| 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)
|
| 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 |
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Medication Reconciliation
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)
|
| 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 |
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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 |
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Pharmacy dispensing of electronically discontinued medications
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| Retrospective cohort study
Setting: Ambulatory Care |
- To assess the frequency of and potential patient harm associated with pharmacy dispensing of discontinued medications in the ambulatory setting within 12 months - 30,406 adult patients with an electronic discontinuation order | - A large amount of prescriptions electronically canceled in EHRs were still filled at the pharmacy - Among 83,902 targeted medications that were electronically discontinued, 1,218 were subsequently dispensed by the pharmacy | - The dispensing of discontinued medications represents an important ambulatory patient safety concern. - Better communication between providers and pharmacists is needed to improve medication safety | Allen et al. (2012)
|
| Allen AS, Sequist TD. Pharmacy dispensing of electronically discontinued medications. Ann Intern Med. 2012;157:700-5. [PMID: 23165661] | ||||
Responsible e-Prescribing Needs e-Discontinuation
Posted on by Ryan J Tran
| Study type/ Setting | Methods | Outcomes | Recommendations | Source |
| JAMA network Viewpoint | Opinion paper | E-prescribing systems that do not allow electronic cancellation of med orders, or e-discontinuation, and can lead to more medication reconciliation errors | Fischer S et al. (2017) | |
| Fischer S, Rose A. Responsible e-Prescribing Needs e-Discontinuation. JAMA. 2017;317(5):469–470. doi:10.1001/jama.2016.19908 | ||||
The Case for Electronic Cancel or Discontinuation of Prescription Therapy at the Pharmacy
Posted on by Ryan J Tran
| Study Type/ Setting | Methods | Outcomes | Recommendations | Source |
| Article | Objective was to focus on integration of cancel Rx both from provider end and pharmacy end to reduce inappropriate therapy
|
- Study conducted in Brigham and Women’s - 1.5% of all discontinued prescription medications in their target medication study sample were dispensed by pharmacies. - More importantly, investigators reported at least 50 patients, or 12% of those receiving discontinued medications, had experienced some adverse outcome that ranged from mild side effects to life-threatening allergic reactions. | Prescribers and pharmacists should reach out to their software technology providers and convey to them the urgency and the need to implement the CancelRx /Response Rx transaction capability | Dhavel A
|
| Dhavel A. The Case for Electronic Cancel or Discontinuation of Prescription Therapy at the Pharmacy. LinkedIn. https://www.linkedin.com/pulse/case-electronic-canceldiscontinuation-prescription-therapy-dhavle. Accessed May 27, 2019. | ||||
NCPDP Foundation Awards a Grant to Johns Hopkins Medicine to Support Implementation of CancelRx Functionality in NCPDP’s SCRIPT Standard
Posted on by Ryan J Tran
| Study Type/ Setting | Methods | Outcomes | Recommendations | Source |
| Report by PRWeb
Setting: Ambulatory Care |
- Primary objective is to implement CancelRx functionality in EHRs and pharmacy management systems in the ambulatory setting | - Reported 3% Rx are filled erroneously following discontinuation | - Implementation of CancelRx would minimize erroneous filling and medication error | |
| Ncpdpfoundation.org. (2019). [online] Available at: http://ncpdpfoundation.org/PDF/NCPDP_Foundation_Grant_Johns_Hopkins_Medicine.pdf [Accessed 27 May 2019]. | ||||
Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx
Posted on by Ryan J Tran
| Study Type/ Setting | Methods | Outcomes | Recommendations | Source |
| Retrospective analysis | - N=1,400,000 - 410,591 prescribers using 734 EHRs
- 7 day follow up (Nov 6, 2016-Nov 12, 2016) - The sample size was calculated to be representative with a margin of 0.8% error at a confidence level of 99.9% - Variable: New Rx with cancellation message vs CancelRx |
- Identified 9735 (0.7% of the total) NewRx messages containing prescription cancellation instructions with 78.5% observed in the Notes field; 35.3% of identified NewRxs were associated with high-alert or LASA medications.
- The most prevalent cancellation instruction types were medication strength or dosage changes (39.3%) and alternative therapy replacement orders (39.0%) |
- Wider adoption of CancelRx in the EHR and pharmacy systems can significantly impact patient safety by reducing duplication and inappropriate medications |
|
| Yang Y, Ward-Charlerie S, Kashyap N, Demayo R, Agresta T, Green J. Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx. Journal of the American Medical Informatics Association. 2018;25(11):1516-1523. |
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A New Frontier: Using Pharmacy Claims Within the EHR To Conduct Medication Reconciliation in Primary Care Practice
Posted on by Ryan J Tran
Study Type/Setting |
Methods |
Outcomes |
Recommendations |
Source |
Retrospective cohort study
Setting: Primary Care |
- Medication listed in the primary care office EHR vs pharmacy claims data available through the EHR- Identified and characterized the discrepancies between the 2 lists - 14 primary care sites providing care for over 100,000 people and the surrounding communities- All practices share an EHR; providers can request aggregated pharmacy claims data in real time within the EHR |
- The majority of patients (468 of 609; 76.8%) had at least 1 medication discrepancy.- Patients with a discrepancy were more likely to have had a hospitalization in the past year |
- Aggregated pharmacy claims data available within the provider EHR can be used to identify discrepancies at the individual level in a multi-payer setting.- Availability of this information in real time should be made a priority |
No open access version availableAuthor:Comer D, Couto J, Aguiar R, Wu P, Elliott D. |
| Comer D, Couto J, Aguiar R, Wu P, Elliott D. A New Frontier: Using Pharmacy Claims Within the EHR To Conduct Medication Reconciliation in Primary Care Practice. Value in Health. 2014;17(3), p.A123. |
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Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial
Posted on by Ryan J Tran
Study Type/Setting |
Methods |
Outcomes |
Recommendations |
Source |
Cluster-randomized trial
Setting: Primary Care |
N=541; 267 Intervention vs 274 controls- 11 primary care practices that used the same Personal Health Record (PHR)- Intervention practices received access to a medications module promoting patients to review their documented med, identify discrepancies and generate ‘eJournals’ |
- The proportion of medications per patient with unexplained discrepancies was lower in the intervention arm vs the control (42% vs 51%) |
- Discrepancies between documented and patient-reported medication regimens can be reduced with a PHR medication review tool linked to the provider’s medical record |
Schnipper et al |
| Schnipper JL, Gandhi TK, Wald JS, et al. Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial. Journal of the American Medical Informatics Association. 2012;19(5):728-734. | ||||