1222 / Medication Reconciliation at Hospital Discharge: Evaluating Discrepancies before and after rollout of an electronic technology tool

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Implemented
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Health IT
Medication / IV Fluids There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
The aim is to reduce the number of medication discrepancies detected at hospital discharge and improving patient safety and the knowledge of their treatment
Description of the Patient Safety Practice
 
According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient is subject to at least one medication error per day. This confirms previous research findings that medication errors represent the most common patient safety error. More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients. Many of these errors would be averted if medication reconciliation processes were in place.

The process of reconciliation at discharge on a general medicine service is especially critical given the complex needs of the patients involved (multiple comorbidities and polymedication). Recent studies have found that discrepancies occur more frequently on hospital discharge than on admission.

We reviewed 100% of electronic prescriptions of all complex chronic patients who were discharged from the hospital from 15 July 2014 to 31 August 2014 (n = 88). 63% of patients had at least one discrepancy between the information in the report and high electronic prescriptions given to the patient. This result was consistent with the findings of previous studies that demonstrated that discrepancies occur frequently on hospital discharge; 41.0-56.3% of the patients in those studies had a medication discrepancy on discharge3.

Currently, an electronic technology tool is being designed in our hospital to prevent medication discrepancies. It consists in a software which collects all the active medication in the patient’s pharmacotherapeutic plan. Through a clinical interview with the patient or the responsible of the medication, the pharmacist selects the drugs he is really taking and adds more information about adherence and side effects of the medication selected. He can also indicate who is responsible for the medication (the patient himself, a relative or an institution) and the level of knowledge they have about their treatment plan.
Subsequently a report is automatically included in the medical history of the patient and the attending physician may change it at any time.
At discharge the reconciliation report is given to the patient with the changes resulting from hospitalization and stays visible in the clinical history for further consultations
This tool is going to allow us to have more information from computerized patient’s pharmacotherapeutic plan and we expect it will decrease the medication errors that result from inadequate reconciliation during admission, transfer and discharge of patients.

When implanted, we will do a similar reviewed we did on 2014 in order to determine the effect of this tool specially designed for preventing discharge medication errors
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
No
Level of implementation of reported practice
There is no specified text here
Specific and measurable outcome for the reported practice were defined
There is no specified text here
A baseline measurement before implementation of the reported practice was obtained
There is no specified text here
A measurement after full implementation of the reported practice was obtained
There is no specified text here
Evaluation of a "positive" effect of the reported practice on Patient Safety
There is no specified text here
Type of before-and after evaluation
There is no specified text here
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Nursing facility
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Pharmacists
Technical support / technician
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Other
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Not known
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Management support
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 6
External consultants: 0
Support staff: 30
Managerial staff: 1
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 8
External consultants: 0
Support staff: 2
Managerial staff: 0
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
2000
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
0
Contact information
 
Name: Pilar Barrufet
Country: SPAIN
Organisation: Consorci Sanitari del Maresme
E-mail: mbarrufet@csdm.cat
Phone: 937417700
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