Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 4,014
- 试验地点
- 2
- 主要终点
- Adverse drug event
研究概览
简要总结
The purpose of this study is to determine if a physician's use of electronic medication reconciliation software when writing a patient's discharge prescription will prevent adverse drug events and readmissions to the hospital. This electronic medication software will provide the physician with the most up-to-date list of medications the patient was taking before being admitted to the hospital, through a real-time link to the provincial drug insurance agency's administrative databases. It will also provide the list of medications the patient has taken while admitted to the hospital. With these two pieces of information, the physician will write the discharge prescription using the medication management software, print the discharge prescription for the patient, and the software will fax a copy of any prescriptions that should be stopped to the patient's community pharmacist.
详细描述
Background:
- Drug-related illness accounts for 5-23% of hospital admissions, 4-8% of ambulatory visits, and is now claimed to be the 6th leading cause of mortality.
- At least 58% of adverse drug events (ADEs) are considered preventable.
- Transitions in care, particularly between community and hospital, account for a substantial number of preventable ADEs. In fact, between 12% to 17% of patients will have an adverse drug event within 30 days of discharge from hospital, and 14.3% will be readmitted.
- A major contributor to preventable ADEs is the failure to reconcile pre-admission medications with drugs prescribed at discharge. To avoid preventable ADEs, medication reconciliation is now a required organizational practice for hospital accreditation in Canada and the United States.
- However, there are substantial challenges in implementing medication reconciliation, as 87% of patients do not know what drugs they are taking, and 63% of the time staff cannot access outside records from the community pharmacy or primary care physician. As a result, 60-70% of medication histories contain at least one error.
- The time and resources required to obtain the community drug profile far outstrips the capacity to deliver this essential service for most patients.
Goal:
- Providing the medical team with the capacity to electronically retrieve the most up-to-date community drug list from all pharmacies will optimize the accuracy of medication histories and reduce the time required to reconcile the community and hospital drug lists at discharge.
- This strategy will also identify and advise the community pharmacies and physicians of the changes made during hospitalization, so that prescriptions for drugs that are discontinued because of adverse effects or ineffective treatment do not continue to be filled.
Preliminary work & novel opportunities:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •have public drug insurance: this includes all those 65 years and older in the province of Quebec, as well as those under 65 on social assistance or who do not have drug insurance available through their employer
- •admitted to the hospital from the community
- •admitted to a surgical or internal medicine unit
- •discharged alive
排除标准
- 未提供
研究组 & 干预措施
Electronic Medication Reconciliation
Electronic medication reconciliation includes:
- Electronic retrieval of the community drug list at admission
- Generation of discharge prescription using the discharge reconciliation module at discharge
- Transfer of information on discontinued and changed medication to respective dispensing pharmacies and prescribing physicians
干预措施: Electronic Medication Reconciliation (Other)
Usual practice medication reconciliation
Usual practice in dealing with medication reconciliation. This includes viewing the hospital medications through the hospital electronic pharmacy system, and viewing the community drugs in the patient's chart, if it was collected at admission (not always the case). However not all physicians view the community drugs before writing the discharge prescription. The physician will write a paper discharge prescription to be given to the patient, but communications are generally not made directly to the community pharmacist or previous prescribing physicians.
结局指标
主要结局
Adverse drug event
时间窗: Withing the 30 days post-discharge from hospital
Adverse drug event: an injury resulting from medical intervention related to a drug. Assessed using: 1. self-reported patient information 30 days post-discharge 2. chart and administrative data on drugs that were started, stopped, or continued at discharge as well as acute and chronic health problems 3. reviewing \& adjudicating the presence of an adverse event and the probability of it being drug related by a blinded expert panel review of each patient's chart and post-discharge interview data using the Leape \& Bates method, and the Naranjo criteria.
次要结局
- Emergency room visit / Hospital readmission(Within the 30 days post-discharge from hospital)
- Failure to re-start community medications used for chronic conditions after discharge from hospital.(90 days after discharge from hospital)
- Readiness for hospital discharge(Within the 30 days post-discharge from hospital)
- Time to complete medication history and discharge medication reconciliation with prescription.(At admission to study unit, and upon discharge from hospital)
- Therapy duplication(Withing the 30 days post-discharge from hospital)
- Unplanned dose changes(Withing the 30 days post-discharge from hospital)
- Errors of omission(Withing the 30 days post-discharge from hospital)