“engaging patients in medication reconciliation via a patient portal following hospital discharge”

Does medication reconciliation reduce readmissions or other adverse events after discharge?

Transitions between inpatient and outpatient care can result in medication discrepancies. An interdisciplinary team designed a new 'Secure Messaging for Medication Reconciliation Tool' (SMMRT) within a patient web portal and piloted it among 60 patients at a Veterans Affairs hospital, an integrated system with a shared electronic health record.

Can secure messaging improve medication reconciliation between inpatient and outpatient care?

Feb 01, 2014 · Leonie Heyworth, Allison M Paquin, Justice Clark, Victor Kamenker, Max Stewart, Tracey Martin, Steven R Simon, Engaging patients in medication reconciliation via a patient portal following hospital discharge, Journal of the American …

What is medication reconciliation?

Oct 02, 2013 · Medication errors are a major cause of adverse events after hospital discharge, and as a result, medication reconciliation is a critical part of care transitions programs. This study, conducted at a Veterans Affairs hospital, evaluated a novel method of accomplishing medication reconciliation and identifying potentially dangerous medication errors through …

Is medication reconciliation part of national patient safety goal #3?

Sep 13, 2013 · Engaging patients in medication reconciliation via a patient portal following hospital discharge. Leonie Heyworth, 1, 2 Allison M Paquin, 3 Justice Clark, 1 Victor Kamenker, 1 Max Stewart, 1 Tracey Martin, 1 and Steven R Simon 1, 2 Author information Article notes ...

What is the purpose of medication reconciliation when a patient is discharged from a hospital to home care?

What are the most effective practices for medication reconciliation in a hospital setting?

What are the 5 steps of medication reconciliation?

What three steps are in the medication reconciliation process?

What is the medication reconciliation process?

Can nurses perform medication reconciliation?

What is the nurse's role in the medication reconciliation process?

Who are the key players in medication reconciliation process?

Why is medication reconciliation important in healthcare?

What strategies can a nurse do to identify a medication error during medication reconciliation?

What is the first task a pharmacy technician will do when performing medication reconciliation?

How does medication reconciliation improve healthcare delivery?

Abstract

Few ambulatory medication reconciliation tools exist. Transitions between inpatient and outpatient care can result in medication discrepancies.

Introduction

Adverse drug events (ADEs) are the most common healthcare-associated adverse events. 1 Serious preventable medication discrepancies, which may predispose to ADEs, occur in 3.3 million outpatient visits each year in the USA, costing US$4.2 billion and resulting in 7000 deaths.

Methods

We recruited patients hospitalized at the Veterans Affairs (VA) Boston Healthcare System from June to December 2012 for pilot testing of the Secure Messaging for Medication Reconciliation Tool (SMMRT).

Results

We enrolled 60 patients, of whom 56 (93%) were male. Average age was 61 years and 58 (97%) had a primary care provider. Most (70%) had private health insurance or Medicare, and more than three-quarters (78%) had more than five medications on their discharge medication list.

Discussion

This pilot study demonstrated that patient-mediated medication reconciliation via a web portal after hospital discharge is feasible and readily accepted. We found that over two-thirds of participants had at least one medication discrepancy at discharge, and nearly one-third had at least one potential ADE.

Acknowledgements

The authors thank Dr Blake Lesselroth and Justin Yang for assistance in developing the SMMRT tool. We would also like to thank Thomas Marcello for his work on the initial IRB submission and assistance during the early stages of this project. We appreciate feedback from James Wu on an earlier draft of this manuscript.

Contributors

LH designed the pilot study, assisted with the ‘Secure Messaging for Medication Reconciliation Tool’ development, monitored data collection for the whole pilot study, wrote the statistical analysis plan, cleaned and analyzed the data, and drafted and revised the paper. She is guarantor.

Why is medication reconciliation difficult?

Medication reconciliation has therefore become an example of a safety intervention that has been effective in research settings but has been difficult to implement successfully in general practice. A 2016 commentary identified the major reasons for difficulty achieving safety improvements via medication reconciliation. They include the resource intensive nature of interventions such as clinical pharmacists, which disincentivizes organizations from investing in medication reconciliation; the alterations to clinical workflow that result from interventions, which creates inefficiencies and confusion regarding the best possible medication history; and conflict between medication reconciliation and other system quality improvement priorities, such as patient flow improvement. The commentary provides recommendations for organizations, clinicians, and researchers on how to better implement and evaluate medication reconciliation interventions.

What is the goal of medication reconciliation?

Medication reconciliation was named as 2005 National Patient Safety Goal #8 by the Joint Commission. The Joint Commission's announcement called on organizations to "accurately and completely reconcile medications across the continuum of care." In 2006, accredited organizations were required to "implement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient" and to communicate "a complete list of the patient's medications to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization."

When did the Joint Commission suspend scoring of medication reconciliation?

The Joint Commission suspended scoring of medication reconciliation during on-site accreditation surveys between 2009 and 2011. This policy change was made in recognition of the lack of proven strategies for accomplishing medication reconciliation. As of July 2011, medication reconciliation has been incorporated into National Patient Safety Goal #3, "Improving the safety of using medications." This National Patient Safety Goal requires that organizations "maintain and communicate accurate medication information" and "compare the medication information the patient brought to the hospital with the medications ordered for the patient by the hospital in order to identify and resolve discrepancies."

Does medication reconciliation reduce readmissions?

However, both the actual clinical effect of medication discrepancies after discharge appears to be small, and therefore, medication reconciliation alone does not reduce readmissions or other adverse events after discharge.

Can pharmacists prevent medication discrepancies?

A 2016 systematic review found evidence that pharmacist-led processes could prevent medication discrepancies and potential ADEs at hospital admission, in-hospital transitions of care (such as transfer into or out of the intensive care unit), and at hospital discharge.

Who funded the 75Q80119C00004?

This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality ( AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers

What is the patient survey?

Patient Survey: We collected information about demographics, socioeconomic status, and technology literacy using our previously described patient survey. 39 We used Chew and colleagues’ 3-item questionnaire to screen participants for inadequate health literacy. 40 We used the 13-item Patient Activation Measure (PAM) to assess patient activation, 41–47 a tool we have previously validated in the acute care setting. 48 Patient activation refers to patients’ knowledge, skills, and confidence in managing their health and healthcare. The PAM categorizes patients into 1 of 4 activation levels: 1) disengaged and overwhelmed, 2) becoming aware, but still struggling, 3) taking action, 4) maintaining behaviors and pushing further. We assessed illness severity using the Emergency Severity Index (ESI), ranging from level 1 (most urgent) to level 5 (least urgent). 49

How many changes did clinicians make to patients' home medication lists?

On average, clinicians made 2.11 changes to patients’ home medication lists on admission (range 0-15; Table 2 ). No significant differences existed between groups. In the before group, clinicians made 42 (42%) of the changes that patients suggested. Clinicians made an average of 1.06 changes that patients did not suggest.

What are unintentional medication discrepancies?

Unintentional medication discrepancies, defined as differences in documented medication regimens across different care sites, contribute substantially to adverse drug events (ADEs) in hospitalized patients. 1–4 The most common cause of preventable ADEs is unintentional discrepancies in the admission medication list. 1,5,6 Studies demonstrate that 48% to 87% of emergency department (ED) patients’ medication lists contain one or more discrepancies, 7,8 and 22% to 54% still contain discrepancies on hospital admission. 1,6,9 To avoid unintentional discrepancies and prevent ADEs, the Joint Commission has designated medication reconciliation at admission, transfer, and discharge, a National Patient Safety Goal since 2005. 10 Medication reconciliation is the process of systematically reviewing a patient’s complete medication regimen to ensure its accuracy. 11

What is medication discrepancy?

Medication discrepancies, defined as unintentional differences found between patients’ medical records and patients’ reports of medications they are taking, occur frequently after hospital discharge, predisposing patients to adverse drug events, emergency department (ED) visits, and readmissions. 1,2,3 Medication reconciliation is required at every care transition, yet high discrepancy rates after hospital discharge remain and suggest the need to develop strategies to ensure accurate and reliable medication data within the electronic health record. One innovative solution is to leverage online patient portals (e.g., myHealtheVet) that allow interactive, asynchronous electronic communication for review of medications. Thus, we developed an electronic tool for medication review, known as the Secure Messaging for Medication Reconciliation Tool (SMMRT). 4

How many days after discharge do you have fewer medication discrepancies?

Thirty days after discharge, fewer medication discrepancies occurred in the SMMRT group (4.4/person) than in the UC group (6.4/person; p<0.001), a 34 percent reduction. No between-group difference occurred in rates of the combined endpoint of 30-day readmissions and ED visits (SMMRT, 30% vs. UC, 34%; p=0.51).