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"medication reconciliation"

Megan E Young, Lindsay B Demers, Victoria Parker, Hollis Day, Serena Chao
Internal medicine residency programs consider effectively discharging patients from the hospital an important training milestone. However, it is rare for residents to have the opportunity to follow discharged patients into the community and see discharge plans in action. This curriculum provided residents with the opportunity to evaluate patients in their homes after they were discharged from the hospital to assess the alignment of the discharge plan with patients' real-life circumstances. Thirty-nine internal medicine residents participated in a structured exercise during a posthospital discharge home visit to older patients they cared for during the hospital admission...
July 18, 2018: Gerontology & Geriatrics Education
Christine D Jones, Amanda Anthony, Matthew D Klein, Courtney Shakowski, Holly K Smith, Amy Go, Katharine Perica, Hemali Patel, Jonathan Pell, Read Pierce
OBJECTIVES: To evaluate the feasibility and effect of a pharmacist-led transitions-of-care (TOC) pilot targeted to patients at high risk of readmission on process measures, hospital readmissions, and emergency department (ED) visits. SETTING: Academic medical center in Colorado. PRACTICE DESCRIPTION: Pharmacists enrolled patients identified as high risk for readmission in a TOC pilot from July 2014 to July 2015. The pilot included medication reconciliation, medication counseling, case management or social work evaluation, a postdischarge telephone call, and an expedited primary care follow-up appointment...
July 15, 2018: Journal of the American Pharmacists Association: JAPhA
Luiza Kerstenetzky, Kristina M Heimerl, Katherine J Hartkopf, David R Hager
OBJECTIVES: To evaluate the impact of a pharmacist screening and automated referral process that identifies patients at risk for readmission due to medication-related problems (MRPs). SETTING: University of Wisconsin (UW) Hospital is 505-bed flagship hospital that is part of UW Health, an academic health system. PRACTICE DESCRIPTION: The integrated pharmacy practice model at UW Health has inpatient pharmacists who perform discharge medication reconciliation...
July 15, 2018: Journal of the American Pharmacists Association: JAPhA
Sajani Patel, A Scott Mathis, Jennifer Costello, Hoytin Lee Ghin, Germin Fahim
Purpose: To survey advanced nurse practitioners, physician assistants, nurses, physicians, and resident physicians involved with collecting and reconciling medication histories in the emergency department (ED) to measure their satisfaction with the current process involving pharmacy technicians. Methods: Two sites within a large health system with pharmacy technician-driven medication reconciliation processes asked health care professionals to complete a survey of 20 multiple-choice questions...
July 2018: P & T: a Peer-reviewed Journal for Formulary Management
Stephen D Persell, Kunal N Karmali, Danielle Lazar, Elisha M Friesema, Ji Young Lee, Alfred Rademaker, Darren Kaiser, Milton Eder, Dustin D French, Tiffany Brown, Michael S Wolf
Importance: Complex medication regimens pose self-management challenges, particularly among populations with low levels of health literacy. Objective: To test medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention. Design, Setting, and Participants: This 3-group cluster randomized clinical trial was performed in community health centers in Chicago, Illinois...
July 9, 2018: JAMA Internal Medicine
Ryan Craynon, David R Hager, Mike Reed, Julie Pawola, Steve S Rough
PURPOSE: Results of a pilot project to improve the safety and efficiency of the discharge process by adding daily pharmacist review and preparation of discharge medication orders to an existing discharge medication reconciliation workflow are reported. SUMMARY: Due to patient capacity issues, the pharmacy department of a large tertiary medical center implemented changes to the existing medication discharge workflow. A steering committee was established, with subgroups responsible for workflow development, electronic medical record enhancement, and data collection designated...
July 5, 2018: American Journal of Health-system Pharmacy: AJHP
Danielle McDonald, Rupal Mansukhani, Suzannah Kokotajlo, Frank Diaz, Christine Robinson
OBJECTIVE: This study was conducted to evaluate the impact of education on optimizing medication histories in a single-center pediatric emergency department. METHODS: This was a prospective, 2-phase study of 200 patients ages 21 years and younger who presented to the pediatric emergency department in January and February 2017. In phase I of the study, 100 patients were interviewed by both a nurse and a pharmacist. Between phases I and II, the pharmacist educated each nurse and disseminated standardized education materials...
May 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Naina Sinha Gregory, Jane J Seley, Savira Kochhar Dargar, Naveen Galla, Linda M Gerber, Jennifer I Lee
PURPOSE OF REVIEW: Patients with diabetes are known to have higher 30-day readmission rates compared to the general inpatient population. A number of strategies have been shown to be effective in lowering readmission rates. RECENT FINDINGS: A review of the current literature revealed several strategies that have been associated with a decreased risk of readmission in high-risk patients with diabetes. These strategies include inpatient diabetes survival skills education and medication reconciliation prior to discharge to send the patient home with the "right" medications...
June 21, 2018: Current Diabetes Reports
Marieke M Ebbens, Sylvia A van Laar, Elsbeth J Wesselink, Kim B Gombert-Handoko, Patricia M L A van den Bemt
BACKGROUND: Pharmacy-led medication reconciliation in elective surgery patients is often performed at the preoperative screening (POS). Because of the time lag between POS and admission, changes in medication may lead to medication errors at admission (MEAs). In a previous study, a risk prediction model for MEA was developed. OBJECTIVE: To validate this risk prediction model to identify patients at risk for MEAs in a university hospital setting. METHODS: The risk prediction model was derived from a cohort of a Dutch general hospital and validated within a comparable cohort from a Dutch University Medical Centre...
June 1, 2018: Annals of Pharmacotherapy
Aldo L Schenone, Venu Menon
PURPOSE OF REVIEW: This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. RECENT FINDINGS: Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome...
June 14, 2018: Current Cardiology Reports
Alexander Turchin, Olukayode Sosina, Huabing Zhang, Maria Shubina, Sonali P Desai, Donald C Simonson, Marcia A Testa
OBJECTIVE: To investigate the association between ambulatory medication reconciliation and health care utilization in patients with diabetes. RESEARCH DESIGN AND METHODS: In this retrospective cohort analysis, we studied adults taking at least one diabetes medication treated in primary care practices affiliated with two academic medical centers between 2000 and 2014. We assessed the relationship between the fraction of outpatient diabetes medications reconciled over a 6-month period and the composite primary outcome of combined frequency of emergency department (ED) visits and hospitalizations over the subsequent 6 months...
June 11, 2018: Diabetes Care
Adrian Wong, Joseph M Plasek, Steven P Montecalvo, Li Zhou
The safety of medication use has been a priority in the United States since the late 1930s. Recently, it has gained prominence due to the increasing amount of data suggesting that a large amount of patient harm is preventable and can be mitigated with effective risk strategies that have not been sufficiently adopted. Adverse events from medications are part of clinical practice, but the ability to identify a patient's risk and to minimize that risk must be a priority. The ability to identify adverse events has been a challenge due to limitations of available data sources, which are often free text...
June 9, 2018: Pharmacotherapy
Jean Yoon, Evelyn Chang, Lisa V Rubenstein, Angel Park, Donna M Zulman, Susan Stockdale, Michael K Ong, David Atkins, Gordon Schectman, Steven M Asch
Background: Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization. Objective: To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients. Design: Randomized quality improvement trial. ( NCT03100526)...
June 19, 2018: Annals of Internal Medicine
Alfredo Iardino, Orlando Garner, Gabriella Lorusso, Franco Lotta
Ergotism is an ischaemic complication due to vasoconstriction throughout the body due to ingestion of ergotamine. A 34-year-old Hispanic man with HIV infection treated with saquinavir, ritonavir and abacavir/lamivudine presented to the emergency department complaining of left foot pain 1 week prior to admission. The affected extremity was cold with absence of pedal and tibial pulses. Arterial Doppler revealed absent arterial flow from the popliteal artery later confirmed by arteriography. Medication reconciliation revealed a recent prescription for migraine headache containing ergotamine...
June 4, 2018: BMJ Case Reports
Masashi Saiga
 Community pharmacists are often not included in home healthcare teams; their absence from such teams places patients undergoing transitions at risk for potential medication-related errors. However, community pharmacists can improve medication adherence and decrease heart failure (HF)-related hospital readmission rates. The expansion of home medication teaching services for patients by community pharmacists to reach as many patients as possible could only augment those benefits. Community pharmacists provide home health services including medication reconciliation and teaching...
2018: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
Kei Ouchi, Charlotta Lindvall, Peter R Chai, Edward W Boyer
Adverse drug events (ADEs) are common and have serious consequences in older adults. ED visits are opportunities to identify and alter the course of such vulnerable patients. Current practice, however, is limited by inaccurate reporting of medication list, time-consuming medication reconciliation, and poor ADE assessment. This manuscript describes a novel approach to predict, detect, and intervene vulnerable older adults at risk of ADE using machine learning. Toxicologists' expertise in ADE is essential to creating the machine learning algorithm...
June 1, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Mary J Thomson, Anna S Lok, Elliot B Tapper
Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis...
May 30, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Mohammad Mehdi Talebi, Aida Sefidani Forough, Parsa Riazi Esfahani, Raha Eskandari, Roodabeh Haghgoo, Fanak Fahimi
Medication interactions are associated with various unwanted adverse drug reactions. Medication Reconciliation involves a process in which a complete list of patient's previously prescribed medications are recorded and subsequently evaluated within the context of concomitantly prescribed medications and present medical condition during the hospitalization. Medical records of randomly selected 270 patients hospitalized in internal medicine, cardiovascular and infectious diseases wards were evaluated. Drug interactions were checked by LexiComp® database...
2018: Iranian Journal of Pharmaceutical Research: IJPR
Frank Pandolfe, Adam Wright, Warner V Slack, Charles Safran
Objective: Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications. Methods: A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list...
May 17, 2018: Journal of the American Medical Informatics Association: JAMIA
Maria Sjölander, Lars Lindholm, Bettina Pfister, Jeanette Jonsson, Jörn Schneede, Hugo Lövheim, Maria Gustafsson
BACKGROUND: Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far. OBJECTIVES: To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments...
May 16, 2018: Research in Social & Administrative Pharmacy: RSAP
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