The medication reconciliation process and classification of discrepancies: a systematic review

Almanasreh, Enas; Moles, Rebekah; Chen, Timothy

doi:10.1111/bcp.13017

Cited by 93 publications

(81 citation statements)

References 109 publications

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“…Almanasreh et al . in their systematic review reported that a majority of studies related to medication reconciliation process used an empirical classification of discrepancies 26. In the same review, they suggested that “in order to understand the medication reconciliation process and identify the strategies for standardization, we need to clearly define and classify medication discrepancies as these are the only quantitative measures related to the medication reconciliation process”.…”

Section: Discussionmentioning

confidence: 99%

Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Mazhar¹,

Akram²,

Al-Osaimi

et al. 2017

Pharm Pract (Granada)

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Background:Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it.Objective:The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors.Methods:This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors.Results:A total of 328 patients (138 in surgical and 198 in medical) were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6%) were reconciliation errors. The errors affected 177 patients (54%). The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (p<0.001). In both groups, the most frequent reconciliation error was the omission (43.5% and 51.2%). Lipid-lowering (12.4%) and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17.7% were rated as potentially harmful. A multivariate logistic regression model showed that patients aged ≥65 years, polypharmacy, and prescriptions for hypoglycemic drugs and warfarin were more likely associated with reconciliation errors.Conclusion:There is a high failure rate in medication reconciliation process in patients admitted to the medical and surgical department. The reconciliation process proves to be a useful tool since nearly half of avoided reconciliation errors were unintentional and had the potential for harm. This strategy, based on our results and the difficulty of applying the process to all patients should be directed primarily to the patients at increased risk of error.

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Section: Discussionmentioning

confidence: 99%

Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Mazhar¹,

Akram²,

Al-Osaimi

et al. 2017

Pharm Pract (Granada)

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“…Medication error may include the addition, withdrawal or changed dosage of a drug without documentation as stated by Midlöv et al [3], while medication discrepancy is a wider concept commonly also including changes in the mode or frequency of administration [4,5]. However, no clear and uniform definition exists [6].…”

Section: Introductionmentioning

confidence: 99%

Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

Caleres

Modig

Midlöv

et al. 2019

Drugs - Real World Outcomes

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Background and Objective Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients. Methods Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient-and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed. Results Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76-0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48-4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05-1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55-5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88-0.99). Conclusions Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.

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“…We only would obtain a BPMH compared with a gold standard medication list after talking with patients and/or caregivers. Using the PharmaCloud system, we implemented medication reconciliation to find medication discrepancy as an unintended error in prescribing admission medications . The PharmaCloud system has been shown to improve the quality of care and prevent 5.83% of duplicated prescriptions .…”

Section: Discussionmentioning

confidence: 99%

“…Using the PharmaCloud system, we implemented medication reconciliation to find medication discrepancy as an unintended error in prescribing admission medications. 14…”

Section: Discussionmentioning

confidence: 99%

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

Hung

Chen

et al. 2019

Brit J Clinical Pharma

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Aims The aim of this study was to improve medication reconciliation and reduce the occurrence of duplicate prescriptions by pharmacists and physicians within 72 hours of hospital admission using an intelligent prescription system combined with the National Health Insurance PharmaCloud system to integrate the database with the medical institution computerized physician order entry (CPOE) system. Methods This 2‐year intervention study was implemented in the geriatric ward of a hospital in Taiwan. We developed an integrated CPOE system linked with the PharmaCloud database and established an electronic platform for coordinated communication with all healthcare professionals. Patients provided written informed consent to access their PharmaCloud records. We compared the intervention effectiveness within 72 hours of admission for improvement in pharmacist medication reconciliation, increased at‐home medications documentation and decreased costs from duplicated at‐home prescriptions. Results The medication reconciliation rate within 72 hours of admission increased from 44.0% preintervention to 86.8% postintervention (relative risk = 1.97, 95% confidence interval [CI]: 1.69–2.31; P < .001). The monthly average of patients who brought and took home medications documented in the CPOE system during hospitalization increased by 7.54 (95% CI 5.58–20.49, P = .22). The monthly average of home medications documented increased by 102.52 (95% CI 38.44–166.60; P = .01). Savings on the monthly average prescription expenditures of at‐home medication increased by US$ 2,795.52 (95% CI US$1310.41–4280.63; P < .01). Conclusion Integrating medication data from PharmaCloud to the hospital's medical chart system improved pharmacist medication reconciliation, which decreased duplicated medications and reduced in‐hospital medication costs.

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The medication reconciliation process and classification of discrepancies: a systematic review

Cited by 93 publications

References 109 publications

Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

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