Top

Published in:

01-04-2021 | Systems-Level Quality Improvement

Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients

Authors: Pi-Lien Hung, Pei-Chin Lin, Jung-Yi Chen, Miao-Ting Chen, Ming-Yueh Chou, Wei-Chun Huang, Wang-Chuan Juang, Yu-Te Lin, Alex C. Lin

Published in: Journal of Medical Systems | Issue 4/2021

Abstract

The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1–November 30, 2015) and post-intervention (October 1–December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68–1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03–0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.

Available only for authorised users

Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE (2005) Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 165:424-429. https://doi.org/10.1001/archinte.165.4.424CrossRefPubMed

Cheng SH, Chen CC (2014) Effects of continuity of care on medication duplication among the elderly. Med Care 52:149-156. https://doi.org/10.1097/MLR.0000000000000042CrossRefPubMed

Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA (2004) Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm 61:1689-1695. https://doi.org/10.1093/ajhp/61.16.1689CrossRefPubMed

Lee JY, Leblanc K, Fernandes OA, Huh JH, Wong GG, Hamandi B, Lazar NM, Morra D, Bajcar JM, Harrison J (2010) Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry. Ann Pharmacother 44:1887-1895. https://doi.org/10.1345/aph.1P314CrossRefPubMed

Schnipper JL, Liang CL, Hamann C, Karson AS, Palchuk MB, McCarthy PC, Sherlock M, Turchin A, Bates DW (2011) Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge. J Am Med Inform Assoc 18:309-313. https://doi.org/10.1136/amiajnl-2010-000040CrossRefPubMedPubMedCentral

Moore P, Armitage G, Wright J, Dobrzanski S, Ansari N, Hammond I, Scally A (2011) Medicines reconciliation using a shared electronic health care record. J Patient Saf 7:148-154. https://doi.org/10.1097/PTS.0b013e31822c5bf9CrossRefPubMed

Bédard P, Tardif L, Ferland A, Bussières JF, Lebel D, Bailey B, Girard M, Lachaîne J (2011) A medication reconciliation form and its impact on the medical record in a paediatric hospital. J Eval Clin Pract 17:222-227. https://doi.org/10.1111/j.1365-2753.2010.01424.xCrossRefPubMed

De Winter S, Vanbrabant P, Spriet I, Desruelles D, Indevuyst C, Knockaert D, Gillet JB, Willems L (2011) A simple tool to improve medication reconciliation at the emergency department. Eur J Intern Med 22:382-385. https://doi.org/10.1016/j.ejim.2011.03.010CrossRefPubMed

Feldman LS, Costa LL, Feroli ER, Jr., Nelson T, Poe SS, Frick KD, Efird LE, Miller RG (2012) Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. J Hosp Med 7:396-401. https://doi.org/10.1002/jhm.1921CrossRefPubMed

10.

Henneman EA, Tessier EG, Nathanson BH, Plotkin K (2014) An evaluation of a collaborative, safety focused, nurse-pharmacist intervention for improving the accuracy of the medication history. J Patient Saf 10:88-94. https://doi.org/10.1097/PTS.0b013e318294890cCrossRefPubMed

11.

National Health Insurance Administration(NHIA) (2016) NHI PharmaCloud system. https://www.nhi.gov.tw/English/Content_List.aspx?n=02BA04454AED80E0&topn=BCB2B0D2433F6491. Accessed 15 September 2018

12.

Liao CY, Wu MF, Poon SK, Liu YM, Chen HC, Wu CL, Sheu WH, Liou WS (2019) Improving medication safety by cloud technology: Progression and value-added applications in Taiwan. Int J Med Inform 126:65-71. https://doi.org/10.1016/j.ijmedinf.2019.03.012CrossRefPubMed

13.

Hung PL, Chen JY, Chen MT, Li PL, Li WC, Wang ZC, Huang TT, Liang YT, Lin PC (2019) The impact of a medication reconciliation programme at geriatric hospital admission: A pre-/postintervention study. Br J Clin Pharmacol 85:2614-2622. https://doi.org/10.1111/bcp.14095CrossRefPubMedPubMedCentral

14.

Talebi MM, Sefidani Forough A, Riazi Esfahani P, Eskandari R, Haghgoo R, Fahimi F (2018) Medication interaction and physicians' compliance assessment through medication reconciliation forms in a university affiliated hospital. Iran J Pharm Res 17:159-167PubMedPubMedCentral

15.

Developed through the ASHP Council on Pharmacy Practice, approved by the ASHP Board of Directors on April, by the ASHP House of Delegates on June (2013) ASHP statement on the pharmacist's role in medication reconciliation. Am J Health Syst Pharm 70:453-456. https://doi.org/10.2146/sp120009

16.

Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, Kettis-Lindblad A, Melhus H, Mörlin C (2009) A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 169:894-900. https://doi.org/10.1001/archinternmed.2009.71CrossRefPubMed

17.

Christensen M, Lundh A (2016) Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2:CD008986. https://doi.org/10.1002/14651858.CD008986.pub3CrossRefPubMed

18.

Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief P, van Bommel J, Tan S, van Kranenburg MJ, van den Bemt P (2018) The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care 8:19. https://doi.org/10.1186/s13613-018-0361-2CrossRefPubMedPubMedCentral

19.

Lisby M, Thomsen A, Nielsen LP, Lyhne NM, Breum-Leer C, Fredberg U, Jorgensen H, Brock B (2010) The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. Basic Clin Pharmacol Toxicol 106:422-427. https://doi.org/10.1111/j.1742-7843.2009.00511.xCrossRefPubMed

20.

Liu YL, Chu LL, Su HC, Tsai KT, Kao PH, Chen JF, Hsieh HC, Lin HJ, Hsu CC, Huang CC (2019) Impact of computer-based and pharmacist-assisted medication review initiated in the Emergency Department. J Am Geriatr Soc 67:2298-2304. DOI:https://doi.org/10.1111/jgs.16078CrossRefPubMed

21.

World Health Organization High 5s: Standard operating procedures. https://www.who.int/patientsafety/topics/high-5s/en/. Accessed 05 May 2019

22.

Moore C, Wisnivesky J, Williams S, McGinn T (2003) Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 18:646-651. https://doi.org/10.1046/j.1525-1497.2003.20722.xCrossRefPubMedPubMedCentral

23.

Sullivan C, Gleason KM, Rooney D, Groszek JM, Barnard C (2005) Medication reconciliation in the acute care setting: opportunity and challenge for nursing. J Nurs Care Qual 20:95-98. https://doi.org/10.1097/00001786-200504000-00001CrossRefPubMed

24.

WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health (2018) Updates included in the ATC/DDD Index. https://www.whocc.no/atc_ddd_index/updates_included_in_the_atc_ddd_index/. Accessed 10 July 2019

25.

Tamblyn R, Winslade N, Lee TC, Motulsky A, Meguerditchian A, Bustillo M, Elsayed S, Buckeridge DL, Couture I, Qian CJ, Moraga T, Huang A (2018) Improving patient safety and efficiency of medication reconciliation through the development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project. J Am Med Inform Assoc 25:482-495. https://doi.org/10.1093/jamia/ocx107CrossRefPubMed

26.

Mekonnen AB, Abebe TB, McLachlan AJ, Brien JA (2016) Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis. BMC Med Inform Decis Mak 16:112. https://doi.org/10.1186/s12911-016-0353-9CrossRefPubMedPubMedCentral

27.

Yang CY, Lo YS, Chen RJ, Liu CT (2018) A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation. JMIR Med Inform 6:e6. https://doi.org/10.2196/medinform.9064CrossRefPubMedPubMedCentral

28.

Nebeker JR, Barach P, Samore MH (2004) Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med 140:795-801. https://doi.org/10.7326/0003-4819-140-10-200405180-00009CrossRefPubMed

29.

Klarin I, Wimo A, Fastbom J (2005) The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 22:69-82. https://doi.org/10.2165/00002512-200522010-00005CrossRefPubMed

30.

Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI (2012) Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med 27:1513-1520. https://doi.org/10.1007/s11606-012-2168-4CrossRefPubMedPubMedCentral

31.

Brown LM (2013) Emerging opportunities for pharmacists to improve health care for the poor and underserved. J Health Care Poor Underserved 24:6-14. https://doi.org/10.1353/hpu.2013.0042CrossRefPubMed

32.

Poole DL, Chainakul JN, Pearson M, Graham L (2006) Medication reconciliation: a necessity in promoting a safe hospital discharge. J Healthc Qual 28:12-19. https://doi.org/10.1111/j.1945-1474.2006.tb00607.xCrossRefPubMed

33.

De Winter S, Spriet I, Indevuyst C, Vanbrabant P, Desruelles D, Sabbe M, Gillet JB, Wilmer A, Willems L (2010) Pharmacist- versus physician-acquired medication history: a prospective study at the emergency department. Qual Saf Health Care 19:371-375. https://doi.org/10.1136/qshc.2009.035014CrossRefPubMed

34.

Mekonnen AB, McLachlan AJ, Brien JA (2016) Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 6:e010003. https://doi.org/10.1136/bmjopen-2015-010003CrossRefPubMedPubMedCentral

Title: Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients
Authors: Pi-Lien Hung
Pei-Chin Lin
Jung-Yi Chen
Miao-Ting Chen
Ming-Yueh Chou
Wei-Chun Huang
Wang-Chuan Juang
Yu-Te Lin
Alex C. Lin
Publication date: 01-04-2021
Publisher: Springer US
Published in: Journal of Medical Systems / Issue 4/2021
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI: https://doi.org/10.1007/s10916-021-01717-8

At a glance: The STEP trials

Springer Medicine

Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2021

Technology Acceptance of a Machine Learning Algorithm Predicting Delirium in a Clinical Setting: a Mixed-Methods Study

Rician Denoising Based on Correlated Local Features LMMSE Approach

Emotion Recognition Using Electrodermal Activity Signals and Multiscale Deep Convolutional Neural Network

Development of Temperature Monitoring System of Hospital Cold Storages Based on Wireless Network and its Database Management

Practice in Information Technology Support for Fangcang Shelter Hospital during COVID-19 Epidemic in Wuhan, China

TensioBot: a Chatbot Assistant for Self-Managed in-House Blood Pressure Checking