Medication Reconciliation During Hospitalization and in Hospital-Home Interface: An Observational Retrospective Study

Abstract

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.

Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians’ experience and a review of patient records

“…Many clinicians in our survey experienced that patients had an incorrect medication list. We believe that our study supports medication reconciliation still being a weak link in patients’ care transitions 13 46 47…”

Comorbidity in lipoprotein apheresis: Their role in the era of new lipid‐lowering therapies

“…5 In an Italian analysis of general practitioners was reported an average CCI of 1.1 (with an expected mortality rate < 10%), 11 lower than our population where the growing burden of comorbidities significantly increases the prescribed drugs potentially raising the risk of drug interactions and therapeutic adherence. [12][13][14][15][16] It is plausible that the lower observed mortality rate in our population, compared to that predicted by the CCI, is also a consequence of the high compliance obtained by sharing with the patients the nature and severity of their pathology.…”

“…LA procedures were performed in agreement to guidelines 9 and manufacturer's instructions with a median inter-apheresis interval of 14 [10][11][12][13][14] days. treating 4000 mL plasma/session for subjects in HELP system or 1.5 patient plasma volume/session with the other systems.…”

Erros De Prescrição Na Terapêutica Medicamentosa De Paciente Em Internamento Hospitalar

“…Já no estudo de Fernandes et al (2021) foram identificadas 1.770 discrepâncias, sendo 93,8% intencionais, 0,7% intencionais documentadas e 5,4% não intencionais. Volpi et al (2021), realizaram um estudo observacional retrospectivo no Departamento Cardiotorácico dos hospitais da Fondazione Toscana Gabriele Monasterio e como resultado percebeu que entre 14.573 prescrições analisadas, foram encontradas 4.363 discrepâncias. Dentre essas, 1.310 foram classificadas como não intencionais.…”