Implementation of an Electronic System for Medication Reconciliation
Implementation of an Electronic System for Medication Reconciliation
Purpose: The feasibility of implementing an electronic system for targeted pharmacist- and nurse-conducted admission and discharge medication reconciliation and its effects on patient safety, cost, and satisfaction among providers and nurses were studied.
Methods: This study was conducted in two phases: a preimplementation phase and a postimplementation phase. In the preimplementation phase, admission medication histories and discharge medication counseling followed standard care processes. During postimplementation, pharmacists and nurses collaborated to electronically complete admission and discharge medication reconciliation documentation. Four reports were developed for medication reconciliation documentation: (1) home medication profile report, (2) home medication reconciliation report, (3) discharge medication reconciliation report, and (4) patient discharge medication report. Patients were contacted after discharge to measure their satisfaction with the medication counseling and medication instructions received. Health care providers completed a survey indicating their satisfaction with the electronic medication reconciliation processes.
Results: A total of 283 patients were included in the study. Patients in the postimplementation group took significantly more prescription and nonprescription medications, and their total number of medications significantly exceeded the number taken by the preimplementation group. Pharmacists completed significantly more dosage changes in the postimplementation phase than in the preimplementation phase. In the preimplementation phase, nurses identified more incomplete medication orders, dosage changes, and allergies than they did in the postimplementation phase. Patients in the postimplementation group reported a higher level of agreement on all survey items regarding adequate discharge medication instructions.
Conclusion: Patients who had their medications electronically reconciled reported a greater understanding of the medications they were to take after discharge from the hospital, including medication administration instructions and potential adverse effects.
An estimated 5% of hospitalized patients experience medication errors, 60% of which occur during transitions of care (i.e., admission, transfer between levels of care, and discharge). In the United States, this translates to over 90,000 hospitalized patients who experience medication errors each year.
Two critical times to prevent medication errors are at admission and discharge. Adverse drug events are responsible for 3.29.6% of hospital admissions and are the fifth leading cause of death in the United States. Recording an accurate and complete medication history is an important part of the initial patient assessment at admission. Inaccuracies in the medication history result in wasted time and interrupted or inappropriate drug therapy and may jeopardize patient safety. Nonprescription medications and herbal preparations are also associated with clinically significant drug interactions and adverse effects. In a Finnish study of nonprescription and prescription drug interactions, 4% of adults taking nonprescription products were exposed to potentially clinically significant drug interactions.
Discharge from the hospital is another crucial time for ensuring medication accuracy and maintaining patient safety. Less than half of 43 patients in a New York City hospital remembered medication-related information (i.e., name, purpose, and major adverse effects) at discharge. An accurate assessment of a patients medications during hospitalization, along with knowledge of medications taken at home, is necessary to write correct discharge medication orders and educate the patient about medications that are to be continued on an outpatient basis. Without a standardized process for medication reconciliation, the reliability of the information recorded at admission is variable and can be influenced by the training and background of the personnel involved, the time allotted with the patient, and the patients level of familiarity with his or her drug therapies.
Although pharmacist-conducted medication histories and discharge counseling are considered desirable clinical pharmacy services, only about 5% of U.S. hospitals reported having pharmacists in these roles in 2002. More recently, 44.8% of hospitals surveyed reported having a medication reconciliation system in place; however, the report did not reveal whether pharmacists had a role in medication reconciliation. This increase in the implementation of medication reconciliation systems likely reflects a new focus on this service by the Joint Commission on Accreditation of Healthcare Organizations. The American Society of Health-System Pharmacists (ASHP), in its ASHP Health-System Pharmacy 2015 Initiative, has stated that pharmacists should be involved in managing the acquisition of medication admission histories and provision of discharge counseling for 75% of hospital inpatients with complex and high-risk medication regimens by 2015. A previous pilot study conducted at our hospital and other published literature demonstrated that pharmacist-obtained medication histories are efficient and improve patient safety ( Table 1 ). However, many hospitals do not have the funding and support necessary to consistently provide this service.
Several articles explain the importance of medication reconciliation documentation and include paper forms for use in capturing the necessary information at the time of hospital admission, but few address completing similar documentation at discharge. Luther Midelfort Hospital (Mayo Health System) has provided one of the few published reports of computer-generated discharge medication lists.
Development of an electronic process to streamline the flow of patients information is a relatively new concept for many hospitals, but the Department of Veterans Affairs has been using such systems for many years. North Mississippi Medical Center, a regional integrated managed health system, reported how an electronic-based admission and discharge medication reconciliation process has helped pharmacists with obtaining medication histories and nurses with completing discharge medication processing. At Thomas Hospital in Fairhope, Alabama, an automated process to retrieve patient prescription medication histories from insurance carriers or pharmacy benefit management companies is used to begin the medication reconciliation process.
Pharmacists and nurses collaborate daily to provide patient-centered care, particularly in the medication-safety arena. Both disciplines are positioned to work together to perform medication reconciliation documentation. Our hospital, Wesley Medical Center, located in Wichita, Kansas, and licensed for 760 beds and 102 bassinets, developed an electronic process for medication reconciliation using our clinical patient care system (CPCS) (Meditech, Inc., Boston, MA) to enable collaborative, standardized, targeted, pharmacistand nurse-conducted admission and discharge medication reconciliation documentation. The goal of this study was to evaluate the medication reconciliation systems feasibility and effects on patient safety.
Purpose: The feasibility of implementing an electronic system for targeted pharmacist- and nurse-conducted admission and discharge medication reconciliation and its effects on patient safety, cost, and satisfaction among providers and nurses were studied.
Methods: This study was conducted in two phases: a preimplementation phase and a postimplementation phase. In the preimplementation phase, admission medication histories and discharge medication counseling followed standard care processes. During postimplementation, pharmacists and nurses collaborated to electronically complete admission and discharge medication reconciliation documentation. Four reports were developed for medication reconciliation documentation: (1) home medication profile report, (2) home medication reconciliation report, (3) discharge medication reconciliation report, and (4) patient discharge medication report. Patients were contacted after discharge to measure their satisfaction with the medication counseling and medication instructions received. Health care providers completed a survey indicating their satisfaction with the electronic medication reconciliation processes.
Results: A total of 283 patients were included in the study. Patients in the postimplementation group took significantly more prescription and nonprescription medications, and their total number of medications significantly exceeded the number taken by the preimplementation group. Pharmacists completed significantly more dosage changes in the postimplementation phase than in the preimplementation phase. In the preimplementation phase, nurses identified more incomplete medication orders, dosage changes, and allergies than they did in the postimplementation phase. Patients in the postimplementation group reported a higher level of agreement on all survey items regarding adequate discharge medication instructions.
Conclusion: Patients who had their medications electronically reconciled reported a greater understanding of the medications they were to take after discharge from the hospital, including medication administration instructions and potential adverse effects.
An estimated 5% of hospitalized patients experience medication errors, 60% of which occur during transitions of care (i.e., admission, transfer between levels of care, and discharge). In the United States, this translates to over 90,000 hospitalized patients who experience medication errors each year.
Two critical times to prevent medication errors are at admission and discharge. Adverse drug events are responsible for 3.29.6% of hospital admissions and are the fifth leading cause of death in the United States. Recording an accurate and complete medication history is an important part of the initial patient assessment at admission. Inaccuracies in the medication history result in wasted time and interrupted or inappropriate drug therapy and may jeopardize patient safety. Nonprescription medications and herbal preparations are also associated with clinically significant drug interactions and adverse effects. In a Finnish study of nonprescription and prescription drug interactions, 4% of adults taking nonprescription products were exposed to potentially clinically significant drug interactions.
Discharge from the hospital is another crucial time for ensuring medication accuracy and maintaining patient safety. Less than half of 43 patients in a New York City hospital remembered medication-related information (i.e., name, purpose, and major adverse effects) at discharge. An accurate assessment of a patients medications during hospitalization, along with knowledge of medications taken at home, is necessary to write correct discharge medication orders and educate the patient about medications that are to be continued on an outpatient basis. Without a standardized process for medication reconciliation, the reliability of the information recorded at admission is variable and can be influenced by the training and background of the personnel involved, the time allotted with the patient, and the patients level of familiarity with his or her drug therapies.
Although pharmacist-conducted medication histories and discharge counseling are considered desirable clinical pharmacy services, only about 5% of U.S. hospitals reported having pharmacists in these roles in 2002. More recently, 44.8% of hospitals surveyed reported having a medication reconciliation system in place; however, the report did not reveal whether pharmacists had a role in medication reconciliation. This increase in the implementation of medication reconciliation systems likely reflects a new focus on this service by the Joint Commission on Accreditation of Healthcare Organizations. The American Society of Health-System Pharmacists (ASHP), in its ASHP Health-System Pharmacy 2015 Initiative, has stated that pharmacists should be involved in managing the acquisition of medication admission histories and provision of discharge counseling for 75% of hospital inpatients with complex and high-risk medication regimens by 2015. A previous pilot study conducted at our hospital and other published literature demonstrated that pharmacist-obtained medication histories are efficient and improve patient safety ( Table 1 ). However, many hospitals do not have the funding and support necessary to consistently provide this service.
Several articles explain the importance of medication reconciliation documentation and include paper forms for use in capturing the necessary information at the time of hospital admission, but few address completing similar documentation at discharge. Luther Midelfort Hospital (Mayo Health System) has provided one of the few published reports of computer-generated discharge medication lists.
Development of an electronic process to streamline the flow of patients information is a relatively new concept for many hospitals, but the Department of Veterans Affairs has been using such systems for many years. North Mississippi Medical Center, a regional integrated managed health system, reported how an electronic-based admission and discharge medication reconciliation process has helped pharmacists with obtaining medication histories and nurses with completing discharge medication processing. At Thomas Hospital in Fairhope, Alabama, an automated process to retrieve patient prescription medication histories from insurance carriers or pharmacy benefit management companies is used to begin the medication reconciliation process.
Pharmacists and nurses collaborate daily to provide patient-centered care, particularly in the medication-safety arena. Both disciplines are positioned to work together to perform medication reconciliation documentation. Our hospital, Wesley Medical Center, located in Wichita, Kansas, and licensed for 760 beds and 102 bassinets, developed an electronic process for medication reconciliation using our clinical patient care system (CPCS) (Meditech, Inc., Boston, MA) to enable collaborative, standardized, targeted, pharmacistand nurse-conducted admission and discharge medication reconciliation documentation. The goal of this study was to evaluate the medication reconciliation systems feasibility and effects on patient safety.
Source...