Pharmacist-Led Medication Reconciliation

Impact of pharmacists directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting.

Posted on by Ryan J Tran
Randomized controlled study

 

Setting: Hospital

 

 

 - To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies during a 3month study period - 200 internal medicine patients from Jordan University Hospital - 2 groups: control vs intervention

- The number and types of medication discrepancies

were identified at admission.

- At discharge, the number of unintentional discrepancies was evaluated for both groups

 - The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group.

- At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, while no significant change was found for the control group

 - The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors Salameh

LK et al.

(2018)

 

No open access version available
Salameh LK, Farha RKA, Hammour KMA, Basheti IA. Impact of pharmacists directed medication reconciliation on reducing medication discrepancies during transition of
care in hospital setting. Journal of Pharmaceutical Health Services Research. 2018;10(1):149-156. doi:10.1111/jphs.12261

Medicines reconciliation in primary care: a study evaluating the quality of medication-related information provided on discharge from secondary care

Posted on by Ryan J Tran
A collaborative project

 

Setting: Primary Care

 

 

 - The objective was to assess the completeness, timeliness and reconciliation in primary care of medication information on hospital discharge summaries.  - Clinical Commissioning Groups (CCGs) pharmacist identified patients retrospectively from GP prescribing system and collected data that were then entered onto an excel spreadsheet and submitted electronically for collation and analysis - 47 CCGs participated and submitted data for 1,454 patients

- Although many discharge summaries were generated (89%) and transferred (72%) electronically, only 43% were received by the GP practice on the same day (range 0-38 days) - Intentional changes were actioned on the GP system within 7 days of the discharge for 42.5% of patients.  - At least one change was actioned incorrectly for 5.5% of patients.

 - Medication reconciliation in primary care is as important as on admission to hospital

- There is scope to maximize transfer and action on information to improve safety

 Jani Y et al.(2017)

 

No open access version available
Jani Y, Shah C, Hough J. Isqua17-3144Medicines Reconciliation in Primary Care Following Hospitalization. International Journal for Quality in Health Care.
2017;29(suppl_1):39-40. doi:10.1093/intqhc/mzx125.62

The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. International

Posted on by Ryan J Tran
Study type/ Setting Methods Outcomes Recommendations Source
Prospective 3 month study

 

Setting: Tertiary care hospital

 

 

 - To identify the types of medication discrepancy that occurred during medication reconciliation performed by a pharmacist gathering the best possible medication history

- Medication histories taken by physician and by pharmacist gathering the BPMH were compared

 - Total number of medications recorded by physicians was 2,548, versus 3,085 by the pharmacist.

- 48.3% of patients had at least one unintended medication discrepancy by physicians.

 - Patient medication histories are frequently recorded inaccurately by physicians during admission of patients, resulting in medication-related errors and compromises in patient safety.

- Pharmacists can help in reducing these medication-related errors

 Abdulghani KH et al.

(2017)

 

No open access version available
Abdulghani KH, Aseeri MA, Mahmoud A, Abulezz R. The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. International
Journal of Clinical Pharmacy. 2017;40(1):196-201. doi:10.1007/s11096-017-0568-6

 

Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults

Posted on by Ryan J Tran
A cluster randomized trial

 

Setting: Community

 

 

 - To compare the effectiveness of a consumer targeted, pharmacist-led educational intervention (to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion) vs usual care on discontinuation of inappropriate medication among community-dwelling older adults.

- 69 community pharmacies were recruited

- Patients included were adults aged >/= 65yo who were prescribed 1 of 4 Beers criteria medications

 - Pharmacist led intervention led to greater discontinuation of inappropriate prescriptions after 6 months.

- 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group.

 A pharmacist-led educational intervention compared with usual care resulted in greater discontinuation of prescriptions

for inappropriate medication after 6 months

 Martin P et al. (2018)

 

 
Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older
Adults. Jama. 2018;320(18):1889. doi:10.1001/jama.2018.16131