Medication reconciliation in the emergency department: opportunities for workflow redesign

Hummel, Jeffrey W.; Evans, P C; Lee, H

doi:10.1136/qshc.2009.035121

Cited by 16 publications

(33 citation statements)

References 19 publications

(10 reference statements)

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“…However, application of HLM stimulates discussion about how to solve system and process issues and improve quality and patient safety 22,60,68,74. Most of the analyzed papers have underscored the limits of HLM and barriers to its implementation,9,21,31,32,39,52,54,56,57,60,62,63,65,66,68,78 demonstrating that HLM can not be successfully implemented without considering the proper critical factors and precautions highlighted in the previous section of this paper.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for overcoming hospital managerial challenges: a systematic literature review

Crema

Verbano

2013

TCRM

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PurposeThe need to respond to accreditation institutes’ and patients’ requirements and to align health care results with increased medical knowledge is focusing greater attention on quality in health care. Different tools and techniques have been adopted to measure and manage quality, but clinical errors are still too numerous, suggesting that traditional quality improvement systems are unable to deal appropriately with hospital challenges. The purpose of this paper is to grasp the current tools, practices, and guidelines adopted in health care to improve quality and patient safety and create a base for future research on this young subject.MethodsA systematic literature review was carried out. A search of academic databases, including papers that focus not only on lean management, but also on clinical errors and risk reduction, yielded 47 papers. The general characteristics of the selected papers were analyzed, and a content analysis was conducted.ResultsA variety of managerial techniques, tools, and practices are being adopted in health care, and traditional methodologies have to be integrated with the latest ones in order to reduce errors and ensure high quality and patient safety. As it has been demonstrated, these tools are useful not only for achieving efficiency objectives, but also for providing higher quality and patient safety. Critical indications and guidelines for successful implementation of new health managerial methodologies are provided and synthesized in an operative scheme useful for extending and deepening knowledge of these issues with further studies.ConclusionThis research contributes to introducing a new theme in health care literature regarding the development of successful projects with both clinical risk management and health lean management objectives, and should address solutions for improving health care even in the current context of decreasing resources.

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Section: Resultsmentioning

confidence: 99%

Guidelines for overcoming hospital managerial challenges: a systematic literature review

Crema

Verbano

2013

TCRM

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“…In addition, it was found that implementation of the eMedRec tool had a significant impact on improving compliance 31 32. Meanwhile, one study demonstrated that increased participation of patients and clerical staff in the generation of medication lists can improve the MedRec process 33. Whether the workflow can function to facilitate or increase the compliance of MedRec remains unknown, due to a lack of more evidence.…”

Section: Discussionmentioning

confidence: 99%

Electronic medication reconciliation in hospitals: a systematic review and meta-analysis

et al. 2018

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ObjectiveMedication reconciliation (MedRec) is recognised as a multiprofessional process for the prevention of medication discrepancies. The goal of this study is to evaluate the available electronic medication reconciliation (eMedRec) tools and their effect on unintended discrepancies that occur in hospital institutions.MethodPubMed, EMBASE, the Cochrane Library, Web of Science, the ClinicalTrials.gov website and four other Chinese databases were searched for relevant studies starting from their inception through October 2017. Methodological quality was assessed using the nine standard criteria of Cochrane Effective Practice and Organisation of Care Review Group (EPOC) and meta-analysis was performed using RevMan5.3 software.ResultsA total of 13 studies (three randomised controlled trials and 10 non-randomised controlled trials) were identified. Meta-analysis results demonstrated a reduced number of medications with unintended discrepancies (relative risk (RR)=1.85, 95% confidence interval (CI) 1.55 to 2.21), while no statistically significant differences were observed in the number of patients with unintended medication discrepancies (RR=2.74, 95% CI 0.59 to 12.73). Common discrepancies included medication omission, dose discrepancy, and frequency discrepancy. We found that the clinical impact of medication discrepancy was mild. A total of 12 electronic tools were reported and were mostly integrated into the hospital’s information system. However, the usability, user adherence, and user satisfaction were found to lack sufficient evidence.ConclusioneMedRec was shown to reduce the incidence of medication with unintended discrepancies and improve medication safety. However, the electronic tools are diversified and the effects on other outcomes still require a comprehensive evaluation.Systematic review registrationPROSPERO CRD42017067528.

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“…18 Until now, only one study has used a process mapping technique to address MedRec. An evaluation of four community hospital EDs in Washington identified common problems that inhibited high-quality and efficient MedRec, which led to the development of an improved workflow 19. However, the process mapping was only done in focus groups, so represented what clinicians believed to happen, rather than what was actually observed to happen.…”

Section: Introductionmentioning

confidence: 99%

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

et al. 2016

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BackgroundMedication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness.MethodsProcess engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions.ResultsAcross all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses.DiscussionMedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required.

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Medication reconciliation in the emergency department: opportunities for workflow redesign

Cited by 16 publications

References 19 publications

Guidelines for overcoming hospital managerial challenges: a systematic literature review

Guidelines for overcoming hospital managerial challenges: a systematic literature review

Electronic medication reconciliation in hospitals: a systematic review and meta-analysis

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

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