From hospital to home healthcare: the need for medication reconciliation

Medication reconciliation is a process of comparing medications being used by a client to a current list of prescribed medications to verify its accuracy, and is a best-practice strategy to reduce medication errors. In home healthcare, medication reconciliation includes comparing medications specified in hospital discharge instructions, those taken before the hospitalization, and those now taken by the client, and documenting action taken to resolve discrepancies noted. This exploratory study was designed to describe the adequacy of medication reconciliation in a Midwestern home healthcare agency.     

Nurses' perceptions of medication safety and medication reconciliation practices

Medication reconciliation (MR) involves the accurate transfer of medication information across the continuum of care. The aim of this study was to measure nurses perceptions of patient safety, medication safety and current MR practice at transition points in a patient's hospital stay. Surveys were distributed to 111 nursing staff in three general medicine units at Capital Health District, Nova Scotia, in August 2005. A total of 39 nurses (35% response rate) completed the survey. "Teamwork within units" was the safety culture dimension with the highest positive response (98.1%), while the processes of handoffs and transitions received the lowest positive response (42.8%). Key areas identified for improvement relative to the current level of MR practice include institutional patient safety systems (e.g., low confidence in existing systems and procedures), inconsistent practices (e.g., wide variation in whether community pharmacists are contacted to verify medication profiles), lack of communication (e.g., between healthcare professionals) and staffing resources (e.g., MR is perceived as a very time-consuming process). Addressing these challenges prior to implementing a formalized MR program should help to ensure success of the project. The insights gained through the use of this survey may prove valuable to other Canadian healthcare organizations that are implementing MR services.     

Evaluation of a medication education program for elderly hospital in-patients

To improve elderly patients' understanding and safe usage of their medications. English-speaking hospital inpatients aged > or =65 years were recruited. They were self-medicating at home with at least 1 regular medication and had a Mini-Mental State Examination (MMSE) score of at least 20 out of 30. The patients were taught medication details on 3 consecutive days. The patients' medication knowledge was recorded before education and again at a home visit after discharge from hospital. Patient medication knowledge before education showed that participants knew 50% of brand names, dosage and times, 55% of medication purpose, and 15% of major side effects. At follow-up home visits, the relevant figures improved significantly to 90%, 85%, and 25%, respectively (P < or = .05). Similar improvement occurred in the 2 patient groups with an MMSE score of 20 to 24 and 25 to 30 (P = .03). This simple, practical, nursing-staff-conducted program worked well in a hospital setting and resulted in improved medication knowledge, even in patients with mild cognitive impairment.     

A systems-based medication reconciliation process: with implications for home healthcare

This article describes the medication reconciliation process applied on hospital discharge of patients to home with home care services within Seton Health System, an integrated health delivery network located in Troy, New York. The project, which was not research based, was characterized by an intensive pharmacotherapeutic medication reconciliation at hospital discharge by the hospital-based pharmacist with continued pharmacist support available to home healthcare nurses collaboratively at the time of start of care and resumption of care. The goal of this process was to identify and resolve medication-related problems and reduce hospital readmissions.     

Evaluating process changes in a pediatric hospital medication system

This article describes a process change designed to increase the safety of prescribing and interpreting complex order sets. All chemotherapy orders written for pediatric oncology patients at a major teaching hospital in the Eastern United States and the affiliated ambulatory clinic from June 1998 through February 2000 (n = 1792) were reviewed to evaluate a new process for communication of chemotherapy orders. The multidisciplinary check (MDC) is a forum where all disciplines simultaneously review and change complex order sets. Evaluation of the MDC included monthly completion rate and classification of changes made to orders at MDC. Over the study period, 96% of eligible orders received a multidisciplinary check, and 44% were changed. The most common change was to clarify discrepancies between the order and the protocol. Changes were made to avoid medication errors in 99 of 451 orders. Changes to avoid medication errors were more likely to involve nonchemotherapy medications. The MDC is an efficient and feasible process to increase safety at the beginning of the medication system.     

Medication reconciliation: a practical tool to reduce the risk of medication errors

Preventable adverse drug events are associated with one out of five injuries or deaths. Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. This study was performed to reduce medication errors in patient’s discharge orders through a reconciliation process in an adult surgical intensive care unit (ICU). A discharge survey was implemented as part of the medication reconciliation process. The admitting nurse initiated the survey within 24 hours of ICU admission and the charge nurse completed the survey on discharge. Baseline data were obtained through a random sampling of 10% of discharges in first 2 weeks of the study (July 2001-May 2002). Medical and anesthesia records were reviewed, allergies and home medications verified with patient/family and findings compared with orders at time of ICU discharge. Baseline data revealed that 31 of 33 (94%) patients had orders changed. By week 24, nearly all medication errors in discharge orders were eliminated. In conclusion, use of the discharge survey in this medication reconciliation process resulted in a dramatic drop in medications errors for patients discharged from an ICU. The survey is now a part of our electronic medical record and used in 4 adult ICUs and 2 medicine floors.     

Psychotropic medication of elderly patients

Drugs medicated for elderly patients show different pharmacokinetics from young patients, because of change in the makeup of bodies, decrease of albumin, increase of alpha-1-acid glycoprotein, hypofunction of metabolism, and excretion by aging. In addition, complications or other concomitant drugs influence their pharmacokinetics. Therefore, when we take medication for elderly patients, we need consideration different from young patients. Psychiatric symptoms which frequently occurred in elderly patients are dementia (including behavioral and psychological symptoms of dementia), depressive state, sleep disturbance, and delirium. As warned by Food and Drug Administration, some studies reported that using antipsychotics for elderly patients with dementia increase their death rate. We have to give informed consent sufficiently to patients and their families.     

护理干预对老年病人口服用药安全性认知的影响

目的:探讨护理干预对老年病人口服用药安全性认知的影响。方法:采用自行设计的调查问卷,对105例老年病人口服用药安全性认知情况进行调查,针对病人对口服用药安全性不认知的主要内容,采取相应的护理干预措施。结果:护理干预后老年病人对口服用药安全性认知有明显的提高(P<0.01)。结论:采取针对性的护理干预措施可提高老年病人口服用药安全性的认知,对治疗起良好的保障作用,有效地控制疾病发展,减少并发症的发生,提高老年病人生存质量。     

开展质量管理活动 确保老年病人服药安全

质量管理（QC）小组是在生产或工作岗位上从事各种劳动的职工、围绕企业的经营战略、方针目标和现场存在的问题，以改进质量、降低消耗、提高人的素质和经济效益为目的组织起来，运用质量管理的理论和方法开展活动的小组。我科为老年病综合内科，绝大部分住院病人年龄超过65岁且病种复杂多变，各种生理机能衰退，听力、视力、记忆力下降。在临床工作中发现，由于护士每班的工作安排不科学、不合理，发药时间非常紧迫，护士为了能够按时交接班，只能把药放在病人床头由病人自己或陪人帮助服药，易导致服药不安全隐患。按原有的发药方法，护士做不到服药到口，病人常常会出现漏服、不按时服、错服（多服或少服）、误服（外用药或药晶包装锡箔等）或在服药过程中发生呛、噎等不安全隐患，其结果导致治疗效果受影响甚至会危及病人的生命安全。因此，成立了QC小组并设立该课题。现将本次QC小组活动过程报告如下。     

开展质量管理活动确保老年病人服药安全

质量管理(QC)小组是在生产或工作岗位上从事各种劳动的职工、围绕企业的经营战略、方针目标和现场存在的问题,以改进质量、降低消耗、提高人的素质和经济效益为目的组织起来,运用质量管理的理论和方法开展活动的小组。我科为老年病综合内科,绝大部分住院病人年龄超过65岁且病种复杂多变,各种生理机能衰退,听力、视力、记忆力下降。在临床工作中发现,由于护士每班的工作安排不科学、不合理,发药时间非常紧迫,护士为了能够按时交接班,只能把药放在病人床头由病人自己或陪人帮助服药,易导致服药不安全隐患。按原有的发药方法,护士做不到服药到…     

自制护理用药安全手册用于患者安全管理

目的：了解目前临床用药中护理差错发生的原因,探索相应的对策以确保用药安全。方法针对2011年医院41个护理单元上报用药不良事件及11月开展用药安全专项检查存在的问题进行原因分析,制定用药安全手册,包括健全各种用药安全管理组织及制度,收集临床多品种、多规格、看似听似药品拍成图片进行比对,临床应控制滴速、接触易发生反应药物,药物配制信息,药物配伍禁忌,宜从中心静脉输注的药物,高危药物外渗紧急处理,抢救药物药理知识,以表格形式进行罗列。规范使用药物流程、组织培训与考核等一系列措施。结果2012年护理用药不良事件总数较2011年减少15起,下降18．5％。与2011年相比,2012年用药专项月检查存在问题,通过护理用药安全手册的制作与应用,加强了用药安全管理,促进护理人员掌握药品管理及用药知识,有效提高了护理人员用药安全能力,保障了患者用药安全。结论该手册为护士临床用药安全提供参考,起到临床用药指引作用,有效提高了护理人员用药能力。     

某院门急诊老年患者潜在不适当用药的评价分析

目的 使用Beers标准(2019版)对某院门急诊老年患者潜在不适当用药(PIM)情况进行系统分析,为促进患者用药安全提供依据.方法 回顾性抽取某院2020年第四季度门急诊处方,对65岁及以上的老年患者用药情况进行统计分析,以Beers标准(2019版)为评判依据,评价老年患者PIM情况.结果 共收集该院2020年第四...