Impact of pharmacist's directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting

Abstract

Objectives To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies and improving patient's outcomes at discharge from hospital. Methods During the 3‐month study period, 200 patients were randomly selected from internal medicine department from Jordan University Hospital (JUH) and allocated into two groups (intervention and control groups). The number and types of medication discrepancies were identified at admission. Then, pharmacist implemented medication reconciliation and medication counselling services to the intervention group patients. At discharge, the number of unintentional discrepancies was evaluated for both groups. Patients were assessed at 1 month following their discharge for any subsequent hospital readmissions, emergency department visits or side effects of medication therapy. Key findings The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group. Omission and addition represented the most common types of discrepancies for both groups. Of the 84 recommendations submitted by pharmacists, clinicians accepted 78 cases (92.8%), and implemented only 46 recommendations (54.7%). At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, P‐value (0.014), while no significant change was found for the control group, P‐value = 0.508. One month postdischarge, a significantly higher number of patients in the control group reported experiencing side effects compared with the intervention group, P‐value = 0.020. Conclusion The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors and improving health outcomes.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…The outcome denominator was clearly defined in all papers and the data collection method was described clearly in all but one study [91]. The study setting was clearly described in all but six studies [73,80,90,91,93,98]. Validity measures, to assess if independent personnel or an expert panel evaluated the event other than the data collector, were applied in 29 studies […”

“…Three studies [62,64,68] All studies explicitly used the number of discharged patients as their denominator. Across five studies [24,58,64,73,91] that used patients affected by events as their numerator, a median of 27% (IQR 18-40.5) of adult and elderly patients experienced one or more ADRs post-hospital discharge. Two studies [24,73] that used a telephone follow-up as the most common data collection method reported the rate of ADRs post-discharge to be 20.4-27% of discharged patients.…”

“…Across five studies [24,58,64,73,91] that used patients affected by events as their numerator, a median of 27% (IQR 18-40.5) of adult and elderly patients experienced one or more ADRs post-hospital discharge. Two studies [24,73] that used a telephone follow-up as the most common data collection method reported the rate of ADRs post-discharge to be 20.4-27% of discharged patients. A range of 27-51% of elderly discharged patients (n = 3) experienced ADRs post-discharge [24,58,64].…”

Exit-Knowledge About Dispensed Medications and Associated Factors Among Patients Attending the Outpatient Pharmacy of Ambo General Hospital, Western Ethiopia

“…[5][6][7][8] A strong pharmacist-patient relationship is essential to ensure the safe use of drug and prevent the occurrence of drug therapy problems. [9][10][11][12] The pharmacist should provide sufficient to patients about the name of the medication and counsel them about, the frequency and duration of therapy, the route of administration, and the potential toxicities the medication dispensed. 7 Several factors affect the dispensing practice of pharmacists, such as the language barrier, the pharmacists' commitments, knowledge and experience and the dispensing room environment.…”

Evaluation of the completeness of information sources used to prepare the best possible medication histories at a tertiary teaching hospital in Jordan

“…12 It was shown that patients had less medication errors when medication reconciliation was performed compared with patients who received standard care. 13,14 Although medication reconciliation has been found to be beneficial in reducing medication discrepancies in both adult and paediatric populations, 12,[15][16][17] however, its success is highly dependent on the ability of healthcare providers to accurately and completely collect a reliable patient medication history at the beginning of the process.…”