Medication Reconciliation During Admission to an Internal Medicine Department: A Pilot Study

Authors

  • Thaís Costa e Silva Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. https://orcid.org/0000-0002-7989-5788
  • Patrícia Dias Serviço de Medicina Interna. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0002-1158-5417
  • Catarina Alves e Cunha Unidade de Farmacologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0002-0628-8899
  • José Feio Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0003-0070-2988
  • Marta Lavrador Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. https://orcid.org/0000-0002-8582-7853
  • Joelizy Oliveira Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Fundação Capes. Ministério da Educação. Brasília. Brasil. Centro de Documentação e Informação em Educação Superior. Ministério da Educação Superior e Pesquisa do Governo do Grão-Ducado de Luxemburgo. Luxemburgo. https://orcid.org/0000-0002-2812-0042
  • Isabel Vitória Figueiredo Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. https://orcid.org/0000-0003-0127-4575
  • Marília João Rocha Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0003-2981-094X
  • Margarida Castel-Branco Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra.

DOI:

https://doi.org/10.20344/amp.16892

Keywords:

Internal Medicine, Medication Errors, Medication Reconciliation, Patient Safety, Transitional Care

Abstract

Introduction: The purpose of medication reconciliation is to promote patient safety by reducing medication errors and adverse events due to medication discrepancies in transition of care. The aim of this pilot study of medication reconciliation at the time of hospital admission was to identify the necessary resources for its implementation in clinical practice.
Material and Methods: Pilot study with 100 patients admitted to an Internal Medicine department between October and December 2019, aged 18 and over, and chronically taking at least one medicine. The best possible medication history was obtained systematically, with subsequent identification, classification and resolution of the discrepancies.
Results: The study sample, in general characterized by polypharmacy and by having multiple long-term conditions, presented a mean age of 77.04 ± 13.74 years, being 67.0% male. Overall, 791 discrepancies were identified. Intentional discrepancies were 95.7% and 50.9% of them were documented. The difficulties encountered were mainly related with the access and quality of therapeutic information and communication problems between different healthcare professionals. The key priority resources that were identified were related with the process, tools, and personnel categories.
Conclusion: The data revealed weaknesses in the clinical records available at the primary/hospital care interface. Optimization of data sources, standardization and informatization of the process, multidisciplinary approach and definition of priority groups were identified as opportunities for optimization.

Downloads

Download data is not yet available.

References

Direção-Geral da Saúde. Norma 018/2016: Reconciliação da Medicação. 2016. [consultado 2021 nov 18]. Disponível em: https://

www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norman-0182016-de-30122016.aspx.

World Health Organization. Medication Safety in Transitions of Care. 2019. [consultado 2021 nov 18]. Disponível em: https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.9.

Institute for Healthcare Improvement. How-to guide: prevent adverse drug events by implementing medication reconciliation. 2011.

[consultado 2021 nov 18]. Disponível em: http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventAdverseDrugEvents.aspx.

World Health Organization. The High5s Project-Standard Operating Protocol - assuring medication accuracy at transitions in care. 2014. [consultado 2021 nov 18]. Disponível em: https://www.who.int/initiatives/high-5s-standard-operating-procedures.

Michaelsen M, McCague P, Bradley C, Sahm L. Medication reconciliation at discharge from hospital: a systematic review of the quantitative literature. Pharmacy. 2015;3:53–71. DOI: https://doi.org/10.3390/pharmacy3020053

Mansukhani RP, Bridgeman MB, Candelario D, Eckert LJ. Exploring transitional care: evidence-based strategies for improving provider communication and reducing readmissions. P T. 2015;40:690-4.

Oliveira J, Cabral AC, Lavrador M, Costa FA, Almeida FF, Macedo A, et al. Contribution of different patient information sources to create the best possible medication history. Acta Med Port. 2020;33:384-9. DOI: https://doi.org/10.20344/amp.12082

Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173:510–5. DOI: https://doi.org/10.1503/cmaj.045311

Buckley MS, Harinstein LM, Clark KB, Smithburger PL, Eckhardt DJ, Alexander E, et al. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in “high-risk” patients. Ann Pharmacother. 2013;47:1599–610. DOI: https://doi.org/10.1177/1060028013507428

Anderson LJ, Schnipper JL, Nuckols TK, Shane R, Le MM, Robbins K, et al. Effect of medication reconciliation interventions on outcomes: a systematic overview of systematic reviews. Am J Health Syst Pharm. 2019;76:2028–40. DOI: https://doi.org/10.1093/ajhp/zxz236

Temido H. Internamento em Medicina Interna: evolução em 20 anos num hospital universitário. Med Interna. 2018;25:275–9. DOI: https://doi.org/10.24950/rspmi/original/224/4/2018

Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindiquist L, Liss D, et al. Results of the Medications at Transitions and Clinical Handoffs (MATCH) Study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2010;25:441–7. DOI: https://doi.org/10.1007/s11606-010-1256-6

Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, et al. Classifying and predicting errors of inpatient

medication reconciliation. J Gen Intern Med. 2008;23:1414–22. DOI: https://doi.org/10.1007/s11606-008-0687-9

Bell CM, Rahimi-Darabad P, Orner AI. Discontinuity of chronic medications in patients discharged from the intensive care unit. J Gen

Intern Med. 2006;21:937-41. DOI: https://doi.org/10.1007/BF02743141

Abu Farha R, Abu Hammour K, Al-Jamei S, AlQudah R, Zawiah M. The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients. BMC Health Serv Res. 2018;18:966. DOI: https://doi.org/10.1186/s12913-018-3795-1

Mongaret C, Quillet P, Vo TH, Aubert L, Fourgeaud M, Michelet-Huot E, et al. Predictive factors for clinically significant pharmacist interventions at hospital admission. Medicine. 2018;97:e9865. DOI: https://doi.org/10.1097/MD.0000000000009865

Karaoui LR, Chamoun N, Fakhir J, Abi Ghanem W, Droubi S, Diab Marzouk AR, et al. Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals. BMC Health Serv Res. 2019;19:493. DOI: https://doi.org/10.1186/s12913-019-4323-7

Digiantonio N, Lund J, Bastow S. Impact of a pharmacyled medication reconciliation program. P T. 2018;43:105-10.

Giannini O, Rizza N, Pironi M, Parlato S, Waldispühl Suter B, Borella P, et al. Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward. BMJ Open. 2019;9:e026259. DOI: https://doi.org/10.1136/bmjopen-2018-026259

Redmond P, Munir K, Alabi O, Grimes T, Clyne B, Hughes C, et al. Barriers and facilitators of medicines reconciliation at transitions of care in Ireland – a qualitative study. BMC Fam Pract. 2020;21:116. DOI: https://doi.org/10.1186/s12875-020-01188-9

Linden-Lahti C, Holmström AR, Pennanen P, Airaksinen M. Facilitators and barriers in implementing medication safety practices across hospitals within 11 European Union countries. Pharm Pract. 2019;17:1583. DOI: https://doi.org/10.18549/PharmPract.2019.4.1583

Patel E, Pevnick JM, Kennelty KA. Pharmacists and medication reconciliation: a review of recent literature. Integr Pharm Res Pract. 2019;8:39-45. DOI: https://doi.org/10.2147/IPRP.S169727

Rungvivatjarus T, Kuelbs CL, Miller L, Perham J, Sanderson K, Billman G, et al. Medication reconciliation improvement utilizing process redesign and clinical decision support. Jt Comm J Qual Patient Saf. 2020;46:27-36. DOI: https://doi.org/10.1016/j.jcjq.2019.09.001

Published

2022-03-04

How to Cite

1.
Costa e Silva T, Dias P, Alves e Cunha C, Feio J, Lavrador M, Oliveira J, Figueiredo IV, Rocha MJ, Castel-Branco M. Medication Reconciliation During Admission to an Internal Medicine Department: A Pilot Study. Acta Med Port [Internet]. 2022 Mar. 4 [cited 2024 Nov. 23];35(11):798-806. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/16892

Issue

Section

Original