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Objective Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases. Methods A retrospective observational study was conducted in the Cardiothoracic Department of the Fondazione Toscana Gabriele Monasterio hospitals. Medication history was reviewed for all the patients admitted from and discharged to the community, from January to March 2013. Patients were excluded if they had less than 4 drugs or less than 2 drugs for cardiovascular system in their prescription list at admission or if they died during follow-up. We selected 714 patients, and we obtained the clinical charts and all drug prescriptions collected during patients’ hospitalization by the electronic clinical recording system. We also analyzed the list of prescriptions of this sample of patients, from 6 months before admission to 9 months after discharge, extracted from the regional prescription registry. In the resulting sample, prescriptions were analyzed to assess unintentional discrepancies. Results The study included 298 patients (mean age, 71.2 years), according to the inclusion and exclusion criteria. Among 14,573 prescriptions analyzed, we found 4363 discrepancies (14.6 discrepancies per patient). Among these discrepancies, 1310 were classified as unintentional (4.4 discrepancies per patient). Among unintentional discrepancies, only 63 (4.8%) took place during hospitalization. Although at the hospital-home interface, 33.1% of unintentional discrepancies were detected through the comparison between the patients’ declared therapy and the previous medication consumption and 62.1% were identified in the comparison between the prescription at the discharge and the following medication pattern at home. Conclusions Medication errors have important implications for patient safety, and their identification is a main target for improving clinical practice. The comparison between the medication patterns acquired through the regional prescription registry before and after hospitalization outlined critical touchpoint in the current medication reconciliation process, calling for the definition of shared medication reconciliation standards between hospitals and primary care services to minimize medication discrepancies and enhance patient safety.

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Background: In order to ensure quality and safety of prescriptions, electronic medication management system needs to comply with medication safety requirements and human factors principles. The design of such a system can make the difference on physician acceptance and consequently on medication safety. The aim of the study is to evaluate to what extent the changes in the design of the electronic medication management system may affect the rate of medication errors. Materials and method:In light of the growing development of computerized systems in health services it has become necessary to design electronic medication management system for drug prescription and administration compliant with the requirements of medication safety practices.Prescription data relative to 100 patients admitted to the Cardiothoracic Department of the Gabriele Monasterio Foundation Heart Hospital (FTGM) were extracted from the computerized medical notes from March 2013 until May 2013. The prescriptions examined had been written using the electronic documentation prompt without structured entry fields. All prescriptions were evaluated using the medication safety requirements of the medication safety practice developed by the Centre for Patient Safety of the Regional Department of Health in Tuscany, Italy. The same prescriptions were then simulated using the novel electronic medication management module and reassessed according to the safety requirements. Results:Of the 4112 prescriptions pertaining to the 100 study patients analyzed, 88.5% were found to be erroneous or incomplete. In particular 46.8% did not include the route of administration, 29.4% the pharmaceutical form, 10.6% the number of administrations per day and/or the time of administration, in 8.2% the dose was not defined and 4.9% did not include the active pharmaceutical agent or trade name. 14.9% were considered with high potential for harm. The same prescriptions simulated through the novel electronic module were 99.1% correct and complete. Conclusions:The ergonomic design of the module for electronic prescription meets the medication safety requirements and has a role in reducing drug errors and enhancing the safety of the workflow. The module introduced structured fields pertaining the type of drug being prescribed which were positively embodied in the routine and produced a significant reduction of prescription errors. Journal of PharmacovigilanceJou rn a l o f P harma c o v ig il a nc e

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