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Medication reconciliation: a quality and safety challenge.

Parneet Jaggi, Rhonda Tomlinson, Kirstie McLelland, Warren Ma, Carol Manson-McLeod, Michael J Bullard
BACKGROUND: Medical advances and increasingly complex patients presenting to the Emergency Department (ED) make nursing challenging. Gaining new knowledge and skills is a perpetual requirement. New quality initiatives to improve patient safety and care are being constantly introduced and create significant work and time pressures for healthcare providers involved. STUDY QUESTION: Do ED nurses support the introduction of new quality standards, in addition to their current heavy workload? STUDY DESIGN: A cross-sectional survey...
April 2018: Applied Nursing Research: ANR
Blake Lesselroth, Kathleen Adams, Stephanie Tallett, Scott Ragland, Victoria Church, Elizabeth M Borycki, Andre Kushniruk
Internationally, major efforts are underway to improve medication safety and reduce medication errors during transitions of care. One strategy that has emerged to improve data accuracy and close information gaps is the introduction of software applications and workflow models that allow patients to review, enter, and modify their own patient data (e.g. information about medications they are taking). Evaluating the quality and effectiveness of such patient-facing healthcare applications is critical, especially when this approach is applied to high-stakes clinical tasks such as medication reconciliation...
2015: Studies in Health Technology and Informatics
Mitchell R Knisely, Rebecca J Bartlett Ellis, Janet S Carpenter
PURPOSE: The purpose of this article is to identify medication-related considerations for clinical nurse specialist practice by presenting a case report detailing the complexities of medication management, unresolved medication discrepancies, and reconciliation across care transitions. BACKGROUND: Care transitions are a vulnerable time for medication-related problems to occur. Unresolved medication discrepancies can lead to adverse drug events and other poor health outcomes, including hospital readmissions and increased healthcare costs...
September 2015: Clinical Nurse Specialist CNS
Haavi Morreim
No abstract text is available yet for this article.
July 2015: Hastings Center Report
Kamila Przytula, Stacy Cooper Bailey, William L Galanter, Bruce L Lambert, Neeha Shrestha, Carolyn Dickens, Suzanne Falck, Michael S Wolf
BACKGROUND: The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is 'Tools for Optimizing Medication Safety.' Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the 'Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use'...
January 27, 2015: Trials
Cornelia Mahler, Tobias Freund, Annika Baldauf, Susanne Jank, Sabine Ludt, Frank Peters-Klimm, Walter Emil Haefeli, Joachim Szecsenyi
Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance...
2014: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
Lucien Roulet, Nathalie Asseray, Françoise Ballereau
Overview of clinical pharmacy practice around the world shows that pharmaceutical services in emergency departments (EDs) are far less common in Europe than in North America. Reported experiences have shown the impact of a clinical pharmacy service on drug utilisation and safety issues. This commentary presents the implementation of a pharmacy presence in the ED of a French tertiary care hospital. Our experience helps to define the role of the clinical pharmacist in the ED, including patient interviewing, providing medication reconciliation, promoting drug safety, and supporting specific interventions to improve quality of care and patient safety...
June 2014: International Journal of Clinical Pharmacy
Sanchita Sen, Laura Siemianowski, Michelle Murphy, Susan Coutinho McAllister
PURPOSE: An inpatient medication reconciliation (MR) program emphasizing pharmacy technicians' role in the MR process is described. SUMMARY: As part of quality-improvement (QI) efforts focused on MR-related adverse drug events, an urban academic medical center in New Jersey implemented a pharmacy technician-centered MR (PTMR) program targeting patients on its internal medicine, oncology, and clinical decision units. The program is staffed by five full- or part-time technicians who are trained in MR methods and work under direct pharmacist supervision, interviewing newly admitted patients and using other information sources (e...
January 1, 2014: American Journal of Health-system Pharmacy: AJHP
Jennifer I Lee, Fran Ganz-Lord, Judy Tung, Tara Bishop, Carol DeJesus, Claire Ocampo, Paula Tinghitella, Karen A Scott
PROBLEM: Academic medical centers face unique challenges to ensuring patient safety after a hospital discharge, including those related to providing patient follow-up care in practices staffed by residents who are not comfortable managing care transitions. APPROACH: In 2011, the authors designed a quality improvement program for early postdischarge follow-up (bridge visits) at a resident primary care outpatient practice, using existing resources. The authors added a unique appointment template to the outpatient electronic health record to guide residents during the visit...
November 2013: Academic Medicine: Journal of the Association of American Medical Colleges
Blake J Lesselroth, Kathleen Adams, Stephanie Tallett, Scott D Wood, Amy Keeling, Karen Cheng, Victoria L Church, Robert Felder, Hanna Tran
OBJECTIVE: Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design. BACKGROUND: Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission...
2013: HERD
Amanda H Salanitro, Sunil Kripalani, Joanne Resnic, Stephanie K Mueller, Tosha B Wetterneck, Katherine Taylor Haynes, Jason Stein, Peter J Kaboli, Stephanie Labonville, Edward Etchells, Daniel J Cobaugh, David Hanson, Jeffrey L Greenwald, Mark V Williams, Jeffrey L Schnipper
BACKGROUND: Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation...
June 25, 2013: BMC Health Services Research
Sia Beng Yi, Janice Chan Pei Shan, Goh Lay Hong
PURPOSE: Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra-hospital transfer or discharge. Effectively and consistently performing medication reconciliation at care-interfaces continues to be a challenge. Tan Tock Seng Hospital (TTSH) averages 4,700 admissions monthly. Many patients are elderly (> 65 years old) at risk from poly-pharmacy. As part of a medication safety initiative, pharmacy staff started a medication reconciliation service in 2007, which expanded to include all patients in October 2009...
2013: International Journal of Health Care Quality Assurance
Bhavik Nana, Sun Lee-Such, Glenn Allen
PURPOSE: The initiation of a medication reconciliation program and other pharmacy services in the emergency department (ED) of a community hospital is described. SUMMARY: Despite a lack of funding for additional staff, the pharmacy department of a community hospital led an initiative to establish an ED pharmacy program; a major goal of the program was to address errors and inconsistencies in ED admission and discharge medication reconciliations. Implementing the program in a cost-neutral manner required the realignment of staff duties and schedules and an arrangement with the hospital's off-site central order-entry pharmacy contractor for expanded coverage hours...
October 1, 2012: American Journal of Health-system Pharmacy: AJHP
Blake J Lesselroth, Patricia J Holahan, Kathleen Adams, Zhen Z Sullivan, Victoria L Church, Susan Woods, Robert Felder, Shawn Adams, David A Dorr
BACKGROUND: Although medication reconciliation (MR) can reduce medication discrepancies, it is challenging to operationalise. Consequently, we developed a health information technology (HIT) to collect a patient medication history and make it available to the primary care (PC) provider. We deployed a self-service kiosk in a PC clinic that permits patients to indicate a medication adherence history. Patient responses are immediately viewable in the legacy electronic health record. This paper describes a survey developed to assess PC provider perceptions of our HIT and HIT implementation effectiveness...
2011: Informatics in Primary Care
Donna M Daniel, Donald E Casey, Jeffrey L Levine, Susan T Kaye, Raquel B Dardik, Prathibha Varkey, Kimberly Pierce-Boggs
The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation...
December 2009: Academic Medicine: Journal of the Association of American Medical Colleges
Kathleen E Walsh, Walter H Ettinger, Robert A Klugman
The slow progress in health care quality improvement and patient safety in America can be attributed, in part, to the challenge of physician engagement. As multidisciplinary patient-centered care becomes the standard, it is essential to integrate physicians into this process. To this end, the UMass Memorial Medical Center redesigned its Physician Quality Officer (PQO) program in 2007. The PQOs of the UMass Memorial Medical Center, who are all practicing clinicians, are fully compensated for their time and effort, trained in safety science, and teamed with other members of the department of quality and patient safety...
July 2009: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Jerome W Freeman, Molly McDaniel, Joanne Landis, Wendell Hoffman
No abstract text is available yet for this article.
March 2009: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Mandalyn Schwarz, Rhonda Wyskiel
During the past 5 years since the medication reconciliation process was formalized and automated, it has become an independent redundancy. The patient intervention rates are maintained at 30% to 35%, with ADE rates related to medication reconciliation at zero. The medication process takes into account the accuracy and appropriateness of restarting prehospital medications and current ICU medications. It includes the omission of important home medications along with inaccuracies of dosages and frequencies. This form assures that the patient is receiving continuity of care ad decreases complications of the patients health related to the changing of medications...
December 2006: Critical Care Nursing Clinics of North America
Bernadette A M Chevalier, David S Parker, Neil J MacKinnon, Ingrid Sketris
Medication reconciliation (MR) involves the accurate transfer of medication information across the continuum of care. The aim of this study was to measure nurses perceptions of patient safety, medication safety and current MR practice at transition points in a patient's hospital stay. Surveys were distributed to 111 nursing staff in three general medicine units at Capital Health District, Nova Scotia, in August 2005. A total of 39 nurses (35% response rate) completed the survey. "Teamwork within units" was the safety culture dimension with the highest positive response (98...
September 2006: Nursing Leadership
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