Medication reconciliation on discharge in a tertiary care Riyadh Hospital: An observational study

Abstract

The purpose of this study was to assess the frequency and characteristics of discharge medication discrepancies as identified by pharmacists during discharge medication reconciliation. We also attempted to identify the factors that influence the occurrence of drug discrepancies during medication reconciliation. From June to December 2019, a prospective study was performed at the cardiac center of King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh. The information from discharge prescriptions as compared to the medication administration record (MAR), medication history in the cortex system, and the patient home medication list collected from the medication reconciliation form on admission. The study included all adult patients discharged from KFMC’s cardiac center. These participants comprised 776 patients, 64.6 percent of whom were men and 35.4 percent of whom were women. Medication discrepancies were encountered in 180 patients (23.2%) out of 776 patients. In regards to the number of discharged medications, 651(83.9%) patients had ≥ 5 medications. Around, 174 (73.4%) discrepancies were intentional, and 63 (26.6%) were unintentional discrepancies. The risk of unintentional medication discrepancy was increased with an increasing number of medications (P-value = 0.008). One out of every four cardiac patients discharged from our hospital had at least one medication discrepancy. The number of drugs taken and the number of discrepancies was found to be related. Necessary steps should be taken to reduce these discrepancies and improve the standard of care.

Evaluation of Medication Reconciliation Process Among Home Medication, Hospital Admission, Transition Across Different Wards, and Discharge in Mizan Tepi University Teaching Hospital South West Ethiopia: A Prospective Cross-Sectional Study

“…Medication reconciliation is the "process of identifying the most accurate list of all medications a patient is taking [1][2][3][4][5][6][7][8][9][10][11][12][13] Medication discrepancies are de ned as unexplained changes to patients' medication among regimens across different care sites [1][2][3][4][5][6][7][8][9][10][11][12][13] Omission; canceling of a pre-admission prescription medication [9,10,11,12,13].…”

A Importância De Inserir E Desenvolver a Reconciliação Medicamentosa Nos Hospitais: Revisão Sistemática

“…Assim, entende-se que a reconciliação medicamentosa é uma iniciativa eficaz para garantir a segurança do paciente e que visa prevenir ou reduzir discrepâncias ou inconsistências de medicação (Alanazi et al, 2022;Dong et al, 2022). Neste sentido, um estudo prospectivo aponta que a promoção da reconciliação de medicamentos na admissão, ajudou a reduzir discrepâncias não intencionais, melhorando a segurança no uso dos medicamentos e por extensão, Todavia, estudos científicos têm comprovado que além de reduzir desproporções de medicação, por meio da implementação da RM é possível identificar a não adesão à medicação, baixa alfabetização sobre medicação e o uso de medicamentos não prescritos, tais como suplementos e vitaminas (Van der Nat et al, 2022).…”

“…Segundo Lombardi et al (2016) a omissão e a polifarmácia as principais responsáveis por tal discrepância (Alanazi et al, 2022).…”

Arzneimittelversorgung zwischen ambulanter und stationärer Behandlung

“…Nur wenn die häusliche Medikation bei Aufnahme in das Krankenhaus korrekt und umfassend erhoben und dokumentiert wird, ist eine sichere Arzneimitteltherapie während des stationären Aufenthalts und vor allem bei der Entlassung möglich (Francis et al 2021) Ebenso wie bei der Arzneimittel-Anamnese gibt es zahlreiche Studien, die bei der Entlassung aus dem Krankenhaus Diskrepanzen in der Medikation bei 25 bis 55 % der Patienten belegen (Alanazi et al 2022;Wong et al 2008;Dei Tos et al 2020). Dabei kann es sich sowohl um beabsichtigte -aber nicht dokumentierte -als auch um unbeabsichtigte Diskrepanzen handeln, wobei das Risiko für Letztere mit der Anzahl der angewendeten Arzneimittel und der Dauer des Krankenhausaufenthalts ansteigt.…”