Christopher Keeys1, Bamidele Kalejaiye2, Michelle Skinner2, Mandana Eimen2, Joann Neufer2, Gisele Sidbury2, Norman Buster2, Joan Vincent2. 1. Christopher Keeys, Pharm. D., BCPS, is Residency Program Director, Sibley Memorial Hospital-Johns Hopkins Medicine, Washington, DC, and Chief Executive Officer, MedNovations, Inc., Laurel, MD. Bamidele Kalejaiye, Pharm. D., is Clinical Pharmacist; and Michelle Skinner, Pharm. D., is Clinical Pharmacist and Training Coordinator, MedNovations, Inc. Mandana Eimen, Pharm.D., is Clinical Pharmacist; JoAnn Neufer, B.S.Pharm., is Director, Pharmacy Services; Gisele Sidbury, Pharm.D., is Clinical Pharmacist; Norman Buster, Pharm.D., is Clinical Pharmacist; and Joan Vincent, M.S.N., is Senior Vice President and Chief Nursing Officer, Patient Care Services, Sibley Memorial Hospital-Johns Hopkins Medicine. ckeeys@clinpharm.com. 2. Christopher Keeys, Pharm. D., BCPS, is Residency Program Director, Sibley Memorial Hospital-Johns Hopkins Medicine, Washington, DC, and Chief Executive Officer, MedNovations, Inc., Laurel, MD. Bamidele Kalejaiye, Pharm. D., is Clinical Pharmacist; and Michelle Skinner, Pharm. D., is Clinical Pharmacist and Training Coordinator, MedNovations, Inc. Mandana Eimen, Pharm.D., is Clinical Pharmacist; JoAnn Neufer, B.S.Pharm., is Director, Pharmacy Services; Gisele Sidbury, Pharm.D., is Clinical Pharmacist; Norman Buster, Pharm.D., is Clinical Pharmacist; and Joan Vincent, M.S.N., is Senior Vice President and Chief Nursing Officer, Patient Care Services, Sibley Memorial Hospital-Johns Hopkins Medicine.
Abstract
PURPOSE: The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described. SUMMARY: Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants. CONCLUSION: A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients.
PURPOSE: The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described. SUMMARY: Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants. CONCLUSION: A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients.
Authors: Robin Lee; Suzanne Malfair; Jordan Schneider; Sukjinder Sidhu; Caitlin Lang; Nina Bredenkamp; Shu Fei Sophie Liang; Alice Hou; Adil Virani Journal: Can J Hosp Pharm Date: 2018-04-30
Authors: Suhaib M Muflih; Sayer Al-Azzam; Sawsan Abuhammad; Sara K Jaradat; Reema Karasneh; Mohammad S Shawaqfeh Journal: Int J Clin Pract Date: 2021-04-21 Impact factor: 3.149