Objective: The study was conducted to assess the effectiveness of the medication reconciliation and medication error prevention in an emergency department of a tertiary care hospital. Materials and Methods: Patients of either sex, aged above 18 years admitted for more than 24 hours irrespective of their medical diagnosis and for whom medication reconciliation was done were included. Patients' home medication charts were compared with their current admission medication charts to check the number of home medications that were being continued to be administered during their hospital stay. Each home medication that was not ordered or commented on was deemed to represent a discrepancy. The discrepancies were classified according to the criteria of the Safer Healthcare Now! Campaign and reasons for not continuing the drug were also documented. The interventions were brought to the notice of the concerned physician. Results: Of 80 patients (43 males and 37 females; mean age 61 ± 15 years), 74 patients had medication discrepancies categorised as documented intentional discrepancies, undocumented intentional discrepancies and unintentional discrepancies and 6 patients had no discrepancies. There was a statistically significant association between number of home medications and discrepancies, both undocumented intentional discrepancies (P=0.005) and unintentional discrepancies (P=0.049). Conclusion: This study recommends the need for additional resources and educational initiatives for the health care professionals to improve medication reconciliation. For effective medication reconciliation, patients or their care takers must help the physicians and other health care professionals involved in reconciliation by bringing all their home medications at the time of hospital admissions.
The largest democracy on earth, the second most populous country and one of the most progressive countries in the globe, India, has advanced tremendously in most conventional fields of Medicine. However, emergency medicine (EM) is a nascent specialty and is yet to receive an identity. Today, it is mostly practised by inadequately trained clinicians in poorly equipped emergency departments (EDs), with no networking. Multiple factors such as the size of the population, variation in standards of medical education, lack of pre-hospital medical systems and non-availability of health insurance schemes are some of the salient causes for this tardy response. The Indian medical system is governed by a central, regulatory body which is responsible for the introduction and monitoring of all specialties--the Medical Council of India (MCI). This organisation has not recognized EM as a distinct specialty, despite a decade of dogged attempts. Bright young clinicians who once demonstrated a keen interest in EM have eventually migrated to other conventional branches of medicine, due to the lack of MCI recognition and the lack of specialty status. The Government of India has launched a nationwide network of transport vehicles and first aid stations along the national highways to expedite the transfer of patients from a crash site. However, this system cannot be expected to decrease morbidity and mortality, unless there is a concurrent development of EDs. The present article intends to highlight factors that continue to challenge the handful of dedicated, full time emergency physicians who have tenaciously pursued the cause for the past decade. A three-pronged synchronous development strategy is recommended: (i) recognise the specialty of EM as a distinct and independent basic specialty; (ii) initiate postgraduate training in EM, thus enabling EDs in all hospitals to be staffed by trained Emergency physicians; and (iii) ensure that EMs are staffed by trained ambulance officers. The time is ripe for a paradigm shift, since the country is aware that emergency care is the felt need of the hour and it is the right of the citizen.
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