Advertisement

European Journal of Clinical Pharmacology

, Volume 75, Issue 12, pp 1713–1722 | Cite as

Medication reconciliation: time to save? A cross-sectional study from one acute hospital

  • Elaine K. WalshEmail author
  • Ann Kirby
  • Patricia M. Kearney
  • Colin P. Bradley
  • Aoife Fleming
  • Kieran A. O’Connor
  • Ciaran Halleran
  • Timothy Cronin
  • Elaine Calnan
  • Patricia Sheehan
  • Laura Galvin
  • Derina Byrne
  • Laura J. Sahm
Pharmacoepidemiology and Prescription
  • 159 Downloads

Abstract

Purpose

Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance.

Methods

A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated.

Results

Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8–1.9 million.

Conclusions

Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.

Keywords

Medication reconciliation Transitional care Healthcare costs Medication error 

Notes

Acknowledgments

The authors wish to acknowledge the contribution of Ms. Vicki Livingstone of the INFANT Centre UCC.

Authors’ contributions

All authors fulfill the ICMJE criteria for authorship. Particular contributions are listed below.

Dr. Elaine K Walsh: Chief investigator, involved in study design, data analysis, and write up.

Dr. Ann Kirby: Involved in study design, data analysis, and write up.

Professor Patricia M Kearney: Involved in study design, and write up.

Professor Colin P Bradley: Involved in study design, data analysis, and write up.

Dr. Aoife Fleming: Involved in study design, obtaining ethical approval, data collection, and data analysis.

Dr. Kieran O’Connor: Involved in study design, data collection, and write up.

Mr. Ciaran Halleran: Involved in study design, data collection, and write up.

Mr. Timothy Cronin: Involved in data collection and data analysis.

Ms. Elaine Calnan: Involved in data collection and write up.

Ms. Patricia Sheehan: Involved in data collection and write up.

Ms. Laura Galvin: Involved in data collection and write up.

Ms. Derina Byrne: Involved in study design and data collection.

Dr. Laura J Sahm: Involved in study design, data analysis, and write up.

Compliance with ethical standards

Ethical approval

Ethical approval was obtained from the Clinical Research Ethics Committee of the Cork Teaching Hospitals.

Conflict of interest

The authors declare that they have no conflict of interest

Supplementary material

228_2019_2750_MOESM1_ESM.docx (295 kb)
ESM 1 (DOCX 294 kb)

References

  1. 1.
    Midlov P, Bergkvist A, Bondesson A, Eriksson T, Hoglund P (2005) Medication errors when transferring elderly patients between primary health care and hospital care. Pharmacy World & Science : PWS 27(2):116–120Google Scholar
  2. 2.
    Picone DM, Titler MG, Dochterman J, Shever L, Kim T, Abramowitz P, Kanak M, Qin R (2008) Predictors of medication errors among elderly hospitalized patients. Am J Med Q : Off J Am Coll Med Q 23(2):115–127Google Scholar
  3. 3.
    Salanitro AH, Osborn CY, Schnipper JL, Roumie CL, Labonville S, Johnson DC, Neal E, Cawthon C, Businger A, Dalal AK, Kripalani S (2012) Effect of patient- and medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med 27(8):924–932PubMedPubMedCentralGoogle Scholar
  4. 4.
    Institute of Medicine (2000) To Err is Human: Building a Safer Health System. National Academies Press (USA), Washington (DC)Google Scholar
  5. 5.
    Ohta Y, Sakuma M, Koike K, Bates DW, Morimoto T (2014) Influence of adverse drug events on morbidity and mortality in intensive care units: the JADE study. Int J Qual Health Care 26(6):573–578PubMedGoogle Scholar
  6. 6.
    Page RL 2nd, Ruscin JM (2006) The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother 4(4):297–305PubMedGoogle Scholar
  7. 7.
    Diaz Hernandez SH, Cruz-Gonzalez I (2018) Incidence and preventability of medication errors and ADEs in ambulatory care older patients. Consult Pharm : J Am Soc Consult Pharm 33(8):454–466Google Scholar
  8. 8.
    Elliott RA CE, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher MJ, Faria R. : Prevalence and Economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. In. Policy Research Unit in Economic Evaluation of Health & Care Interventions (EEPRU) Available from http://www.eepru.org.uk/wp-content/uploads/2018/02/eepru-report-medication-error-feb-2018.pdf; 2018Google Scholar
  9. 9.
    Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH (2005) The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care 43(12):1171–1176PubMedGoogle Scholar
  10. 10.
    Walsh EK, Hansen CR, Sahm LJ, Kearney PM, Doherty E, Bradley CP (2017) Economic impact of medication error: a systematic review. Pharmacoepidemiol Drug Saf 26(5):481–497PubMedGoogle Scholar
  11. 11.
    Schmiedl S, Rottenkolber M, Szymanski J, Drewelow B, Siegmund W, Hippius M, Farker K, Guenther IR, Hasford J, Thuermann PA (2018) Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf 17(2):125–137PubMedGoogle Scholar
  12. 12.
    Lavan AH, Gallagher PF, O’Mahony D (2016) Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging 11:857–866PubMedPubMedCentralGoogle Scholar
  13. 13.
    Department of Economic and Social Affairs. World Population Aging 2017. In. United Nations, New York, USAGoogle Scholar
  14. 14.
    National Institute for Clinical Excellence (NICE): Medicines Optimisation: The safe and effective use of medicines 2015 [www.nice.org.uk/guidance/ng5 Accessed Spetember 2018]]
  15. 15.
    Institute for Safe Medicines Practice Canada: guidelines for safe medicines practice. [www.ismp.org/tools/guidelines Accessed September 2018]]
  16. 16.
    WHO High 5's Guidance on Medication Reconciliation [http://www.who.int/patientsafety/topics/high-5s/en/]
  17. 17.
    Aronson J (2017) Medication reconciliation. BMJ (Clinical research ed):356Google Scholar
  18. 18.
    Meguerditchian AN, Krotneva S, Reidel K, Huang A, Tamblyn R (2013) Medication reconciliation at admission and discharge: a time and motion study. BMC Health Serv Res 13(1):485PubMedPubMedCentralGoogle Scholar
  19. 19.
    Nguyen CB, Shane R, Bell DS, Cook-Wiens G, Pevnick JM (2017) A time and motion study of pharmacists and pharmacy technicians obtaining admission medication histories. J Hosp Med 12(3):180–183PubMedPubMedCentralGoogle Scholar
  20. 20.
    Institution for Safe Medication Practices Canada. Medication Reconciliation (MedRec) [ https://www.ismp-canada.org/medrec/]
  21. 21.
    Najafzadeh M, Schnipper JL, Shrank WH, Kymes S, Brennan TA, Choudhry NK (2016) Economic value of pharmacist-led medication reconciliation for reducing medication errors after hospital discharge. Am J Manag Care 22(10):654–661PubMedGoogle Scholar
  22. 22.
    Kwan JL, Lo L, Sampson M, Shojania KG (2013) Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med 158(5 Pt 2):397–403PubMedGoogle Scholar
  23. 23.
    Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, Berenholtz S, Dorman T, Lipsett P (2003) Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care 18(4):201–205PubMedGoogle Scholar
  24. 24.
    Varkey P, Cunningham J, O'Meara J, Bonacci R, Desai N, Sheeler R (2007) Multidisciplinary approach to inpatient medication reconciliation in an academic setting. Am J Health Syst Pharm 64(8):850–854PubMedGoogle Scholar
  25. 25.
    Kramer JS, Hopkins PJ, Rosendale JC, Garrelts JC, Hale LS, Nester TM, Cochran P, Eidem LA, Haneke RD (2007) Implementation of an electronic system for medication reconciliation. Am J Health Syst Pharm 64(4):404–422PubMedGoogle Scholar
  26. 26.
    Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T (2018) Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev 8Google Scholar
  27. 27.
    Pevnick JM, Shane R, Schnipper JL (2016) The problem with medication reconciliation. BMJ Qual Saf 25(9):726–730PubMedPubMedCentralGoogle Scholar
  28. 28.
    Breuker C, Macioce V, Mura T, Castet-Nicolas A, Audurier Y, Boegner C, Jalabert A, Villiet M, Avignon A, Sultan A (2017) Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. J Patient Saf:1Google Scholar
  29. 29.
    Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL (2008) Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med 23(9):1414–1422PubMedPubMedCentralGoogle Scholar
  30. 30.
    Hellstrom LM, Bondesson A, Hoglund P, Eriksson T (2012) Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol 12:9PubMedPubMedCentralGoogle Scholar
  31. 31.
    Grimes TC, Duggan CA, Delaney TP, Graham IM, Conlon KC, Deasy E, Jago-Byrne M-C (2011) O' Brien P: medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. Br J Clin Pharmacol 71(3):449–457PubMedPubMedCentralGoogle Scholar
  32. 32.
    Pevnick JM, Nguyen C, Jackevicius CA, Palmer KA, Shane R, Cook-Wiens G, Rogatko A, Bear M, Rosen O, Seki D, Doyle B, Desai A, Bell DS (2018) Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial. BMJ Qual Saf 27(7):512–520PubMedGoogle Scholar
  33. 33.
    Urban R, Armitage G, Morgan J, Marshall K, Blenkinsopp A, Scally A (2014) Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK. Res Soc Adm Pharm 10(2):355–368Google Scholar
  34. 34.
    Vuong QH (1989) Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica 57(2):307–333Google Scholar
  35. 35.
    Cameron AC, Trivedi PK (2010) Microeconometrics using Stata. Stata Press, Revised EditionGoogle Scholar
  36. 36.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379PubMedGoogle Scholar
  37. 37.
    Hair J AE, Tathan R et al.2006 : Multivariate data analysis, 6th edn. New Jersey: Prentice HallGoogle Scholar
  38. 38.
  39. 39.
    Guidelines for the Economic Evaluation of Health Technologies in Ireland. In. Health Information Quality Authority, Dublin, Ireland; 2018Google Scholar
  40. 40.
    Central Statistics Office: Census 2016. In. Central Statistics Office Cork, Ireland https://www.cso.ie/en/census/
  41. 41.
    Activity in Acute Public Hospitals in Ireland 2015 annual report In. http://www.hpo.ie/latest_hipe_nprs_reports/HIPE_2015/HIPE_Report_2015.pdf Accessed Spetember 2018; 2015
  42. 42.
    Population Projection and Planned Population Forecast: calculating growth rate. In: GIS User Manual for Land Use Planning. http://www.gerhardbechtold.com/LUPMIS/Manual/a151_population_projected_and_planned_population_.html [Accessed October 2018]
  43. 43.
    Beckett RD, Crank CW, Wehmeyer A (2012) Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients. J Pharm Pract 25(2):136–141PubMedGoogle Scholar
  44. 44.
    Delgado Sanchez O, Nicolas Pico J, Martinez Lopez I, Serrano Fabia A, Anoz Jimenez L, Fernandez Cortes F (2009) Reconciliation errors at admission and departure in old and polymedicated patients. Prospective, multicenter randomized study. Med Clin 133(19):741–744Google Scholar
  45. 45.
    van den Bemt PM, van der Schrieck-de Loos EM, van der Linden C, Theeuwes AM, Pol AG (2013) Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly adults: a multicenter study. J Am Geriatr Soc 61(8):1262–1268PubMedGoogle Scholar
  46. 46.
    Rodriguez Vargas B, Delgado Silveira E, Iglesias Peinado I, Bermejo Vicedo T (2016) Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int J Clin Pharm 38(5):1164–1171PubMedGoogle Scholar
  47. 47.
    Bonaudo M, Martorana M, Dimonte V, D'Alfonso A, Fornero G, Politano G, Gianino MM (2018) Medication discrepancies across multiple care transitions: a retrospective longitudinal cohort study in Italy. PLoS One 13(1):e0191028PubMedPubMedCentralGoogle Scholar
  48. 48.
    Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE (2005) Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J 173(5):510–515Google Scholar
  49. 49.
    Ebbens MM, Gombert-Handoko KB, Al-Dulaimy M, van den Bemt P, Wesselink EJ (2018) Risk factors for medication errors at admission in preoperatively screened patients. Pharmacoepidemiol Drug Saf 27(3):272–278PubMedGoogle Scholar
  50. 50.
    Cresswell A, Hart M, Suchanek O, Young T, Leaver L, Hibbs S: Mind the gap: Improving discharge communication between secondary and primary care. BMJ Qual Improv Rep 2015, 4(1)PubMedPubMedCentralGoogle Scholar
  51. 51.
    Sampson R, Cooper J, Barbour R, Polson R, Wilson P (2015) Patients' perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research. BMJ Open 5(10):e008708PubMedPubMedCentralGoogle Scholar
  52. 52.
    Redmond P, Carroll H, Grimes T, Galvin R, McDonnell R, Boland F, McDowell R, Hughes C, Fahey T (2016) GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland. Fam Pract 33(2):172–178PubMedGoogle Scholar
  53. 53.
    Fitzsimons M, Grimes T, Galvin M (2011) Sources of pre-admission medication information: observational study of accuracy and availability. Int J Pharm Pract 19(6):408–416PubMedGoogle Scholar
  54. 54.
    Chen HH, Taylor SE, Harding AM, Taylor DM: Accuracy of medication information sources compared to the best possible medication history for patients presenting to the emergency department. Emergency Medicine Australasia, 0(0)Google Scholar
  55. 55.
    Mueller SK, Sponsler KC, Kripalani S, Schnipper JL (2012) Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 172(14):1057–1069PubMedPubMedCentralGoogle Scholar
  56. 56.
    Bassi J, Lau F, Bardal S (2010) Use of information technology in medication reconciliation: a scoping review. Ann Pharmacother 44(5):885–897PubMedGoogle Scholar
  57. 57.
    Kruse CS, Kristof C, Jones B, Mitchell E, Martinez A (2016) Barriers to electronic health record adoption: a systematic literature review. J Med Syst 40(12):252PubMedPubMedCentralGoogle Scholar
  58. 58.
    Centre for Public Impact. The electronic health records system in the UK [ ]Google Scholar
  59. 59.
    Cumbler E, Wald H, Kutner J (2010) Lack of patient knowledge regarding hospital medications. J Hosp Med 5(2):83–86PubMedGoogle Scholar
  60. 60.
    Chung MK, Bartfield JM (2002) Knowledge of prescription medications among elderly emergency department patients. Ann Emerg Med 39(6):605–608PubMedGoogle Scholar
  61. 61.
    Chan FW-k, Wong FY-y, So WY, Kung K, Wong CK-m (2013) how much do elders with chronic conditions know about their medications? BMC Geriatr 13(1):59PubMedPubMedCentralGoogle Scholar
  62. 62.
    Spiers MV, Kutzik DM, Lamar M (2004) Variation in medication understanding among elderly. Am J Health Syst Pharm 61:373–380PubMedGoogle Scholar
  63. 63.
    Barat I, Andreasen F, Damsgaard EMS (2001) Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 51(6):615–622PubMedPubMedCentralGoogle Scholar
  64. 64.
    Werumeus Buning A, Klopotowska JE, Duyvendak M, Engelen LJ, Arts J (2016) Patient empowerment through provision of a mobile application for medication reconciliation: a proof of concept study. BMJ Innovations 2(4):152–157Google Scholar
  65. 65.
    Agency for Healthcare Research and Quality. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication ReconciliationGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Elaine K. Walsh
    • 1
    Email author
  • Ann Kirby
    • 2
  • Patricia M. Kearney
    • 3
  • Colin P. Bradley
    • 1
  • Aoife Fleming
    • 4
  • Kieran A. O’Connor
    • 5
  • Ciaran Halleran
    • 6
  • Timothy Cronin
    • 4
  • Elaine Calnan
    • 6
  • Patricia Sheehan
    • 6
  • Laura Galvin
    • 6
  • Derina Byrne
    • 6
  • Laura J. Sahm
    • 4
  1. 1.Department of General PracticeUniversity College CorkCorkIreland
  2. 2.School of EconomicsUniversity College CorkCorkIreland
  3. 3.School of Public HealthUniversity College CorkCorkIreland
  4. 4.School of PharmacyUniversity College CorkCorkIreland
  5. 5.Department of Geriatric MedicineMercy University HospitalCorkIreland
  6. 6.Department of PharmacyMercy University HospitalCorkIreland

Personalised recommendations