This review article aims to examine the existing evidence on interventions to reduce medication discrepancies or errors in primary or ambulatory care setting during care transition from hospital to primary care. Methods: We systematically reviewed the articles in primary or ambulatory care setting on patients with care transition that involved medication safety, discrepancy, or error as outcome assessment...
May 2018: Journal of Family Medicine and Primary Care
John Faria, Matthew Solverson, Madlin Faria, Margo Benoit, Michael McCormick
Objective To evaluate the frequency of potential cytochrome P450 (CYP) drug-drug interactions affecting opioid metabolism among children undergoing adenotonsillectomy. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods A retrospective review was conducted of 1000 patients undergoing adenotonsillectomy at Children's Hospital of Wisconsin. The discharge medication reconciliation form was reviewed. Each patient's list of medications was compared with various published sources to determine whether medications causing CYP inhibition or induction were present...
August 14, 2018: Otolaryngology—Head and Neck Surgery
Lotta Schepel, Lasse Lehtonen, Marja Airaksinen, Raimo Ojala, Jouni Ahonen, Outi Lapatto-Reiniluoto
BACKGROUND: 10- 30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors. OBJECTIVES: To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs). METHODS: DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH)...
August 6, 2018: International Journal of Risk & Safety in Medicine
Jonathan Penm, Régis Vaillancourt, Annie Pouliot
BACKGROUND: Medication discrepancies occur in up to 80% of hospitalized patients during transitions of care, either at admission or discharge. However, numerous organization have different definitions of medication reconciliation which may result in variations of services being implemented. OBJECTIVE: To develop a consensus definition of medication reconciliation and define the essential components of medication reconciliation based on international consensus using a modified Delphi process...
August 1, 2018: Research in Social & Administrative Pharmacy: RSAP
Nicholas Jandovitz, Hanlin Li, Brady Watts, Jonathan Monteiro, Diana Kohlberg, Demetra Tsapepas
Transplant patients represent a complex patient population for which telemedicine may allow enhanced access to the healthcare team and promote active engagement in health improvement. This retrospective study summarizes a multi-pronged approach that was instituted to implement a pharmacy telemedicine practice at our institution. Telemedicine visits included the provision of six key elements for our patients: (1) medication reconciliation, (2) vaccination history, (3) medication teaching, (4) pharmacotherapy review, (5) medication adherence, and (6) triage to other providers...
January 2018: Digital Health
Addisu Tamiru, Dumessa Edessa, Mekonnen Sisay, Getnet Mengistu
OBJECTIVE: The aim of this study is to determine the magnitude of medication discrepancies and its associated factors at transitions in care of a Specialized University Hospital in eastern Ethiopia. RESULTS: This study enrolled 411 patients having at least one prescription medication. For each of the patient enrolled, a medication reconciliation process was accomplished between medication use history before transition and medication orders at the transition. A total of 1027 medications were reconciled and 298 of them showed discrepancies...
August 3, 2018: BMC Research Notes
Junpei Komagamine, Kenichi Sugawara, Miho Kaminaga, Shinpei Tatsumi
INTRODUCTION: Given that polypharmacy and potentially inappropriate prescribing are common in elderly orthopaedic patients, pharmacist interventions to improve medication practices among this population are important. However, past studies have reported mixed results regarding the effectiveness of pharmacist-led interventions in inpatient elderly care. Furthermore, few randomised controlled trials have evaluated patient-relevant outcomes as a primary endpoint. Therefore, we will evaluate whether a pharmacist-led intervention could reduce readmission of hospitalised elderly orthopaedic patients with polypharmacy or potentially inappropriate prescribing...
July 30, 2018: BMJ Open
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