COMPARISON OF INFORMATION AVAILABLE IN THE MEDICATION PROFILE OF AN ELECTRONIC HEALTH RECORD AND THE INPATIENT BEST POSSIBLE MEDICATION HISTORY IN A MOTHER AND CHILD TEACHING HOSPITAL CENTER
Main Article Content
Keywords
Medication reconciliation, medication history, electronic health records, child
Abstract
Background
Medication reconciliation (MedRec) can improve patient safety. In Canada, most provinces are implementing electronic health records (EHR). The Quebec Health Record (QHR) can theoretically be used for medication reconciliation. However, the quantity and the quality of information available in this EHR have not been studied.
Objectives
The main objective was to compare the quantity and quality of the inf ormation collected between the inpatient best possible medication history (BPMH) and the QHR.
Methods
This is a descriptive prospective study conducted at CHU Sainte- Justine, a 500 -bed tertiary mother -and - child university hospital center. All inpatients from May 19- 26, 2015 were considered for inclusion. Every prescription line in the BPMH and QHR were compared.
Results
The study included 344 patients and 1,039 prescription lines were analyzed. The medications’ name and dosing were more often available in the QHR (95 %) than in the BPMH (61% ). C oncordance between the medication names between QHR and BPMH was found in 48 % of the prescription lines; this rate fell to 29% when also factoring daily dosage.
Conclusions
This study suggests that the QHR can provide high -quality information to support the MedRec hospital process. However, it should be used as a second source to optimize the BPMH obtained from a thorough interview with the patient and/or his or her family. M ore studies are required to confirm the most optimal way to integrate the QHR to the MedRec process in hospitals.
References
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13. Quélennec B, Beretz L, Paya D, et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med 2013;24(6):530– 5.
14. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R , Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J 2005;173(5):510– 5.
15. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the ti me of hospital admission. Arch Intern Med 2005;165(4):424– 9.
16. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health -Syst Pharm 2004;61(16):1689– 95.
17. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med 2008;23(9):1414– 22.
18. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 2007;167(10):1034– 40.
19. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy 2007;27(4):481– 93.
20. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinic al pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166(9):955– 64.
21. Huynh C, Wong ICK, Tomlin S, et al. Medication discrepancies at transitions in pediatrics: a review of the literature. Paediatr Drugs 2013;15(3):203– 15.
22. Terry DRP, Solanki GA, Sinclair AG, Marriott JF, Wilson KA. Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital: observational study of neurosurgical patients. Paediatr Drugs 2010;12(5):331– 7.
23. Fortescue EB, K aushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111(4):722– 9.
24. Dersch -Mills D, Hugel K, Nystrom M. Completeness of information sources used to prepare best possible medication histories for pediatric patients. Can J Hosp Pharm 2011;64(1):10– 5.
25. Salanitro AH, Kripalani S, Resnic J, et al . Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res 2013;13:230.
26. Engels MJ, Chaffee BW, Clark JS. Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives. Am J Health Syst Pharm 2015;72(23):2065 -78.
27. Chan C, Woo R, Seto W, Pong S, Gilhooly T, Russell J. Medication reconciliation in pediatric cardiology performed by a pharmacy technician: a prospective cohort comparison study. Can J Hosp Pharm 2015;68(1):8 -15.
28. Andreoli L, Alexandra JF, Tesmoingt C, et al . Medication reconciliation: a prospective study in an internal medicine unit. Drugs Aging 2014;31(5):387 -93.
29. Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 2000;49(6):597– 603.
30. Beers MH, Munekata M, Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc 1990;38(11):1183– 7.
31. Action on Patient Safety - High 5s. Genève: World Health Organization (2006) Available at: http://www.who.int/patientsafety/implementation/s olutions/high5s/en/ (Accessed Jan 23, 2016).
32. Loi concernant le partage de certains renseignements de santé. Quebec: Gouverne ment du Québec (Aug 1, 2015) Available at: http://www2.publicationsduquebec.gouv.qc.ca/dyn amicSearch/telecharge.php?type=2&file=/P_9 _000 1/P9_0001.html (Accessed Aug 11, 2015).
33. What is the Quebec Health Record? The deployment. Quebec: Gouvernement du Québec (May 15, 2015) Available at: http://www.dossierdesante.gouv.qc.ca/en/populatio n/Qu -est -ce-que -le- DSQ/index.php?Le_deploiement (Accessed Jul 30, 2015).
34. Price M, Bowen M, Lau F, Kitson N, Bardal S. Assessing accuracy of an electronic provincial medication repository. BMC Med Inform Decis Mak 2012;12:42.
35. Kalb K, Shalansky S, Legal M, Khan N, Ma I, Hunte G. Unintended medication discrepancies associated with reliance on prescription databases for medication reconciliation on admission to a general medical ward. Can J Hosp Pharm 2009;62(4):284– 9.
36. Tulloch J, Evans B. Evaluation of the Accuracy of the Saskatchewan Health Pharmaceutical Information Program for Determining a Patient’s Medication Use Immediately before Admission. Can J Hosp Pharm 2009;62(1):21– 7.
37. Warholak TL, McCull och M, Baumgart A, Smith M, Fink W, Fritz W. An exploratory comparison of medication lists at hospital admission with administrative database records. J Manag Care Pharm 2009;15(9):751– 8.
38. Van der Kam WJ, Meyboom de Jong B, Tromp TF, Moorman PW, van der Le i J. Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge. Fam Pract 2001;18(6):605– 9.
39. Grimes T, Fitzsimons M, Galvin M, Delaney T. Relative accuracy and availability of an Irish National Database of dispensed medication as a source of medication history information: observational study and retrospective record analysis. J Clin Pharm Ther 2013;38(3):219– 24.
40. Glintborg B, Poulsen HE, Dalhoff KP. The use of nationwide on -line prescription records improves the drug history in hospitalized patients. Br J Clin Pharmacol 2008;65(2):265– 9.
41. Varkey P, Cunningham J, O'Meara J, Bonacci R, Desai N, Sheeler R. Multidisciplinary approach to inpatient medication reconciliation in an aca demic setting. Am J Health Syst Pharm 2007;64(8):850 - 4.
42. Aag T, Garcia BH, Viktil KK. Shou ld nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial. Eur J Clin Pharmacol 20 14;70(11):1325- 32.
43. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital -based medication reconciliation practices: a systematic review. Arch Intern Med 2012; 172(14):1057 -1069.
44. Andreoli L, Alexandra JF, Tesmoingt C, et al. Medication reconciliation: a prospective study in an internal medicine unit. Drugs Aging 2014;31(5):387 -93.
45. Buck TC, Gronkjaer LS, Duckert ML, Rosholm JU, Aagaard L. Medication reconciliation and prescribing reviews by pharmacy technicians in a geria tric w ard. J Res Pharm Pract 2013;2(4):145 - 50.
46. Lancaster JW, Grgurich PE . Impact of students pharmacists on the medic ation reconciliation process in high- risk hospitalized general medicine patients. Am J Pharm Educ 2014;78(2):34.
47. Johnston R, Saulnier L, Gould O. Best possible medication history in th e emergency department: comparing pharmacy technicians and pharmacists. Can J Hosp Pharm 2010;63(5):359- 65.
48. Provine AD, Simmons EM, Bhagat PH. Establishment and evaluation of pharmacist - managed admission medication history and reconciliation process for pediatric patients. J Pediatr Pharmacol Ther 2014;19(2):98 -102.
49. Tedesco GW, McConaha JL, Skomo ML, Higginbotham SK. A pharmacist's impact on 30- day readmission rates when compared to the current standard of care within a patient -centered medical home: A Pilot Study. J Pharm Pract 2015 Jan 28.
50. Huynh C, Tomlin S, Jani Y, et al. An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Arch Dis Child 2016;101(1):67 -71.
51. Leguelinel -Blache G, Arnaud F, Bouvet S, et al. Impact of admission medication reconciliation performed by clinical pharmacists on medication safety. Eur J Intern Med 2014;25(9):808 -14.
52. Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother 2014;48(10):1298 -312.
2. Wanbon R, Lyder C, Villeneuve E, Shalansky S, Manuel L, Harding M. Medication reconciliation practices in Canadian emergency departments: a national survey. Can J Hosp Pharm 2015;68(3):202 -9.
3. Coffey M. Medication reconciliation: Coming to a hospital near you. Paediatr Child Health 2009;14(2):76 -7.
4. Meguerditchian AN, Krotneva S, Reidel K, Huang A, Tamblyn R. Medication reconciliation at admission and discharge: a t ime and motion study. BMC Health Serv Res 2013;13(1):485.
5. Penfornis S, Bédard P, Bailey B, Bussières J -F. Conformité des bilans comparatifs des médicaments à l’admission transmis au département de pharmacie par télécopieur. Can J Hosp Pharm 2012;65(3):216 -22.
6. Alary V, Thibault M, Nguyen C, Bussières J -F. Utilisation du bilan comparatif des médicaments en chirurgie ambulatoire pédiatrique. Can J Hosp Pharm 2014;67(2):170.
7. Penfornis S, Bédard P, Bailey B, Bussières J -F. Étude pilote sur la participation des parents à la démarche de bilan comparatif des médicaments. Arch Pediatr 2012;19(5):449– 55.
8. Bédard P, Tardif L, Ferland A, et al. A medication reconciliation form and its impact on the medical record in a paediatric hospital: Medication reconciliation in a paediatric hospital. J Eval Clin Pract 2011;17(2):222– 7.
9. Medication Reconciliation (MedRec). ISMP Canada Available at: https://www.ismp - canada.org/medrec/ (Accessed Jan 23, 2016) .
10. Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high -risk patients through medication reconciliation, medication education, and postdischarge call -backs (IPITCH Study). J Hosp Med 2016;11(1):39 -44.
11. Becerra -Camargo J, Martinez -Martinez F, Garcia - Jimenez E. A multicentre, double -blind, randomised, controlled parallel -group study of the effectiveness of a pharmacist -acquired medication history in an emergency department. BMC Health Serv Res 2013;13:337.
12. Van den Bemt PMLA, van der Schrieck -de Loos EM, van der Linden C, Theeuwes AMLJ, Pol AG, Dutch CBO WHO High 5s Study Group. Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly adults: a mu lticenter study. J Am Geriatr Soc 2013;61(8):1262– 8.
13. Quélennec B, Beretz L, Paya D, et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med 2013;24(6):530– 5.
14. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R , Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J 2005;173(5):510– 5.
15. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the ti me of hospital admission. Arch Intern Med 2005;165(4):424– 9.
16. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health -Syst Pharm 2004;61(16):1689– 95.
17. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med 2008;23(9):1414– 22.
18. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 2007;167(10):1034– 40.
19. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy 2007;27(4):481– 93.
20. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinic al pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166(9):955– 64.
21. Huynh C, Wong ICK, Tomlin S, et al. Medication discrepancies at transitions in pediatrics: a review of the literature. Paediatr Drugs 2013;15(3):203– 15.
22. Terry DRP, Solanki GA, Sinclair AG, Marriott JF, Wilson KA. Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital: observational study of neurosurgical patients. Paediatr Drugs 2010;12(5):331– 7.
23. Fortescue EB, K aushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111(4):722– 9.
24. Dersch -Mills D, Hugel K, Nystrom M. Completeness of information sources used to prepare best possible medication histories for pediatric patients. Can J Hosp Pharm 2011;64(1):10– 5.
25. Salanitro AH, Kripalani S, Resnic J, et al . Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res 2013;13:230.
26. Engels MJ, Chaffee BW, Clark JS. Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives. Am J Health Syst Pharm 2015;72(23):2065 -78.
27. Chan C, Woo R, Seto W, Pong S, Gilhooly T, Russell J. Medication reconciliation in pediatric cardiology performed by a pharmacy technician: a prospective cohort comparison study. Can J Hosp Pharm 2015;68(1):8 -15.
28. Andreoli L, Alexandra JF, Tesmoingt C, et al . Medication reconciliation: a prospective study in an internal medicine unit. Drugs Aging 2014;31(5):387 -93.
29. Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 2000;49(6):597– 603.
30. Beers MH, Munekata M, Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc 1990;38(11):1183– 7.
31. Action on Patient Safety - High 5s. Genève: World Health Organization (2006) Available at: http://www.who.int/patientsafety/implementation/s olutions/high5s/en/ (Accessed Jan 23, 2016).
32. Loi concernant le partage de certains renseignements de santé. Quebec: Gouverne ment du Québec (Aug 1, 2015) Available at: http://www2.publicationsduquebec.gouv.qc.ca/dyn amicSearch/telecharge.php?type=2&file=/P_9 _000 1/P9_0001.html (Accessed Aug 11, 2015).
33. What is the Quebec Health Record? The deployment. Quebec: Gouvernement du Québec (May 15, 2015) Available at: http://www.dossierdesante.gouv.qc.ca/en/populatio n/Qu -est -ce-que -le- DSQ/index.php?Le_deploiement (Accessed Jul 30, 2015).
34. Price M, Bowen M, Lau F, Kitson N, Bardal S. Assessing accuracy of an electronic provincial medication repository. BMC Med Inform Decis Mak 2012;12:42.
35. Kalb K, Shalansky S, Legal M, Khan N, Ma I, Hunte G. Unintended medication discrepancies associated with reliance on prescription databases for medication reconciliation on admission to a general medical ward. Can J Hosp Pharm 2009;62(4):284– 9.
36. Tulloch J, Evans B. Evaluation of the Accuracy of the Saskatchewan Health Pharmaceutical Information Program for Determining a Patient’s Medication Use Immediately before Admission. Can J Hosp Pharm 2009;62(1):21– 7.
37. Warholak TL, McCull och M, Baumgart A, Smith M, Fink W, Fritz W. An exploratory comparison of medication lists at hospital admission with administrative database records. J Manag Care Pharm 2009;15(9):751– 8.
38. Van der Kam WJ, Meyboom de Jong B, Tromp TF, Moorman PW, van der Le i J. Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge. Fam Pract 2001;18(6):605– 9.
39. Grimes T, Fitzsimons M, Galvin M, Delaney T. Relative accuracy and availability of an Irish National Database of dispensed medication as a source of medication history information: observational study and retrospective record analysis. J Clin Pharm Ther 2013;38(3):219– 24.
40. Glintborg B, Poulsen HE, Dalhoff KP. The use of nationwide on -line prescription records improves the drug history in hospitalized patients. Br J Clin Pharmacol 2008;65(2):265– 9.
41. Varkey P, Cunningham J, O'Meara J, Bonacci R, Desai N, Sheeler R. Multidisciplinary approach to inpatient medication reconciliation in an aca demic setting. Am J Health Syst Pharm 2007;64(8):850 - 4.
42. Aag T, Garcia BH, Viktil KK. Shou ld nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial. Eur J Clin Pharmacol 20 14;70(11):1325- 32.
43. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital -based medication reconciliation practices: a systematic review. Arch Intern Med 2012; 172(14):1057 -1069.
44. Andreoli L, Alexandra JF, Tesmoingt C, et al. Medication reconciliation: a prospective study in an internal medicine unit. Drugs Aging 2014;31(5):387 -93.
45. Buck TC, Gronkjaer LS, Duckert ML, Rosholm JU, Aagaard L. Medication reconciliation and prescribing reviews by pharmacy technicians in a geria tric w ard. J Res Pharm Pract 2013;2(4):145 - 50.
46. Lancaster JW, Grgurich PE . Impact of students pharmacists on the medic ation reconciliation process in high- risk hospitalized general medicine patients. Am J Pharm Educ 2014;78(2):34.
47. Johnston R, Saulnier L, Gould O. Best possible medication history in th e emergency department: comparing pharmacy technicians and pharmacists. Can J Hosp Pharm 2010;63(5):359- 65.
48. Provine AD, Simmons EM, Bhagat PH. Establishment and evaluation of pharmacist - managed admission medication history and reconciliation process for pediatric patients. J Pediatr Pharmacol Ther 2014;19(2):98 -102.
49. Tedesco GW, McConaha JL, Skomo ML, Higginbotham SK. A pharmacist's impact on 30- day readmission rates when compared to the current standard of care within a patient -centered medical home: A Pilot Study. J Pharm Pract 2015 Jan 28.
50. Huynh C, Tomlin S, Jani Y, et al. An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Arch Dis Child 2016;101(1):67 -71.
51. Leguelinel -Blache G, Arnaud F, Bouvet S, et al. Impact of admission medication reconciliation performed by clinical pharmacists on medication safety. Eur J Intern Med 2014;25(9):808 -14.
52. Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother 2014;48(10):1298 -312.