Int J Med Inform - Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan.

Tópicos

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Resumo

JECTIVES: Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined.METHODS: Patients admitted between May 2008 and September 2009 were recruited. The type and class of medication discrepancies reported by pharmacists, the medication discrepancy rate, physician acceptance rate, and time taken for the intervention were studied. The degree of harm that could have resulted from the discrepancies was independently evaluated by four pharmacists. The association between selected variables and the occurrence of drug discrepancies was analyzed.RESULTS: Among 3013 patients interviewed, the pharmacists identified 243 patients (8%) with at least one medication discrepancy between the patient's medication history and admission orders. There were 576 discrepancies identified. About 19% of the errors prevented could have potentially caused moderate to severe harm. The average time for one intervention was 18?9.8min. The number of preadmission medications, age, frequency of outpatient visits within 3 months prior to this hospital admission, and the number of specialist outpatient clinics the patient had visited within 3 months before the admission were determined to be risk factors for drug discrepancies.CONCLUSIONS: This medication reconciliation program, conducted by pharmacists, was made more efficient by medication usage data from the Taiwan NHI. Pharmacists can reconcile medications more effectively by selecting patients at high risk for unintentional drug discrepancies.

Resumo Limpo

jectiv obtain accur medic histori upon admiss hospit can challeng timeconsum studi evalu efficaci medic reconcili program conduct pharmacist assist medic usag data taiwan nation health insur nhi characterist patient high risk drug discrep also determinedmethod patient admit may septemb recruit type class medic discrep report pharmacist medic discrep rate physician accept rate time taken intervent studi degre harm result discrep independ evalu four pharmacist associ select variabl occurr drug discrep analyzedresult among patient interview pharmacist identifi patient least one medic discrep patient medic histori admiss order discrep identifi error prevent potenti caus moder sever harm averag time one intervent min number preadmiss medic age frequenc outpati visit within month prior hospit admiss number specialist outpati clinic patient visit within month admiss determin risk factor drug discrepanciesconclus medic reconcili program conduct pharmacist made effici medic usag data taiwan nhi pharmacist can reconcil medic effect select patient high risk unintent drug discrep

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