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Optimizing Medication Use through Health Information Technology
Published in Salvatore Volpe, Health Informatics, 2022
Troy Trygstad, Mary Ann Kliethermes, Anne L. Burns, Mary Roth McClurg, Marie Smith, John Easter
Medication handoffs (or lack thereof) are extremely common in our modern healthcare system and require a high level of operational coordination, yet we lack a common lexicon that is universally accepted or understood when engaging in team-based, multi-setting, multi-modality MOS. Conventional use of the term “medication reconciliation” is an unfortunate but salient example of a set of MOS that have generally failed to live up to their potential to prevent harm and produce better patient outcomes owing to a lack of clarity about the intended activities and environmental factors required for successful execution. Current deployments of medication reconciliation range from the application of a software-based algorithm implementing cursory review of a single medication list in a computerized prescription order entry system, to comparing and evaluating an admitted patient’s self-proclaimed list of medications, to the discharge list of medications to the home health’s report of medication use, to the active medication list in the ambulatory clinic’s electronic medical record. Both are broadly considered medication reconciliation and are valuable in their own right when called for, but they vary dramatically in their intensity, depth and appropriateness for a given patient circumstance or situation.
Medicines reconciliation: a case study
Published in Paul Bowie, Carl de Wet, Aneez Esmail, Philip Cachia, Safety and Improvement in Primary Care: The Essential Guide, 2020
Medicines reconciliation is an issue at all interfaces of care but it is particularly important when patients are admitted and discharged from hospital. A schematic detailing the key transitions of care where medicines reconciliation should be done is shown in Figure 28.1. There is evidence that this process does not happen reliably,6.7 with local audits conducted in a single health authority reporting just over half of patients admitted to one of its hospitals had one or more of their usual medicines unintentionally omitted from their prescription chart.8 In total, 60% of patients had medication discrepancies on discharge specifically, relating to medicines that had been started and/or stopped during the admission.9,10
Engaging Patients with Personal Health IT for Quality
Published in Jan Oldenburg, Dave Chase, Kate T. Christensen, Brad Tritle, Engage!, 2020
Many more studies document quality gaps in different areas. EHR data is consistently found to be missing or error-prone. A 2004 study by Kaboli et al found almost 95% of medication lists had some inaccuracies.11 Omissions (medicines taken by the patient but not listed in the EHR) were 25%; commissions (medicines not taken by the patient but listed in the EHR) were 12%. These results highlight the importance of medication reconciliation at each patient visit, as well as the limitations of clinical decision support in accurately processing drug-drug and other types of interactions that rely on accurate data. One third of patients had errors in their allergy and adverse drug reaction list—mostly omissions. Schnipper found gaps not only in medication information, but family history data as well.12 Putting medication lists and medication allergies online can help here too. Some practices are engaging patients in reconciling their medications.13 Patient-facing drug-drug interaction checkers can help, too.
Optimizing pharmacotherapy on geriatric hospital units in Belgium – a national survey
Published in Acta Clinica Belgica, 2022
Julie Hias, Lorenz Van der Linden, Karolien Walgraeve, Jean-Claude Lemper, Laura Hellemans, Isabel Spriet, Jos Tournoy
Most geriatric units performed medication reconciliation both on admission and at discharge and this for a majority of patients. Medication reconciliation on admission was defined in the survey as solely compiling a preadmission medication list. More details on how this was actually executed and whether a comparison was made with other available medication lists was not examined further in this survey. Medication reconciliation is an important first step to optimize drug use in older inpatients, due to older age and polypharmacy both being important determinants for unintentional discrepancies [16]. Strategies to optimize the medication reconciliation process, such as electronic exchanges services, were only available in a third of the hospitals, with an underwhelming minority (n = 3) actually using these software applications in daily practice [17]. Currently, such software packages, e.g. Vitalink© and Abrumed©, are suffering from low implementation in hospitals. This can mainly be explained by the very low uptake in primary care and suboptimal linkage between the many different software packages that are currently being used by Belgian HCP. For example, Vitalink© was primarily developed for sharing health and welfare data between primary care stakeholders and not to communicate medication information between primary and secondary care [18]. Further implementation in secondary care is currently strongly awaited by all involved stakeholders.
Problems in continuity of medication management upon transition between primary and secondary care: patients’ and professionals’ experiences
Published in Acta Clinica Belgica, 2019
Veerle Foulon, Joke Wuyts, Franciska Desplenter, Anne Spinewine, Valérie Lacour, Dominique Paulus, Jan De Lepeleire
Seamless care is defined as ‘the desirable continuity of care delivered to a patient in the health care system across the spectrum of caregivers and environments’ [10]. This seamless transition with regard to medication management is one crucial prerequisite for appropriate, safe patient care. Many interventions, including medication reconciliation, have been tested to improve continuity of care. Medication reconciliation is defined as ‘the process of identifying an accurate list of a person’s current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated’ [11]. Medication reconciliation by hospital and community pharmacists reduces medication discrepancies [12–14]. Overall, there is currently insufficient evidence to draw conclusions about the effects of most of these interventions on hard endpoints related to the quality of medication management [15]. One of the reasons may be that most quality improvement projects are designed intuitively, without systematic approach [16]).
Creating and evaluating an opportunity for medication reconciliation in the adult population of South Africa to improve patient care
Published in Hospital Practice, 2018
Pranusha Naicker, Natalie Schellack, Brian Godman, Elmien Bronkhorst
Medication reconciliation: This is a process of systematically identifying the medications a patient is currently taking in their home and comparing them with newly ordered medications in the hospital [20].Medication error: Any preventable event that occurs during any stage of the medication use process that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer [41,42]. Furthermore, it can also be defined as ‘Any preventable events that may cause or lead to inappropriate medication use or patient harm’.Pharmaceutical care: The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life [43]. It is further stated that it is based on a relationship between the patient and the healthcare providers, who accept responsibility to provide care to the patients, and involves the active participation of both the patient and the healthcare provider in drug therapy decisions [44].