Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study

Sáez, C García-Molina; Sanz, E Urbieta; Torres, Marta Pérez de Heredia; Vera, Tomás Vicente; Cárceles, María Dolores Pérez

doi:10.1111/jcpt.12365

Cited by 15 publications

(17 citation statements)

References 21 publications

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“…Patients included in this study were 65 years or older (median 74 years; IQR 69–80) as in comparable studies, 2,6,10 while other studies also included younger patients. 3–5,7–9 The frequency would be expected as higher in studies of older patients, as polypharmacy is high in this group. 21,22 The inclusion of OTCs in this study probably increased the number of discrepancies found; therefore, data are presented separately for regular medications, as-needed medications and OTCs.…”

Section: Discussionmentioning

confidence: 97%

“…This is a very thorough and time-consuming process but may provide more comprehensive data. In similar studies, the intent of medication discrepancies was judged by the physician, 2–6,8–10 and that is likely to reduce the number of unintended medication changes. As this study was performed post hoc , relying on the information provided in the patient record, the physicians involved had no influence on the assessment, thereby making it not possible to assess whether the undocumented discrepancies were intentional or not.…”

Section: Discussionmentioning

confidence: 99%

“…At discharge, 14–84% of patients experience at least one medication discrepancy. 1–10 Medication discrepancies after discharge can lead to increased hospital visits 6,7,11 or preventable adverse drug events. 12 Older patients are especially at risk, as polypharmacy, comorbidities, and longer hospital stays are associated with increased medication errors.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Graabæk

Terkildsen

Lauritsen

et al. 2019

Therapeutic Advances in Drug Safety

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Transitions of care may result in medication errors, when information about a patient’s medications is not communicated sufficiently. In this clinical record review study, we aimed to evaluate the frequency of undocumented medication discrepancies at discharge from hospital and evaluate which patient characteristics could be associated with undocumented medication discrepancies. Preadmission medication lists were compared against the medication list in the discharge letters, taking into account medication changes documented in the patient record throughout the inpatient stay and in the discharge summary. Out of 200 patients, 174 (87%) were affected by at least one undocumented medication discrepancy, mostly for regular medication. Of the 1972 medications used, 744 (38%) medications were changed without documentation in the patient record, the majority being over-the-counter supplements and herbal medications. Polypharmacy at admission and discharge was associated with increased undocumented medication discrepancies. This study indicates a lack of medication reconciliation during inpatient stay. Correct and complete medication lists at admission and discharge may resolve many of these discrepancies, supporting patient safety at transitions of care.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Graabæk

Terkildsen

Lauritsen

et al. 2019

Therapeutic Advances in Drug Safety

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“…23,51 The most common study design was a pre-post intervention design, used in 20 studies. 27,28,[30][31][32][35][36][37]40,[44][45][46][47][48][49][50][51][52][53][54] Nine studies were randomised controlled trials (RCTs. 21,[23][24][25][26]38,39,41,43 There were two quality improvement studies, 42,29 one study involved a prospective chart review with a historical control, 22 one study involved an interrupted time series design 34 and one study comprised a prospective observational design.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Manias

Kusljic

2020

Therapeutic Advances in Drug Safety

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Background and Aims: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. Results: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. Conclusion: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. Lay summary Activities to reduce medication errors in adult medical and surgical hospital areas Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.

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“…One such resource, the computerised physician order entry (CPOE) system, allows pharmacists to review prescriptions in real time, even if they are not physically present in hospital wards 3. In recent years, multiple studies have shown an increase in the number of pharmacotherapy recommendations (PR) related to the indication, effectiveness and safety of the treatments pharmacists review 4–6…”

Section: Introductionmentioning

confidence: 99%

Promoting clinical pharmacy services through advanced medication review in the emergency department

et al. 2018

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ObjectivesTo determine if an advanced medication review carried out in the emergency department (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors.MethodsWe designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay.ResultsThe study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached.ConclusionsAn advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.

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Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study

Abstract: A computerized pharmaceutical intervention is shown to reduce reconciliation errors in the context of a high incidence of such errors.

Cited by 15 publications

References 21 publications

Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Promoting clinical pharmacy services through advanced medication review in the emergency department

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