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      A retrospective review of student pharmacist medication reconciliation activities in an outpatient family medicine center Translated title: Recisión retrospectiva de las actividades de reconciliación de medicación de estudiantes de farmacia en un centro ambulatorio de medicina de familia

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          Background: Medication reconciliation in the outpatient setting is an important part of preventing medication errors, and is mandated by the Joint Commission. Objective: To describe and quantify medication reconciliation efforts by student pharmacists in an outpatient family medicine center. Methods: A retrospective review was conducted of medication reconciliation documentation forms completed by student pharmacists during an outpatient clinical rotation between May 2012 and April 2013. Discrepancies were defined as any lack of agreement between the medication list in the electronic medical record and the patient reported regimen. Descriptive statistics were used to report results. Results: A total of 557 medication reconciliation documentation forms from 12 student pharmacists were reviewed. The average number of medications per patient interviewed was 9 (range 0-25). A total of 1,783 medication discrepancies were found with an average of 3.2 discrepancies per patient. An additional 272 medication allergy discrepancies were identified. The most common discrepancy was medications the patient was no longer taking (37.3%, n=766). The second most common discrepancy was over-the-counter and herbal medications that had not been added to the medication list (16.2%, n=335). Patient counseling was documented 159 times during the medication reconciliation process. Conclusions: Medication reconciliation by student pharmacists in an outpatient family medicine center resulted in the identification of many discrepancies in medication lists in an electronic health record. Student pharmacists also documented and clarified medication allergies and performed patient counseling.

          Translated abstract

          Antecedentes: La reconcialización de la medicación en pacientes ambulatorios es un elementoimportante de la prevención de errores de medicación, y es obligatoria para la Joint Commission. Objetivo: Describir y cuantificar los esfuerzos en reconciliación de la medicación de los estudiantes de farmacia en un centro ambulatorio de medicina de familia. Métodos: Se realizó una revisión retrospectiva de la documentación de la reconciliación de la medicación completada por estudiantes de farmacia durante la rotación clínica en ambulatorio entre mayo de 2012 y abril de 2013. Se definieron las discrepancias como la falta de acuerdo entre la lista de medicación en la historia clínica electrónica y el régimen comunicado por el paciente. Se utilizaron estadísticas descriptivas para comunicar los resultados. Resultados: se revisaron un total de 557 formularios de documentación de reconciliación de medicación de 12 estudiantes de farmacia. La media de medicamentos por paciente fue de 9 (rango 0-25). Se encontraron un total de 1.783 discrepancias con una media de 3,2 discrepancias por paciente. Se identificaron 272 discrepancias de alergias medicamentos adicionales. La discrepancia más común era la medicación que el paciente ya no tomaba (37,3%; n=766). La segunda discrepancia más común fue medicamentos sin receta o plantas medicinales que no habían sido añadidas a la lista (16,2%; n=335). Se documentó el consejo a pacientes en 159 ocasiones durante el proceso de reconciliación de la medicación. Conclusiones: La reconciliación de medicación por estudiantes de farmacia en un centro ambulatorio de medicina de familia resultó en la identificación de muchas discrepancias en la lista de medicación en las historias clínicas electrónicas. Los estudiantes de farmacia también documentaron y clarificaron alergias a medicamentos y realizaron consejo a pacientes.

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          Most cited references 31

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          Adverse drug events in the outpatient setting: an 11-year national analysis.

          Adverse drug events (ADEs) are a common complication of medical care resulting in high morbidity and medical expenditure. Population level estimates of outpatient ADEs are limited. Our objective was to provide national estimates and characterizations of outpatient ADEs and determine risk factors associated with these events. Data are from the National Center for Health Statistics which collects information on patient visits to outpatient clinics and emergency departments throughout the United States. We examined visits between 1995 and 2005 and measured the national annual estimates of and risk factors for outpatient ADEs requiring medical treatment. The national annual number of ADE-related visits was 4 335,990 (95%CI: 4 326 872-4 345 108). Visits for ADEs to outpatient clinics increased over the study period from 9.0 to 17.0 per 1000 persons (p-value for trend < 0.001). In multivariate analyses, factors associated with ADE visits included patient age (OR: 2.13; 95%CI: 1.63-2.79 for 65 years and older), number of medications taken by patient (OR: 1.88; 95%CI: 1.58-2.25 for five medications or more), and female gender (OR: 1.51; 95%CI: 1.34-1.71). Overall, outpatient ADEs resulted in 107,468 (95%CI: 89 011-125 925) hospital admissions annually, with older patients at highest risk for hospitalization (p-value for trend < 0.001). Both patient age and polypharmacy use are risk factors for ADE-related healthcare visits, which have substantially increased in outpatient clinics between 1995 and 2005. The incidence of ADEs has particularly increased among patients 65 years and older with as many as 1 in 20 persons seeking medical care for an ADE. (c) 2010 John Wiley & Sons, Ltd.
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            Sources and types of discrepancies between electronic medical records and actual outpatient medication use.

            Accuracy and transportability of the recorded outpatient medication list are important in the continuum of patient care. Classifying discrepancies between the electronic medical record (EMR) and actual drug use by the root cause of discrepancy (either system generated or patient generated) would guide quality improvement initiatives. To quantify and categorize the number and type of medication discrepancies that exist between the medication lists recorded in EMRs and the comprehensive medication histories obtained through telephone interviews conducted by a team of nurses providing advice to health plan members at the Palo Alto Medical Foundation in Palo Alto, California. The study was conducted as a retrospective comparison of EMR medication lists with information obtained by patient interview. Interview data were obtained by a review of telephone calls made to a nurse advice line by health plan members seeking information about sinusitis, urinary tract infection, acute conjunctivitis, pharyngitis, emergency contraception, or mastitis. As part of the advice protocol, a medication reconciliation process was conducted between July 1 and December 31, 2006. Changes to the medication list made during the telephone visit were extracted, categorized, and evaluated by the study's principal investigator. Data extraction included the number and type of identified medication discrepancies, patient age, gender, and condition that prompted the telephone contact. A modified version of the Medication Discrepancy Tool (MDT) was used to categorize medication discrepancies as either system generated (e.g., failure of the provider to update a medication list) or patient generated (e.g., failure of the patient to report use of an over-the-counter product). A total of 233 discrepancies were identified from 85 medication reconciliation phone visits, averaging 2.7 per medication list. The most common type of discrepancy was a medication recorded in the EMR but no longer being used by the patient (n=164, 70.4%), followed by omission from the EMR of a medication being taken by the patient (n=36, 15.5%). 79.8% (n=186) of the discrepancies were attributed to system-generated factors, whereas 20.2% (n=47) were patient generated. Approximately half (n=118, 50.6%) of the discrepancies fell into 4 broad American Hospital Formulary System therapeutic classifications: anti-infective agents (14.2%), anti-inflammatory agents (14.2%), analgesics (12.4%), and vitamins (9.9%). The most common patient-generated discrepancy was omission of a multivitamin (n=13, 27.7%), and the most common system-generated prescription drug discrepancy was expired entry for the intranasal corticosteroid mometasone furoate (n=12, 6.5%). Discrepancies in the outpatient setting were common and predominantly system generated. The most common discrepancy was the presence in the EMR of a medication no longer being taken by the patient. Adding foreseeable end dates to prescription drug orders at computerized order entry might be considered in an effort to improve the accuracy of the outpatient medication list. Reliable systems to involve patients in routinely reconciling EMRs with actual medication use may also warrant examination. The MDT methodology served as a useful qualitative guide for evaluating discrepancies and developing targeted means for resolution.
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              Discrepancies in the use of medications: their extent and predictors in an outpatient practice.

              Misuse of medications is a major cause of morbidity and mortality. Few studies have examined the frequency of, and factors associated with, discrepancies between what doctors prescribe and what patients take in actual practice. Patients' medication bottles and their reported use of medications were compared with physicians' records of outpatients seen between November 1997 and February 1998 in a private practice affiliated with an academic medical center in Boston, Mass. Three hundred twelve patients from the practices of 5 cardiologists and 2 internists who were returning for their routine follow-up visits were included. The presence of discrepancies based on comparing medication bottles with medical records. Discrepancies were present in 239 patients (76%). The 545 discrepancies in these patients were the result of patients taking medications that were not recorded (n = 278 [51%]); patients not taking a recorded medication (n = 158 [29%]); and differences in dosage (n = 109 [20%]). Overall, discrepancies were randomly distributed among different drugs and discrepancy types with no discernible pattern. On multivariate analysis, patient age and number of recorded medications were the 2 most significant predictors of medication discrepancy. Discrepancies among recorded and reported medications were common and involved all classes of medications, including cardiac and prescription drugs. Older age and polypharmacy were the most significant correlates of discrepancy. The pervasiveness of discrepancies can have significant health care implications, and action is urgently needed to address their causes. Such action would likely have a positive impact on patient care.

                Author and article information

                Role: ND
                Role: ND
                Pharmacy Practice (Granada)
                Pharmacy Pract (Granada)
                Centro de Investigaciones y Publicaciones Farmacéuticas (Redondela )
                March 2015
                : 13
                : 1
                : 0
                [1 ] Auburn University United Estates
                [2 ] Huntsville Hospital United States


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