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The implementation of pharmacist driven medication reconciliation program at the admission to hospital

Year 2014, Volume: 4 Issue: 4, 226 - 231, 03.05.2015

Abstract

Objective: The aim of the study was to evaluate pharmacist driven medication reconciliation program at the admission to hospital. 

Method: This study was conducted between February 13, 2012 and April 29, 2012 (two days in a week) at internal medicine and oncology service of a private hospital located in Istanbul, Turkey. Patients were eligible if they were older than 18 years old and if the medication reconciliation form was compiled within 48 hours of admission. The pharmacists reviewed if there were any discrepancies between a patient’s home medication and medications prescribed on admission to the hospital. When the discrepancies were found, the pharmacists investigated further whether if this discrepancy was intentional or unintentional by communicating with patient, patient caregiver, the physician or by checking patient’s pharmacy record. Potentially high-risk admission discrepancies were also identified. The discrepancies were classified as omission, duplication, and name/dose/route confusion. 

Results: Fifty four patients (mean age, 61.07±15.21 years; 26 female / 28 male) were included in the study. Twenty three patients were older than 65 years The overall rate of recently started medications at admission to hospital was 6.4 per patient. Forty seven patients utilized at least one high-risk medication. In admission to hospital, at least one medication was intentionally or unintentionally discontinued in 35 patients. In medication reconciliation process, the total of 23 unintended discrepancies were determined among 12 patients. The overall rate of unintended discrepancies was 0.43 per patient. The most common unintended discrepancies were name/dose/route confusion (n=12) and omission of regularly used medication (n=9). 91.70% of the patients with unintended discrepancy utilized at least one high-risk medication. 

Conclusion: This study showed that the pharmacist driven medication reconciliation program would provide benefit on decreasing medication related problems during admission to hospital and needs to be implemented.

References

  • Izzettin FV, Apikoglu-Rabus S, Okuyan B, Sancar M. İlaç Güvenliği. In: Sur H, Palteki T, eds. Hastane Yönetimi. İstanbul: Nobel Tıp Kitabevleri; 2013. p.570-571.
  • Durán-García E1, Fernandez-Llamazares CM, Calleja-Hernández MA. Medication reconciliation: passing phase or real need? Int J Clin Pharm. 2012;34(6):797-802.
  • Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, Dupont AG. Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother. 2010;44(10):1596-1603.
  • De Winter S, Spriet I, Indevuyst C, Vanbrabant P, Desruelles D, Sabbe M, Gillet JB, Wilmer A, Willems L. Pharmacist- versus physician- acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19(5):371-375.
  • Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424-429.
  • Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colón-Emeric C.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(2):115-126.
  • Kemp LO1, Narula P, McPherson ML, Zuckerman I. Medication reconciliation in hospice: a pilot study. Am J Hosp Palliat Care. 2009;26(3):193-199.
  • Allende Bandrés MÁ, Arenere Mendoza M, Gutiérrez Nicolás F, Calleja Hernández MÁ, Ruiz La Iglesia F. Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain. Int J Clin Pharm. 2013;35(6):1083-1090.
  • Quélennec B, Beretz L, Paya D, Blicklé JF, Gourieux B, Andrès E, Michel B. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013;24(6):530-535.
  • Lee YY, Kuo LN, Chiang YC, Hou JY, Wu TY, Hsu MH, Chen HY. Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan. Int J Med Inform. 2013;82(6):522-527.
  • Ghatnekar O1, Bondesson A, Persson U, Eriksson T. Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital. BMJ Open. 2013;3(1).
  • Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, Dupont AG. Discrepancies in medication information for the primary care physician and the geriatric patient at discharge. Ann Pharmacother. 2012;46(7-8):983-990.
  • Hellström LM, Bondesson Å, Höglund P, Eriksson T. Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol. 2012;12:9.
  • Buckley MS, Harinstein LM, Clark KB, Smithburger PL, Eckhardt DJ, Alexander E, Devabhakthuni S, Westley CA, David B, Kane-Gill SL. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in “high-risk” patients. Ann Pharmacother. 2013;47(12):1599-1610.
  • Beckett RD1, Crank CW, Wehmeyer A. Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients. J Pharm Pract. 2012;25(2):136-141.
  • Pippins JR1, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-1422.
  • Lizer MH1, Brackbill ML. Medication history reconciliation by pharmacists in an inpatient behavioral health unit. Am J Health Syst Pharm. 2007;64(10):1087-1091.
  • Pourrat X, Corneau H, Floch S, Kuzzay MP, Favard L, Rosset P, Hay N, Grassin J. Communication between community and hospital pharmacist: impact on medication reconciliation at admission. Int J Clin Pharm. 2013;35: 656-663.

Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi

Year 2014, Volume: 4 Issue: 4, 226 - 231, 03.05.2015

Abstract

Amaç: Çalışmanın amacı yatan hastalarda eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesiydi. 

Yöntem: Bu çalışma 13 Şubat 2012 ile 29 Nisan 2012 tarihleri arasında (haftada 2 gün olarak) İstanbul’daki özel bir hastanenin dahiliye ve onkoloji servislerinde yürütüldü. Çalışmaya 18 yaşından büyük ve hastaneye yatıştan sonraki 48 saat içinde ilaç mutabakatı formu doldurulan hastalar dahil edildi. Hastanın evde kullandığı ilaçları ile hastaneye yatışında reçete edilen ilaçlar arasındaki farklılıkları eczacılar tarafından gözden geçirildi. Bulunan farklılıkların kasıtlı ve/veya kasıtsız olup olmadığı eczacılar tarafından hasta, refakatçisi ve doktoru ile iletişim kurularak veya hastanın eczane kayıtlarından araştırıldı. Hastane yatışında saptanan ilaç farklılıklarının, potansiyel yüksek riskli ilaçları kapsayıp kapsamadığı da değerlendirildi. Farklılıklar ilaç atlanması, doz tekrarı ve ilaç ismi/dozu/yolu karışıklığı şeklinde sınıflandırıldı.

Bulgular: Çalışmada 54 hasta (ortalama yaş 61.07±15.21; 26 kadın / 28 erkek) değerlendirildi. Hastaların 23’ü 65 yaş ve üzeriydi. Hastane yatışında hastaya yeni başlanan ilaçların oranı hasta başına 6.4 idi. Hastaların 47’sinde en az bir yüksek riskli ilaç kullanımı saptandı. Hastaneye yatışta 35 hastanın en az bir ilacının kasıtlı ya da kasıtsız eksik bildirildiği gözlendi. İlaç mutabakatı sürecinde 12 hastaya ait toplamda 23 kasıtsız farklılık bulundu. Kasıtsız farklılık oranı hasta başına 0.43 idi. En sık rastlanılan kasıtsız farklılıkların ilaç ismi/dozu/yolu karışıklıkları (n=12) ve düzenli kullanılan ilaçların atlanması (n=9) olduğu görüldü. Kasıtsız farklılıklar gözlenen hastaların %91.70’si en az bir yüksek riskli ilaç kullanıyordu. 

Sonuç: Bu çalışma hastaneye yatış sırasında eczacı tarafından yürütülen ilaç mutabakatı programının yaygınlaşması gerektiğini ve hastaneye yatışta karşılaşılan ilaç kaynaklı problemlerin azaltılmasında faydalı olabileceğini göstermiştir.

References

  • Izzettin FV, Apikoglu-Rabus S, Okuyan B, Sancar M. İlaç Güvenliği. In: Sur H, Palteki T, eds. Hastane Yönetimi. İstanbul: Nobel Tıp Kitabevleri; 2013. p.570-571.
  • Durán-García E1, Fernandez-Llamazares CM, Calleja-Hernández MA. Medication reconciliation: passing phase or real need? Int J Clin Pharm. 2012;34(6):797-802.
  • Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, Dupont AG. Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother. 2010;44(10):1596-1603.
  • De Winter S, Spriet I, Indevuyst C, Vanbrabant P, Desruelles D, Sabbe M, Gillet JB, Wilmer A, Willems L. Pharmacist- versus physician- acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19(5):371-375.
  • Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424-429.
  • Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colón-Emeric C.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(2):115-126.
  • Kemp LO1, Narula P, McPherson ML, Zuckerman I. Medication reconciliation in hospice: a pilot study. Am J Hosp Palliat Care. 2009;26(3):193-199.
  • Allende Bandrés MÁ, Arenere Mendoza M, Gutiérrez Nicolás F, Calleja Hernández MÁ, Ruiz La Iglesia F. Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain. Int J Clin Pharm. 2013;35(6):1083-1090.
  • Quélennec B, Beretz L, Paya D, Blicklé JF, Gourieux B, Andrès E, Michel B. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013;24(6):530-535.
  • Lee YY, Kuo LN, Chiang YC, Hou JY, Wu TY, Hsu MH, Chen HY. Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan. Int J Med Inform. 2013;82(6):522-527.
  • Ghatnekar O1, Bondesson A, Persson U, Eriksson T. Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital. BMJ Open. 2013;3(1).
  • Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, Dupont AG. Discrepancies in medication information for the primary care physician and the geriatric patient at discharge. Ann Pharmacother. 2012;46(7-8):983-990.
  • Hellström LM, Bondesson Å, Höglund P, Eriksson T. Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol. 2012;12:9.
  • Buckley MS, Harinstein LM, Clark KB, Smithburger PL, Eckhardt DJ, Alexander E, Devabhakthuni S, Westley CA, David B, Kane-Gill SL. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in “high-risk” patients. Ann Pharmacother. 2013;47(12):1599-1610.
  • Beckett RD1, Crank CW, Wehmeyer A. Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients. J Pharm Pract. 2012;25(2):136-141.
  • Pippins JR1, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-1422.
  • Lizer MH1, Brackbill ML. Medication history reconciliation by pharmacists in an inpatient behavioral health unit. Am J Health Syst Pharm. 2007;64(10):1087-1091.
  • Pourrat X, Corneau H, Floch S, Kuzzay MP, Favard L, Rosset P, Hay N, Grassin J. Communication between community and hospital pharmacist: impact on medication reconciliation at admission. Int J Clin Pharm. 2013;35: 656-663.
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Mesut Sancar

Pınar Demir Özker This is me

Emine Er This is me

Bedile Turan This is me

Betul Okuyan This is me

Publication Date May 3, 2015
Submission Date May 3, 2015
Published in Issue Year 2014 Volume: 4 Issue: 4

Cite

APA Sancar, M., Demir Özker, P., Er, E., Turan, B., et al. (2015). Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi. Clinical and Experimental Health Sciences, 4(4), 226-231. https://doi.org/10.5455/musbed.20141015013249
AMA Sancar M, Demir Özker P, Er E, Turan B, Okuyan B. Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi. Clinical and Experimental Health Sciences. October 2015;4(4):226-231. doi:10.5455/musbed.20141015013249
Chicago Sancar, Mesut, Pınar Demir Özker, Emine Er, Bedile Turan, and Betul Okuyan. “Hastane yatışında Eczacı tarafından yürütülen Ilaç Mutabakatı programının değerlendirilmesi”. Clinical and Experimental Health Sciences 4, no. 4 (October 2015): 226-31. https://doi.org/10.5455/musbed.20141015013249.
EndNote Sancar M, Demir Özker P, Er E, Turan B, Okuyan B (October 1, 2015) Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi. Clinical and Experimental Health Sciences 4 4 226–231.
IEEE M. Sancar, P. Demir Özker, E. Er, B. Turan, and B. Okuyan, “Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi”, Clinical and Experimental Health Sciences, vol. 4, no. 4, pp. 226–231, 2015, doi: 10.5455/musbed.20141015013249.
ISNAD Sancar, Mesut et al. “Hastane yatışında Eczacı tarafından yürütülen Ilaç Mutabakatı programının değerlendirilmesi”. Clinical and Experimental Health Sciences 4/4 (October 2015), 226-231. https://doi.org/10.5455/musbed.20141015013249.
JAMA Sancar M, Demir Özker P, Er E, Turan B, Okuyan B. Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi. Clinical and Experimental Health Sciences. 2015;4:226–231.
MLA Sancar, Mesut et al. “Hastane yatışında Eczacı tarafından yürütülen Ilaç Mutabakatı programının değerlendirilmesi”. Clinical and Experimental Health Sciences, vol. 4, no. 4, 2015, pp. 226-31, doi:10.5455/musbed.20141015013249.
Vancouver Sancar M, Demir Özker P, Er E, Turan B, Okuyan B. Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi. Clinical and Experimental Health Sciences. 2015;4(4):226-31.

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