Original scientific paper
https://doi.org/10.3325/cmj.2016.57.572
Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia
Ivana Marinović
orcid.org/0000-0002-1612-9859
; Hospital Pharmacy, University Hospital Dubrava, Zagreb, Croatia
Srećko Marušić
; Department of Clinical Pharmacology,University Hospital Dubrava, Zagreb, Croatia
Iva Mucalo
; Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
Jasna Mesarić
; Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
Vesna Bačić Vrca
; Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
Abstract
Aim To evaluate the clinical pharmacist-led medication
reconciliation process in clinical practice by quantifying
and analyzing unintentional medication discrepancies at
hospital admission.
Methods An observational prospective study was conducted
at the Clinical Department of Internal Medicine,
University Hospital Dubrava, during a 1-year period (October
2014 – September 2015) as a part of the implementation
of Safe Clinical Practice, Medication Reconciliation
of the European Network for Patient Safety and Quality of
Care Joint Action (PASQ JA) project. Patients older than 18
years taking at least one regular prescription medication
were eligible for inclusion. Discrepancies between pharmacists’
Best Possible Medication History (BPMH) and physicians’
admission orders were detected and communicated
directly to the physicians to clarify whether the observed
changes in therapy were intentional or unintentional. All
discrepancies were discussed by an expert panel and classified
according to their potential to cause harm.
Results In 411 patients included in the study, 1200 medication
discrepancies were identified, with 202 (16.8%) being
unintentional. One or more unintentional medication
discrepancy was found in 148 (35%) patients. The most frequent
type of unintentional medication discrepancy was
drug omission (63.9%) followed by an incorrect dose (24.2%).
More than half (59.9%) of the identified unintentional medication
discrepancies had the potential to cause moderate to
severe discomfort or clinical deterioration in the patient.
Conclusion Around 60% of medication errors were assessed
as having the potential to threaten the patient safety.
Clinical pharmacist-led medication reconciliation was
shown to be an important tool in detecting medication
discrepancies and preventing adverse patient outcomes.
This standardized medication reconciliation process may
be widely applicable to other health care organizations
and clinical settings.
Keywords
Hrčak ID:
181397
URI
Publication date:
15.12.2016.
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