TY - JOUR
T1 - Longitudinal medication reconciliation at hospital admission, discharge and post-discharge
AU - Daliri, Sara
AU - Bouhnouf, Mounia
AU - van de Meerendonk, Henk W. P. C.
AU - Buurman, Bianca M.
AU - Scholte op Reimer, Wilma J. M.
AU - Kooij, Marcel J.
AU - Karapinar – Çarkit, Fatma
N1 - Funding Information: This study was supported by a research grant of the Netherlands Organisation for Health Research and Development (ZonMw) , Grant Number 836044008 . Publisher Copyright: © 2020 Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Medication reconciliation (MR) is a widely recognised method to promote patient safety. However, its implementation is generally limited to an interaction at a single transition point. Objectives: To examine the rates and types of changes implemented in patient's medication regimens when MR is performed longitudinally at hospital admission, discharge and post-discharge, and to assess the clinical impact. Methods: A prospective multicentre cohort study was conducted in two hospitals. Patients received MR at admission, discharge and within five days post-discharge at home. Data was collected on rates and types of changes implemented in their medication regimens, due to MR, at all three transition points. These changes entailed corrections of unintentional discrepancies, e.g., between patients’ actual medication use and physician prescriptions, and optimisations of pharmacotherapy, e.g., adding laxatives when opioids are prescribed. Using a validated instrument, the clinical impact of all medication changes were scored. Data were analysed using descriptive statistics. Results: In total, 197 patients with a median age of 73 years were included. In 86.3% of patients at least one change was implemented in the medication regimen due to longitudinal MR. At admission, discharge and post-discharge, changes in medication regimens were necessary in 66.5%, 62.9% and 52.8% of patients, respectively. At admission and post-discharge, mainly unintentional discrepancies were corrected, and at discharge mainly optimisations were implemented. Implemented medication changes, due to longitudinal MR, prevented potential harm in 161 patients (81.7%). Potentially serious medication errors were most often prevented at hospital discharge, and predominantly involved optimising antithrombotic agents. Conclusions: Changes in medication regimens were implemented in 86.3% of patients due to longitudinal MR at admission, discharge and post-discharge. The rates and types of medication changes vary over time. Hospital discharge is an important moment for optimising pharmacotherapy.
AB - Background: Medication reconciliation (MR) is a widely recognised method to promote patient safety. However, its implementation is generally limited to an interaction at a single transition point. Objectives: To examine the rates and types of changes implemented in patient's medication regimens when MR is performed longitudinally at hospital admission, discharge and post-discharge, and to assess the clinical impact. Methods: A prospective multicentre cohort study was conducted in two hospitals. Patients received MR at admission, discharge and within five days post-discharge at home. Data was collected on rates and types of changes implemented in their medication regimens, due to MR, at all three transition points. These changes entailed corrections of unintentional discrepancies, e.g., between patients’ actual medication use and physician prescriptions, and optimisations of pharmacotherapy, e.g., adding laxatives when opioids are prescribed. Using a validated instrument, the clinical impact of all medication changes were scored. Data were analysed using descriptive statistics. Results: In total, 197 patients with a median age of 73 years were included. In 86.3% of patients at least one change was implemented in the medication regimen due to longitudinal MR. At admission, discharge and post-discharge, changes in medication regimens were necessary in 66.5%, 62.9% and 52.8% of patients, respectively. At admission and post-discharge, mainly unintentional discrepancies were corrected, and at discharge mainly optimisations were implemented. Implemented medication changes, due to longitudinal MR, prevented potential harm in 161 patients (81.7%). Potentially serious medication errors were most often prevented at hospital discharge, and predominantly involved optimising antithrombotic agents. Conclusions: Changes in medication regimens were implemented in 86.3% of patients due to longitudinal MR at admission, discharge and post-discharge. The rates and types of medication changes vary over time. Hospital discharge is an important moment for optimising pharmacotherapy.
KW - Medication error
KW - Medication reconciliation
KW - Patient safety
KW - Pharmacists
KW - Transitions in care
UR - http://www.scopus.com/inward/record.url?scp=85086151469&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.sapharm.2020.05.022
DO - https://doi.org/10.1016/j.sapharm.2020.05.022
M3 - Article
C2 - 32532579
SN - 1551-7411
VL - 17
SP - 677
EP - 684
JO - Research in Social and Administrative Pharmacy
JF - Research in Social and Administrative Pharmacy
IS - 4
ER -