Improving Medication Reconciliation in the 21st Century (original) (raw)
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The Joint Commission Journal on Quality and Patient Safety, 2009
Background: Medication reconciliation (MedRecon) has been a Joint Commission National Patient Safety Goal since 2006. However, there is scant literature on the evaluation of electronic MedRecon systems in reducing medication errors and on improving reliability of the MedRecon process. Methods: An electronic MedRecon system was designed and implemented in an acute inpatient care facility. Two analyses were performed: (1) one based on a 2-week pilot evaluation of the system based on 120 MedRecon events, and (2) a more comprehensive 17-month evaluation of the system, based on 19,356 MedRecon events. Results: The unintended discrepancy rate between a patient's home medications and admission medication orders was reduced from 20% during the pilot phase to 1.4%. The omission of a home medication was the most common type of discrepancy. Nighttime admission (8 P.M.-8 A.M.), total home medications > four, patient age > 65 years, and resident physician performing the medication reconciliation were found to have a significant positive correlation (p < .05) with the discrepancy rate. Using computerized alerts improved compliance with the MedRecon process from 34% to 98%-100%. Discussion: Using a multidisciplinary process based on an electronic system substantially reduced medication errors on admission, suggesting that an electronic MedRecon system can be an important tool in improving patient safety. The use of an interactive reminder alert in the MedRecon system improved systems reliability by ensuring physician compliance with MedRecon performance. Although computerized physician order entry (CPOE) decision support tools are an important component of medication error prevention strategies, they alone are not sufficient to prevent errors of prescribing.
Medication reconciliation: a practical tool to reduce the risk of medication errors
Journal of Critical Care, 2003
Preventable adverse drug events are associated with one out of five injuries or deaths. Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. This study was performed to reduce medication errors in patient's discharge orders through a reconciliation process in an adult surgical intensive care unit (ICU). A discharge survey was implemented as part of the medication reconciliation process. The admitting nurse initiated the survey within 24 hours of ICU admission and the charge nurse completed the survey on discharge. Baseline data were obtained through a random sampling of 10% of discharges in first 2 weeks of the study (July 2001-May 2002). Medical and anesthesia records were reviewed, allergies and home medications verified with patient/family and findings compared with orders at time of ICU discharge. Baseline data revealed that 31 of 33 (94%) patients had orders changed. By week 24, nearly all medication errors in discharge orders were eliminated. In conclusion, use of the discharge survey in this medication reconciliation process resulted in a dramatic drop in medications errors for patients discharged from an ICU. The survey is now a part of our electronic medical record and used in 4 adult ICUs and 2 medicine floors.
Journal of Pharmacy Practice and Research, 2015
Background: Unintentional medication errors are common at hospital discharge and have the potential to cause significant patient harm. Current electronic medical records systems offer the facility to change the process of medication reconciliation by pharmacists. Aim: To test the impact of pharmacist-led medication reconciliation at admission recorded on the electronic medication form, on the timeliness and accuracy of discharge prescriptions. Method: A prospective pre-and post-interventional observational study was carried out from June to October 2013 at two district hospitals. Pharmacists recorded admission medication using National Medication Management Plan (phase 1) and the electronic medication form in patients' electronic medical records (phase 2). Data collected included time taken for the medical officer to complete the medication form in electronic medical records, the number of times the medical officer was contacted by the pharmacist completing the discharge reconciliation and unintentional discharge medication discrepancy types. Results: In total 118 patients were included: 66 patients in phase 1 and 52 in phase 2. Data were analysed using chi-squared test, Fisher's exact test and Mann-Whitney test. There was a significant (33-13%, p < 0.0001) reduction in the proportion of medication orders with a discrepancy. This was because of the significant (25.5-1.9%, p < 0.0001) reduction in discrepancies relating to patients' usual medication. Time taken for the medical officer to complete the medication form in electronic medical records decreased from 37 s/item (interquartile range, 29-48; n = 51) to 21 s/item (interquartile range, 11-35; n = 35) (p < 0.001). The number of telephone calls to medical officers decreased from 95 to 73%. Conclusion: This integrated approach to medication reconciliation has highlighted patient safety benefits, and reduced medical and pharmacy workload.
Medication errors: prevention using information technology systems
British Journal of Clinical Pharmacology, 2009
Given the high frequency of medication errors with resultant patient harm and cost, their prevention is a worldwide priority for health systems. 2. Systems that use information technology (IT), such as computerized physician order entry, automated dispensing, barcode medication administration, electronic medication reconciliation, and personal health records, are vital components of strategies to prevent medication errors, and a growing body of evidence calls for their widespread implementation. 3. However, important barriers, such as the high costs of such systems, must be addressed through economic incentives and government policies. 4. This paper provides a review of the current state of IT systems in preventing medication errors. Information technology systems in medication management Clinical decision making is a complex process that depends on human ability to provide undivided attention and to memorize, recall, and synthesize huge amounts of data-all vulnerable areas. IT systems can improve access to pieces of information, organize them, and identify links between them. Clinicians often 'know' the information (such as a patient's allergies, a drug recall warning, or a
CMAJ Open, 2017
Background: To reduce medication discrepancies (unintended differences between a patient's outpatient and inpatient medication regimens), Canadian institutions have implemented medication reconciliation forms that are prepopulated with outpatient medication dispensing data. These may prompt prescribers to reorder discontinued medications or continue newly contraindicated medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of such forms. Methods: This retrospective chart review included patients previously enrolled in an observational study in which a research pharmacist prospectively collected best-possible medication histories in the emergency department. Research assistants uninvolved with the parent study compared medication orders written in the first 48 hours after admission with the research pharmacist's best-possible medication history to identify medication discrepancies and errors of commission, defined as inappropriate medication continuations and reordering of previously stopped medications. An independent panel adjudicated the clinical significance of the errors. Results: Of 151 patients, 71 (47.0% [95% confidence interval (CI) 39.2-54.9]) were exposed to 112 medication errors on admission. Of the 112 errors, 24 (21.4% [95% CI 14.9-29.9]) were clinically significant. Errors of commission accounted for 24.1% (27/112 [95% CI 17.3-32.8]) of all errors; 10 (37.0% [95% CI 18.8-55.2]) of the errors of commission were clinically significant. Interpretation: Medication errors were common after the implementation of electronically prepopulated medication reconciliation forms. Prospective research is required to examine the impact of prepopulated medication reconciliation forms and ensure they do not facilitate errors of commission.
Medication errors with electronic prescribing (eP): Two views of the same picture
BMC Health Services Research, 2010
Background: Quantitative prospective methods are widely used to evaluate the impact of new technologies such as electronic prescribing (eP) on medication errors. However, they are labour-intensive and it is not always feasible to obtain pre-intervention data. Our objective was to compare the eP medication error picture obtained with retrospective quantitative and qualitative methods.
Technology Utilization to Prevent Medication Errors
Current Drug Safety, 2010
Medication errors have been increasingly recognized as a major cause of iatrogenic illness and system-wide improvements have been the focus of prevention efforts. Critically ill patients are particularly vulnerable to injury resulting from medication errors because of the severity of illness, need for high risk medications with a narrow therapeutic index and frequent use of intravenous infusions. Health information technology has been identified as a method to reduce medication errors as well as improve the efficiency and quality of care; however, few studies regarding the impact of health information technology have focused on patients in the intensive care unit. Computerized physician order entry and clinical decision support systems can play a crucial role in decreasing errors in the ordering stage of the medication use process through improving the completeness and legibility of orders, alerting physicians to medication allergies and drug interactions and providing a means for standardization of practice. Electronic surveillance, reminders and alerts identify patients susceptible to an adverse event, communicate critical changes in a patient's condition, and facilitate timely and appropriate treatment. Bar code technology, intravenous infusion safety systems, and electronic medication administration records can target prevention of errors in medication dispensing and administration where other technologies would not be able to intercept a preventable adverse event. Systems integration and compliance are vital components in the implementation of health information technology and achievement of a safe medication use process.
International Journal of Medical Informatics, 2008
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 7 ( 2 0 0 8 ) 153-160 Computerized patient medical records Patient access to records Quality of care Safety Personal health records a b s t r a c t Objective: To evaluate the efficacy of a secure web-based patient portal called Patient Gateway (PG) in producing more accurate medication lists in the electronic health record (EHR), and whether sending primary care physicians (PCPs) a clinical message updating them on the information their patients provided caused physicians to update the EHR medication list. Methods: We compared the medication list accuracy of 84 patients using PG with that of 79 who were not. Patient-reported medication discrepancies were noted in the EHR in a clinical note by research staff and a message was sent to the participants' PCPs notifying them of the updated information. Results: Participants were taking 665 medications according to the EHR, and reported 273 additional medications. A lower percentage of PG users' drug regimens (54% versus 61%, p = 0.07) were reported to be correct than those of PG non-users, although PG users took significantly more medications than their non-user counterparts (5.0 versus 3.1 medications, p = 0.0001). Providing patient-reported information in a clinical note and sending a clinical message to the primary care doctor did not result in PCPs updating their patients' EHR medication lists.
Evaluation of an Inpatient Computerized Medication Reconciliation System
Journal of the American Medical Informatics Association, 2008
A b s t r a c t We designed the Pre-Admission Medication List (PAML) Builder medication reconciliation application and implemented it at two academic hospitals. We asked 1,714 users to complete a survey of their satisfaction with the application and analyzed factors associated with user efficiency. The survey was completed by 626 (36.5%) users. Most (64%) responders agreed that medication reconciliation improves patient care. Improvement requests included better medication information sources and propagation of medication information to order entry. Sixty-nine percent of admitting clinicians reported a typical time to build a PAML of Ͻ10 min. Decreased reported time to build a PAML was associated with reported experience with the application and ease of use but not the average number of medications on the PAML. Most users agreed that medication reconciliation improves patient care but requested tighter integration of the different stages of the medication reconciliation process. Further training may be helpful in improving user efficiency. Ⅲ J Am Med Inform Assoc. 2008;15:449 -452.