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Annual for Hospital Pharmacy

Optimising pharmacy input to medicines reconciliation at admission to hospital: Lessonsfrom a collaborative service evaluation ofpharmacy-led medicines reconciliation services in 30 acute hospitals in England

Linda J Dodds

Abstract

Objective: To compare pharmacy team input to medicines reconciliation (MR) in a variety of care areas in order to inform optimisation of service delivery.

Methods: 30 acute hospital pharmacy departments evaluated their MR services in 10 care areas using a piloted data collection form. Omitted medicines and wrong dose discrepancies on the admission prescription were recorded and rated for clinical severity. Data were collected on whether the admission was planned, the number of coprescribed medicines and if the patient had brought their home medicines into hospital.

Results: 3086 MRs were reviewed and 4041 unintended discrepancies (UDs) in prescribing were identified (mean 1.3/MR). 1616 UDs (0.52 per patient) were ranked as having the potential for moderate impact on patient care (Level 3). Level 3 UDs were identified in all care areas; however, Admissions, Care of the Elderly, General Surgery and Orthopaedic patients had more Level 3 UDs per patient than the total population (twotailed Z test, 99% CI). More UDs was ranked Level 3 in Care of the Elderly and General Surgery patients (twotailed Z test, 99% CI). Over 80% of recorded errors involved four prescribing categories (cardiovascular, central nervous system, endocrine, respiratory). Planned admissions and the presence of the patients` own medicines had little impact on the accuracy of admission prescribing. The average time to carry out MR was 15 min.

Conclusions: Prioritisation of pharmacy-led MR by care area or type of admission alone is not a safe option. Opportunities should instead be taken to explore multidisciplinary methods of implementing MR which optimise available information.


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References

Dornan T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. Final report. http://www.gmc-uk.org/about/research/research_commissioned_4.asp (accessed 8 Aug 2013).

Tam VC, Knowles SR, Cornish PL, et al. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J 2005;173:510-15.

Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care 2006;15:122-6.

Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;165:424-9.

De Winter S, Spriet I, Indevuyst C, et al. Pharmacist-versus physician-acquired medication history: a prospective study at the emergency department. Qual Saf Health Care 2010;19:371-5.

Gleason KM, McDaniel MR, Feinglass J, et al. Results of the medications at transitions and clinical handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med 2010;25:441-7.

Bell CM, Brener SS, Gunraj N, et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. J Am Med Assoc 2011;306:840-7.

Bell CM, Bajcar J, Bierman AS, et al. Potentially unintended discontinuation of long-term medication use after elective surgical procedures. Arch Intern Med 2006;166:2525-31.

Institute for Healthcare Improvement. Medicines reconciliation at all transitions. http://app.ihi.org/imap/tool/#Process=7ce51016-b4f0-423c-9f8b-5e1ea8d7b810 (accessed 8 Aug 2013).

National Institute for Health and Clinical Excellence. PSG001 Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. 12 December 2007. http://guidance.nice.org.uk/PSG001/Guidance/doc/English (accessed 8 Aug 2013).

Karnon J, Campbell F, Czoski-Murray C. Model-based cost-effectiveness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation). J Eval Clin Prac 2009;15:299-306.

Greenwald JL, Halasyamani L, Greene J, et al. Making inpatient medication reconciliation patient centred, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med 2010;5:477-85.

Dodds L. The time-scale for delivery of pharmacy-led medicines reconciliation: results of a collaborative audit across East and South East England. Int J Pharm Prac 2010;18(Suppl 2):41-2.

Dodds L. Unintended discrepancies between pre-admission and admission prescriptions identified by pharmacy-led medicines reconciliation: results of a collaborative service evaluation across east and South East England. Int J Pharm Prac 2010;18(Suppl 2):9-10.

British Medical Society & Royal Pharmaceutical Society. British National Formulary 58 September 2009. Basingstoke, UK: Pharmaceutical Press. http://www.pharmpress.com

National Patient Safety Agency. National Reporting and Learning Service. http://www.nrls.npsa.nhs.uk (accessed 8 Aug 2013).

Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices. A systematic review. Arch Intern Med 2012;172:1057-69.

The Information Centre for Health and Social Care. Prescription cost analysis England 2010. http://www.ic.nhs.uk/webfiles/publications/007_Primary_Care/Prescribing/Prescription_Cost_Analysis_England_2010/Prescription_Cost_Analysis_2010.pdf (accessed 10 Jan 2012).

Van Sluisveld N, Zegers M, Natsch S, et al. Medicine reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety. BMC Health Serv Res 2012;12:170.

Tschantz Unroe K, Pfeiffenberger T, Riegelhaupt S, et al. Inpatient medication reconciliation at admission and discharge: a retrospective cohort study of age and other risk factors for medication discrepancies. Am J Geriatr Pharmacother 2010;8:115-26.

Varkey P, Cunningham J, O`Meara J, et al. Multidisciplinary approach to inpatient medication reconciliation in an academic setting. Am J Health Syst Pharm 2007;64:850-4.

The Royal Pharmaceutical Society. Keeping patients safe when they transfer between care providers- getting the medicines right. Good practice guidance for healthcare professionals. July 2011. http://www.rpharms.com/getting-the-medicines-right/professional-guidance.asp (accessed 10 Jan 2012).

Schnipper JL, Hamann C, Ndumele CD, et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse events. Arch Intern Med 2009;169:771-80.

Bookvar KS, Blum S, Kugler A, et al. Effect of admission medication reconciliation on adverse drug events from admission medication changes (research letter). Arch Intern Med 2011;171:860-1.




DOI: http://dx.doi.org/10.14748/.v2i1.1887

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