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The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital.
Int J Clin Pharm 2018; 40(1):196-201IJ

Abstract

Background Medication errors represent the most common type of error that compromises patient safety, with approximately 20% believed to result in harm. Over 40% of these errors are believed to result from inadequate medication reconciliation during admission, transfer, and discharge of patients and many of these errors could be prevented if adequate medication reconciliation processes were in place. In an effort to minimize adverse events caused during these care transitions, the Joint Commission has stated medication reconciliation as one of its National Patient Safety Goals and health care providers and organizations are encouraged to perform the process at various patient care transitions. Objective Identify the types of medication discrepancy that occurred during medication reconciliation performed by a pharmacist gathering the best possible medication history (BPMH). Estimate the potential for harm with each medication discrepancy using the severity rating methods developed by Cornish et al. (Arch Intern Med 165(4):424-429, 2005). Setting Tertiary care hospital in Jeddah, Saudi Arabia. Method Prospective 3-month study on 286 adult patients, admitted for at least 24 h and regularly taking at least four chronic prescription medications. Medication histories taken by physicians and by a pharmacist gathering the BPMH were compared. Identified discrepancies were reviewed by a panel of clinical pharmacists to assess the potential to cause patient harm with these errors. Main Outcome measure Number and types of medication discrepancies recorded by the pharmacist. Results Total number of medications recorded by physicians was 2548, versus 3085 by the pharmacist. 48.3% of patients had at least one unintended medication discrepancy by physicians. 537 medication discrepancies were reported (17.4% of number of medication discrepancies recorded by pharmacist). Types of medication discrepancies included, omissions (77% of discrepancies), commissions (13%), dosing errors (7%), and frequency errors (3%). 52% of the identified medication discrepancies had the potential to cause moderate to severe patient discomfort. Conclusion Patient medication histories are frequently recorded inaccurately by physicians during admission of patients which results in medication-related errors and compromises patient safety. Medication reconciliation is crucial in reducing these errors. Pharmacists can help in reducing these medication-related errors and the associated risks and complications.

Authors+Show Affiliations

King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, PO Box 9515, c/o Pharmacy, Jeddah, 21423, Saudi Arabia.King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, PO Box 9515, c/o Pharmacy, Jeddah, 21423, Saudi Arabia. AseeriMa@ngha.med.sa.Northwestern Memorial Hospital, Chicago, IL, USA.King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, PO Box 9515, c/o Pharmacy, Jeddah, 21423, Saudi Arabia. Prince Mohamed bin Abdulaziz Hospital, Madinah, Saudi Arabia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29248986

Citation

Abdulghani, Khulood H., et al. "The Impact of Pharmacist-led Medication Reconciliation During Admission at Tertiary Care Hospital." International Journal of Clinical Pharmacy, vol. 40, no. 1, 2018, pp. 196-201.
Abdulghani KH, Aseeri MA, Mahmoud A, et al. The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. Int J Clin Pharm. 2018;40(1):196-201.
Abdulghani, K. H., Aseeri, M. A., Mahmoud, A., & Abulezz, R. (2018). The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. International Journal of Clinical Pharmacy, 40(1), pp. 196-201. doi:10.1007/s11096-017-0568-6.
Abdulghani KH, et al. The Impact of Pharmacist-led Medication Reconciliation During Admission at Tertiary Care Hospital. Int J Clin Pharm. 2018;40(1):196-201. PubMed PMID: 29248986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. AU - Abdulghani,Khulood H, AU - Aseeri,Mohammed A, AU - Mahmoud,Ahmed, AU - Abulezz,Rayf, Y1 - 2017/12/16/ PY - 2017/01/10/received PY - 2017/11/23/accepted PY - 2017/12/19/pubmed PY - 2018/9/4/medline PY - 2017/12/18/entrez KW - Admission KW - Hospital pharmacy KW - Medication history KW - Medication reconciliation KW - Saudi Arabia SP - 196 EP - 201 JF - International journal of clinical pharmacy JO - Int J Clin Pharm VL - 40 IS - 1 N2 - Background Medication errors represent the most common type of error that compromises patient safety, with approximately 20% believed to result in harm. Over 40% of these errors are believed to result from inadequate medication reconciliation during admission, transfer, and discharge of patients and many of these errors could be prevented if adequate medication reconciliation processes were in place. In an effort to minimize adverse events caused during these care transitions, the Joint Commission has stated medication reconciliation as one of its National Patient Safety Goals and health care providers and organizations are encouraged to perform the process at various patient care transitions. Objective Identify the types of medication discrepancy that occurred during medication reconciliation performed by a pharmacist gathering the best possible medication history (BPMH). Estimate the potential for harm with each medication discrepancy using the severity rating methods developed by Cornish et al. (Arch Intern Med 165(4):424-429, 2005). Setting Tertiary care hospital in Jeddah, Saudi Arabia. Method Prospective 3-month study on 286 adult patients, admitted for at least 24 h and regularly taking at least four chronic prescription medications. Medication histories taken by physicians and by a pharmacist gathering the BPMH were compared. Identified discrepancies were reviewed by a panel of clinical pharmacists to assess the potential to cause patient harm with these errors. Main Outcome measure Number and types of medication discrepancies recorded by the pharmacist. Results Total number of medications recorded by physicians was 2548, versus 3085 by the pharmacist. 48.3% of patients had at least one unintended medication discrepancy by physicians. 537 medication discrepancies were reported (17.4% of number of medication discrepancies recorded by pharmacist). Types of medication discrepancies included, omissions (77% of discrepancies), commissions (13%), dosing errors (7%), and frequency errors (3%). 52% of the identified medication discrepancies had the potential to cause moderate to severe patient discomfort. Conclusion Patient medication histories are frequently recorded inaccurately by physicians during admission of patients which results in medication-related errors and compromises patient safety. Medication reconciliation is crucial in reducing these errors. Pharmacists can help in reducing these medication-related errors and the associated risks and complications. SN - 2210-7711 UR - https://www.unboundmedicine.com/medline/citation/29248986/The_impact_of_pharmacist_led_medication_reconciliation_during_admission_at_tertiary_care_hospital_ L2 - https://dx.doi.org/10.1007/s11096-017-0568-6 DB - PRIME DP - Unbound Medicine ER -