Drug Record Discrepancies in an Outpatient Electronic Medical Record: Frequency, Type, and Potential Impact on Patient Care at a Hemodialysis Center

Manley, Harold J.; Drayer, Debra; McClaran, M.L.; Bender, Walter L.; Muther, Richard S.

doi:10.1592/phco.23.2.231.32079

Cited by 69 publications

(67 citation statements)

References 27 publications

(30 reference statements)

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“…A previous study reported drug record discrepancies of 1.7 (SD 1.3) per patient when information gathered from the patient was compared with information in an electronic medical record. 16 Two other Canadian studies, each conducted over a 4-month period, revealed 3.4 and 3.8 medication discrepancies per hemodialysis patient, respectively, when the BPMH was obtained by a pharmacy technician, pharmacy student, or nurse. 4,22 It is possible that the average number of medication discrepancies was somewhat lower in our study because, for patients with multiple ambulatory medication reconciliations, discrepancies identified during the patient's first reconciliation were resolved, lowering the number of discrepancies on subsequent reconciliations conducted during the 2-year study period.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies have shown that dialysis-dependent patients are at an especially elevated risk of medication-related problems, medication discrepancies, and drug-record discrepancies. 3,4,6,7,15,16,[20][21][22][23] In the current 2-year study, the mean number of medication discrepancies identified through ambulatory medication reconciliation was 1.31 per hemodialysis patient and 0.65 per reconciliation process. A previous study reported drug record discrepancies of 1.7 (SD 1.3) per patient when information gathered from the patient was compared with information in an electronic medical record.…”

Section: Discussionmentioning

confidence: 99%

“…15 Additionally, drug record discrepancies were identified for 60% of patients when medical records for outpatients undergoing dialysis were compared with patient surveys. 16 In previous research involving non-dialysis-dependent patients with chronic kidney disease, our group has shown that ambulatory medication reconciliation is an effective tool for identifying and resolving medication discrepancies.…”

Section: Résumémentioning

confidence: 99%

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Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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Background: Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients. Objectives: To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service. Methods: This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepancies identified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation. Results: Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients. Conclusions: This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

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Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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“…Prescription of benzodiazepines has also become more common in recent years. United States Medicare data show that although there were no significant changes in benzodiazepine prescription frequency among ESRD patients between 1993 and 1997 (1), there was a more than three-fold increase between 1998 and 2003 (8% in 1998 versus 26% in 2003) (18,41). The high prevalence of chronic benzodiazepine use may be appropriate to control anxiety and restlessness or less appropriate to treat insomnia.…”

Section: Discussionmentioning

confidence: 99%

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Wyne

Rai

Cuerden

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events.Design, setting, participants, & measurements Two authors reviewed all relevant citations in MEDLINE/ EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in Ն50 dialysis patients were included. ResultsWe identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n ϭ 10) and 8 to 26% (95% CI, 7.1 to 27.3%; n ϭ 9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n ϭ 2). No study rigorously examined for adverse events. ConclusionsThe prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population.

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“…In a small single-center study, 65% of MRPs identified in hospitalized dialysis patients were associated with gaps in transfer in medication information between the patients, caregivers, and different health care settings and caregivers (23). In another study, medication discrepancies were noted in 60% of hemodialysis patients when information gathered from patient self-report and interview were compared with outpatient dialysis facility electronic medical records (24). Similarly, in the general population, discrepancies in medication lists generated from comprehensive patient interview and physician-acquired medical history were reported in up to 67% of cases at the time of admission to the hospital (25).…”

Section: Systematic Medication Reconciliation Is Not Performed In Diamentioning

confidence: 99%

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Pai

Cardone

Manley

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPatients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.

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Drug Record Discrepancies in an Outpatient Electronic Medical Record: Frequency, Type, and Potential Impact on Patient Care at a Hemodialysis Center

Abstract: Drug record discrepancies occur frequently among patients undergoing hemodialysis. Incorporation of a pharmacist into the patient care team may increase the accuracy of the electronic drug record and avert unnecessary drug-related problems.

Cited by 69 publications

References 27 publications

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

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