"medication reconciliation"

Medication reconciliation (MR) is the process of comparing a patient's medication orders to all of the medications that the patient has been taking in order to identify and resolve medication discrepancies. It is an effective means of risk management to avoid medication errors (eg, omissions, duplication, dosage errors, or drug interactions). Some guidelines explicitly state that MR is a pharmacist-led transition of care; however, there is a shortage of qualified pharmacists to meet the increasing clinical needs, and clinical nurses' roles have not been clearly described...

OBJECTIVE: The development of clinical research informatics tools and workflow processes associated with re-engaging biobank participants has become necessary as genomic repositories increasingly consider the return of actionable research results. MATERIALS AND METHODS: Here we describe the development and utility of an informatics application for participant recruitment and enrollment management for the Veterans Affairs Million Veteran Program Return Of Actionable Results Study, a randomized controlled pilot trial returning individual genetic results associated with familial hypercholesterolemia...

BACKGROUND: Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. OBJECTIVE: This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. METHODS: This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran...

Background: Patients with palliative care needs are at high risk of medication errors during transitions of care (TOC). Palliative Care Pharmacist Interventions surrounding Medication Prescribing Across Care Transitions (IMPACT) program was developed to improve the TOC process from hospital to community setting for cancer patients followed by palliative care. We describe (1) the program and (2) pilot study feasibility and effectiveness data. Methods: We recorded pharmacist time, medication errors, drug therapy problems (DTPs), and palliative care provider satisfaction and compared 7- and 30-day readmissions and emergency department (ED) visits between IMPACT and usual care patients...

INTRODUCTION: Clinicians frequently rely on patients to accurately tell them what prescription medications and doses they are taking in outpatient visits. This information is essential to monitor the efficacy of a medication and to determine any adverse interactions. This study aimed to assess urologist and urology trainee's visual recognition of common urology medications. METHODS: An online survey was distributed to urologists and urology trainees in Ireland. Images of 11 commonly prescribed urological medications were presented with free text options for answering...

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BACKGROUND: Several hospital pharmacy services exist, which take place at different interfaces of patient care. Although they are an important tool for improving medication safety, they are not yet sufficiently implemented in hospitals around the world. OBJECTIVE: This scoping review aims to summarise different hospital pharmacy services at transition of care (TOC) points in order to identify development trends and practice patterns in high-income countries over the past decade...

OBJECTIVES: To evaluate usability of and clinician satisfaction with the electronic health record (EHR) in the context of caring for children with medical complexity (CMC) at a large academic pediatric hospital and to identify key areas for targeted improvements. METHODS: Cross-sectional study of pediatric faculty and advanced practice providers across several pediatric specialties using an online Research Electronic Data Capture survey. EHR usability was measured with 6 validated questions from the National Usability-Focused Health Information System Scale, and satisfaction with common EHR functionalities was measured with 6 original Likert-scale questions and 3 free-text questions...

INTRODUCTION: The objective was to characterize real-world outcomes of drug-drug interactions (DDIs) between antiretrovirals (ARVs) and other drugs, including over-the-counter medications (OTC), and treatment outcomes in clinical practice. METHODS: www.clinicalcasesDDIs.com is an open-access website for healthcare providers to consult and briefly describe real-world clinical cases on DDI with ARVs. We reviewed all the clinical cases reported to the website between March 2019 and May 2023...

Background: Polypharmacy and potentially inappropriate medications (PIMs) impose a burden on patients with advanced cancer near the end of their lives. However, only a few studies have addressed factors associated with PIMs in such patients. Objective: To examine polypharmacy and factors associated with PIMs in end-of-life patients with advanced cancer. Design: Retrospective chart review. Setting/Subjects: We analyzed 265 patients with advanced cancer who died in a palliative care unit (PCU) or at home in a home medical care (HMC) from April 2018 to December 2022 in Japan...

INTRODUCTION: Liver transplant recipients receive many medications for anti-rejection, infection prophylaxis, and treatment of comorbidities. Most of them also receive medications from multiple sources. Therefore, these patients are prone to drug-related problems (DRPs) and medication errors. This study aimed to study the effect of medication reconciliation (MR) and pharmaceutical care processes by transplant pharmacists in the post-liver transplant clinic. METHODS: This study was a retrospective study in Siriraj Liver Transplant Center, Mahidol University, Thailand...

BACKGROUND: Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home. AIM: In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions...

OBJECTIVE: This study aims to characterize the impact of a pharmacist-driven discharge medication reconciliation and counseling program targeting high-risk pediatric patients to mitigate barriers in transitions of care. METHODS: This was a single-center quality improvement initiative including high-risk pediatric patients within a large academic medical center. Pharmacy, medical, and information technology team members developed a scoring system to identify patients at high risk of hospital readmission that resulted in a trigger tool built within the electronic medical record (EMR)...

BACKGROUND: There is a need for reproducible methods to measure over-the-counter (OTC) medication possession and use. This is because OTC medications are self-managed, variably monitored by healthcare professionals, and in certain populations such as older adults some OTC medications may introduce risk and cause more harm than benefit. OBJECTIVE: (s): To develop and assess the feasibility of the Home Medication Inventory Method (HMIM), a novel method to measure possession and use of OTC medications...

BACKGROUND: Since 2003 when memantine was first approved for use in the management of moderate-severe Alzheimer's dementia, its use has become more widespread and is being explored in other diseases like neuropathic pain, epilepsy, and mood disorders. Our case uniquely highlights two important adverse effects in a patient who overdosed on memantine. One is hypertension, which is easy to overlook as a medication side effect. The other is echolalia which is the repetition of words and phrases spoken by another person...

BACKGROUND: Most studies have focused on the impact of medication reconciliation on one of the points of hospital admission or discharge. In this study, we aimed to investigate the impact of medication reconciliation at both admission and discharge on medication safety in patients hospitalized with acute decompensated heart failure. METHODS: This was a prospective, single-center, cohort study conducted in a tertiary care cardiovascular hospital from October 2022 to March 2023 on patients hospitalized with acute decompensated heart failure...

BACKGROUND: Medication errors are common during transitions of care, such as discharge from the emergency department (ED) or urgent care (UC). The Joint Commission has identified medication reconciliation as a key safety practice. Our aim was to increase the percentage of patients with completed medication reconciliation at discharge from our pediatric ED and 4 UCs from 25% to 75% in 12 months. METHODS: Key stakeholders included ED and UC physicians and nurses, informatics, and quality management...

While medication reconciliation is necessary to reduce errors, it is often challenging to gather an accurate history in the clinic. Telemedicine offers a relative advantage over clinic and hospital-based interviews by enabling the clinician to inspect the home environment, review pill bottles, and identify social determinants affecting adherence, such as financial instability. To be effective, however, clinicians must be trained in best-practice interview methods and the proper use of telemedicine. There is very little information in the literature describing the best strategies for teaching students or measuring competencies in telemedicine...

In Norway, the process of developing a national shared medication list has been underway for several years. The shared medication list provides an overview of all the medications used by a patient. However, its proper use requires that it be maintained regularly through so-called medication reconciliation processes in which health personnel clarify - and ask patients - what and how much medication they use. We explore the work embedded in the bedside medication reconciliation process at a hospital, the health personnel conducting this work and the implications for the shared medication list...

BACKGROUND: Nephrotic syndrome (NS) is a commonly encountered chronic kidney disease in pediatric populations, with South Asian children being at high risk and requiring long-term pharmacological management. Thus, identifying medication discrepancies and evaluating the appropriateness of therapy and its economic burden are vital for inpatient management. The aim of the study was to assess medication reconciliation, medication appropriateness, and cost analysis in NS cases. METHODS: An ambispective cohort observational study was carried out with 150 NS patients where medication discrepancies were identified retrospectively and prospectively using the best possible medication history and following up patients correspondingly...