Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events

Schnipper, Jeffrey L.; Hamann, Claus; Ndumele, Chima D.; Liang, Catherine; Carty, Marcy G.; Karson, Andrew S.; Bhan, Ishir; Coley, Christopher M.; Poon, Eric G.; Turchin, Alexander; Labonville, Stephanie; Diedrichsen, Ellen K.; Lipsitz, Stuart; Broverman, Carol A.; McCarthy, Patricia C.; Gandhi, Tejal K.

doi:10.1001/archinternmed.2009.51

Cited by 220 publications

(220 citation statements)

References 25 publications

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“…For example, other studies report at least some understanding of new medications among 64-68 % of patients; 16,17,25 the corresponding rate in our study was 53.2 %. These low rates of understanding existed despite the fact that we allowed patients to consult discharge instructions or other documentation in answering the survey, excluded clearly cognitively impaired patients, and excluded medication changes that were potential provider errors.…”

Section: Discussionsupporting

confidence: 59%

“…By contrast, a recent study of an electronic medication reconciliation intervention demonstrated a reduction in provider errors. 25 Our hospital's electronic records system for discharge instructions does not provide a formal reconciliation process for admission home medications, inpatient orders, and anticipated discharged medications. It is therefore possible that systems factors such as information technology play a larger role in transitionrelated medication errors than provider factors such as level of training or expertise.…”

Section: Discussionmentioning

confidence: 99%

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Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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“…The investigators describe a random component in the sequence generation process 2 The description of the sequence generation involve some systematic but non-random approach 3 Insufficient information permit judgment of 'Low risk' or 'High risk'…”

Section: Selection Bias (Randomisation)mentioning

confidence: 99%

“…Poor communication of clinical information at healthcare transitions is 32 responsible for over 50% of all medication errors and up to 20% of adverse events. [1][2][3][4] …”

mentioning

confidence: 99%

“…2,8,9,10 In the US, the Joint Commission for health care 41 organizations accreditation defines MR as the process of "obtaining and maintaining 42 an accurate, detailed list of all medicines taken by a patient and using this list to 43 provide correct medicines anywhere within the health care system". 10 In the UK, MR is 44 described similarly and recommended to be performed every time a transfer of care takes 45 place.…”

mentioning

confidence: 99%

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Pharmacy led medicine reconciliation at hospital: A systematic review of effects and costs

Hammad

Bale

Wright

et al. 2017

Research in Social and Administrative Pharmacy

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Effect of Admission Medication Reconciliation on Adverse Drug Events From Admission Medication Changes

Boockvar¹

2011

Arch Intern Med

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M edication reconciliation, a process by which a health care provider obtains and documents a thorough medication history with specific attention to comparing current and previous medication use, has been a focus of major patient safety initiatives. Evaluations of medication reconciliation programs have reported factors associated with successful implementation 1 and its effect on prescribing outcomes such as medication errors 2 and potential adverse drug events 3 but not its effect on actual adverse drug events (ADEs). The objective of this study was to estimate the effectiveness of inpatient medication reconciliation at the time of hospital admission on ADEs caused by admission prescribing changes.Methods. The study setting was an urban, academic Department of Veterans Affairs (VA) medical center. A computerized medication reconciliation tool and admission process were developed to comply with the Joint Commission's National Patient Safety Goal. The tool consisted of a dialogue with which a health care provider could (1) view the patient's outpatient medication use for the last 90 days from VA computerized pharmacy data, (2) view current VA inpatient orders, (3) record discrepancies between patientreported medications and outpatient and inpatient medications in the VA computerized database, and (4) record diagnostic indications for each medication and a response to each discrepancy. The tool was implemented in a staggered fashion between

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Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events

Cited by 220 publications

References 25 publications

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Pharmacy led medicine reconciliation at hospital: A systematic review of effects and costs

Effect of Admission Medication Reconciliation on Adverse Drug Events From Admission Medication Changes

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