August 7, 2019

The incidence and severity of adverse events affecting patients after discharge from the hospital

BACKGROUND Studies of hospitalized patients identify safety as a significant problem, but few data are available regarding injuries occurring after discharge. Patients may be vulnerable during this transition period. OBJECTIVE To describe the incidence, severity, preventability, and “ameliorability” of adverse events affecting patients after discharge from the hospital and to […]
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BACKGROUND Studies of hospitalized patients identify safety as a significant problem, but few data are available regarding injuries occurring after discharge. Patients may be vulnerable during this transition period. OBJECTIVE To describe the incidence, severity, preventability, and “ameliorability” of adverse events affecting patients after discharge from the hospital and to develop strategies for improving patient safety during this interval. DESIGN Prospective cohort study. SETTING A tertiary care academic hospital. PATIENTS 400 consecutive patients discharged home from the general medical service. MEASUREMENTS The three main outcomes were adverse events, defined as injuries occurring as a result of medical management; preventable adverse events, defined as adverse events judged to have been caused by an error; and ameliorable adverse events, defined as adverse events whose severity could have been decreased. Posthospital course was determined by performing a medical record review and a structured telephone interview approximately 3 weeks after each patient's discharge. Outcomes were determined by independent physician reviews. RESULTS Seventy-six patients had adverse events after discharge (19% [95% CI, 15% to 23%]). Of these, 23 had preventable adverse events (6% [CI, 4% to 9%]) and 24 had ameliorable adverse events (6% [CI, 4% to 9%]). Three percent of injuries were serious laboratory abnormalities, 65% were symptoms, 30% were symptoms associated with a nonpermanent disability, and 3% were permanent disabilities. Adverse drug events were the most common type of adverse event (66% [CI, 55% to 76%]), followed by procedure-related injuries (17% [CI, 8% to 26%]). Of the 25 adverse events resulting in at least a nonpermanent disability, 12 were preventable (48% [CI, 28% to 68%]) and 6 were ameliorable (24% [CI, 7% to 41%]). CONCLUSIONS Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies.
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http://www.annals.org/content/138/3/161.abstract

August 7, 2019

The Hospitalist, March 2009: New Design for Discharge–Four-part process improves patient outcomes, lowers readmission rates

With hospitalists playing key roles in improving transitions in care, a new study has tested a low-cost process that shows increases in outpatient follow-up and completed workups soon after hospital discharge. The improvements potentially could lead to better patient outcomes and lower readmission rates, according to Richard B. Balaban, MD, […]
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With hospitalists playing key roles in improving transitions in care, a new study has tested a low-cost process that shows increases in outpatient follow-up and completed workups soon after hospital discharge. The improvements potentially could lead to better patient outcomes and lower readmission rates, according to Richard B. Balaban, MD, who as the medical director of Cambridge Health Alliance’s (CHA) Somerville, Mass., primary-care center and a hospitalist at CHA’s Cambridge Hospital has a unique, dual perspective on the discharge process. Dr. Balaban’s team’s discharge-transfer intervention process, tested in one of the few randomized controlled studies on the subject of transitions of care, is intended to improve communication between hospitalists and primary-care providers, as well as promptly connect inpatients to outpatient providers. It’s also designed to better equip patients to participate in their care and to improve accountability within the medical team.
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http://www.the-hospitalist.org/details/article/182425/New_Design_for_Discharge.html

August 7, 2019

Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors: Quality Chasm Series

In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation s quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the series To Err […]
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In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation s quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the series To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004) this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.
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http://www.nap.edu/catalog.php?record_id=11623#description

August 7, 2019

Redefining and Redesigning Hospital Discharge to Enhance Patient Care: A Randomized Controlled Study

BACKGROUND: Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge processmay improve the continuity and the quality of patient care. OBJECTIVES: To evaluate a low-cost intervention designed to promptly reconnect patients to […]
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BACKGROUND: Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge processmay improve the continuity and the quality of patient care. OBJECTIVES: To evaluate a low-cost intervention designed to promptly reconnect patients to their “medical home” after hospital discharge. DESIGN: Randomized controlled study. Intervention patients received a “user-friendly” Patient Discharge Form, and upon arrival at home, a telephone outreach from a nurse at their primary care site. PARTICIPANTS: A culturally and linguistically diverse group of patients admitted to a small community teaching hospital. MEASUREMENTS: Four undesirable outcomes were measured after hospital discharge: (1) no outpatient follow-up within 21 days; (2) readmission within 31 days; (3) emergency department visit within 31 days; and (4) failure by the primary care provider to complete an outpatient workup recommended by the hospital doctors. Outcomes of the intervention group were compared to concurrent and historical controls. RESULTS: Only 25.5% of intervention patients had 1 or more undesirable outcomes compared to 55.1% of the concurrent and 55.0% of the historical controls. Notably, only 14.9% of the intervention patients failed to follow-up within 21 days compared to 40.8% of the concurrent and 35.0% of the historical controls. Only 11.5% of recommended outpatient workups in the intervention group were incomplete versus 31.3% in the concurrent and 31.0% in the historical controls. CONCLUSIONS: A low-cost discharge–transfer intervention may improve the rates of outpatient follow-up and of completed workups after hospital discharge.
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http://www.springerlink.com/content/j81085h6634x2665/fulltext.pdf

August 7, 2019

Case Study: Identifying Potential Problems at the Human/Technical Interface in Complex Clinical Systems

Many who would like to improve patient safety in health care have advocated for the widespread adoption of computerized physician order entry and electronic medical records. However, unforeseen consequences of this new technology may put patients at greater risk of harm, not less. The authors present a clinical scenario that […]
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Many who would like to improve patient safety in health care have advocated for the widespread adoption of computerized physician order entry and electronic medical records. However, unforeseen consequences of this new technology may put patients at greater risk of harm, not less. The authors present a clinical scenario that demonstrates system vulnerabilities in the interface between humans and such technology. Furthermore, the authors suggest that managers could anticipate these vulnerabilities by using techniques such as cause-and-effect analysis or failure mode and effect analysis, both before the installation of electronic medical records and as ongoing surveillance mechanisms. The case study demonstrates that adoption of technology is not a quick fix to the patient safety issue; proactive and ongoing efforts to address the human factors issues raised by the introduction of new technology will be required to prevent patient harm.
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http://ajm.sagepub.com/content/20/6/353.abstract

August 7, 2019

Consecutive Medicare stays involving inpatient and skilled nursing facilities

In this OIG report, medical review of consecutive stay sequences revealed instances of problems with quality of patient care and fragmentation of health care services across multiple stays. Physician reviewers’ examination of medical records for consecutive stays sequences enabled the reviewers to analyze and identify the broader impacts of quality-of-care […]
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In this OIG report, medical review of consecutive stay sequences revealed instances of problems with quality of patient care and fragmentation of health care services across multiple stays. Physician reviewers’ examination of medical records for consecutive stays sequences enabled the reviewers to analyze and identify the broader impacts of quality-of-care problems and fragmentation of services beyond the level of an individual inpatient stay.
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http://oig.hhs.gov/oei/reports/oei-07-06-00340.pdf

August 7, 2019

Acute Care/ Hospitalization: Studies suggest ways to improve the hospital discharge process to reduce post-discharge adverse events and rehospitalizations.

After patients are discharged from U.S. hospitals, 13 percent require rehospitalization and one in five patients suffers an adverse event. Many of these problems are due to inadequate postdischarge followup of patients’ unresolved medical problems. More patients with unresolved problems would receive outpatient workups if their primary care doctors received […]
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After patients are discharged from U.S. hospitals, 13 percent require rehospitalization and one in five patients suffers an adverse event. Many of these problems are due to inadequate postdischarge followup of patients' unresolved medical problems. More patients with unresolved problems would receive outpatient workups if their primary care doctors received the hospital doctors' discharge summary recommendations, concludes a study supported by the Agency for Healthcare Research and Quality (HS14020). A second AHRQ-supported study (HS14289 and HS15905) describes 11 factors that could be modified during the hospital discharge process to reduce posthospital adverse events and rehospitalizations. Both studies are briefly discussed here.
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http://archive.ahrq.gov/research/dec07/1207RA12.htm

August 7, 2019

Unintended medication discrepancies at the times of hospital admission

BACKGROUND Prior studies suggest that unintended medication discrepancies that represent errors are common at the time of hospital admission. These errors are particularly worthy of attention because they are not likely to be detected by computerized physician order entry systems. METHODS We prospectively studied patients reporting the use of at […]
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BACKGROUND Prior studies suggest that unintended medication discrepancies that represent errors are common at the time of hospital admission. These errors are particularly worthy of attention because they are not likely to be detected by computerized physician order entry systems. METHODS We prospectively studied patients reporting the use of at least 4 regular prescription medications who were admitted to general internal medicine clinical teaching units. The primary outcome was unintended discrepancies (errors) between the physicians’ admission medication orders and a comprehensive medication history obtained through interview. We also evaluated the potential seriousness of these discrepancies. All discrepancies were reviewed with the medical team to determine if they were intentional or unintentional. All unintended discrepancies were rated for their potential to cause patient harm. RESULTS After screening 523 admissions, 151 patients were enrolled based on the inclusion criteria. Eighty-one patients (53.6%; 95% confidence interval, 45.7%-61.6%) had at least 1 unintended discrepancy. The most common error (46.4%) was omission of a regularly used medication. Most (61.4%) of the discrepancies were judged to have no potential to cause serious harm. However, 38.6% of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration. CONCLUSIONS Medication errors at the time of hospital admission are common, and some have the potential to cause harm. Better methods of ensuring an accurate medication history at the time of hospital admission are needed.
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http://archinte.ama-assn.org/cgi/content/full/165/4/424

August 7, 2019

Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure (JAMA May 5, 2010 303:1716-1722)

Context: Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates. Objective: To examine associations between outpatient follow-up […]
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Context: Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates. Objective: To examine associations between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days. Design, Setting, and Patients: Observational analysis of patients 65 years or older with heart failure and discharged to home from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines-Heart Failure quality improvement program from January 1, 2003, through December 31, 2006. Main Outcome Measure: All-cause readmission within 30 days after discharge. Results: The study population included 30 136 patients from 225 hospitals. Median length of stay was 4 days (interquartile range, 2-6) and 21.3% of patients were readmitted within 30 days. At the hospital level, the median percentage of patients who had early follow-up after discharge from the index hospitalization was 38.3% (interquartile range, 32.4%-44.5%). Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3%), the rates of 30-day readmission were 20.5% among patients in the second quartile (risk-adjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.78-0.93), 20.5% among patients in the third quartile (risk-adjusted HR, 0.87; 95% CI, 0.78-0.96), and 20.9% among patients in the fourth quartile (risk-adjusted HR, 0.91; 95% CI, 0.83-1.00). Conclusions: Among patients who are hospitalized for heart failure, substantial variation exists in hospital-level rates of early outpatient follow-up after discharge. Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.
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http://jama.ama-assn.org/cgi/content/abstract/303/17/1716

August 7, 2019

Drug-Related Problems on Hospital Admission: Relationship to Medication Information Transfer

BACKGROUND Patients with end-stage renal disease (ESRD) are at risk for drug-related problems (DRPs), especially on hospital admission. OBJECTIVE To identify and characterize the DRPs experienced by patients with ESRD on admission and investigate how these DRPs could be related to gaps in medication information transfer. METHODS Patients with ESRD […]
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BACKGROUND Patients with end-stage renal disease (ESRD) are at risk for drug-related problems (DRPs), especially on hospital admission. OBJECTIVE To identify and characterize the DRPs experienced by patients with ESRD on admission and investigate how these DRPs could be related to gaps in medication information transfer. METHODS Patients with ESRD admitted to the hospital were prospectively identified and clinically assessed by a pharmacist to identify and categorize DRPs on admission. Each DRP was evaluated to determine whether it could have been caused by a gap in medication information transfer. For DRPs caused in this manner, the interface in the information transfer process where the gap may have occurred was determined. RESULTS A total of 199 DRPs were identified in 47 patients with ESRD over a 12 week period. Ninety-two percent of patients had at least one DRP on admission, with an average of 4.2 ± 2.2 DRPs per patient. The most common DRP identified was indication for drug therapy—patient requires drug but is not receiving it (51.3%). Of the total DRPs, 130 (65%) were related to gaps in medication information transfer, with 21.5% occurring between the inpatient hospital and the ambulatory clinic pharmacists and 17.7% between the admitting physician and the patient. CONCLUSIONS Results of this study demonstrate that, in patients with ESRD, DRPs on admission are frequently related to gaps in medication information transfer between healthcare professionals and also between healthcare providers and patients. Improved communication is required at medication information transfer interfaces to prevent these DRPs. Key Words: drug-related problems, end-stage renal disease
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http://www.theannals.com/cgi/content/abstract/40/3/408

August 7, 2019

Adverse drug events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities

Background: Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer. Objectives: To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes. Methods: […]
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Background: Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer. Objectives: To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes. Methods: Participants were residents of 4 nursing homes in the New York City metropolitan area admitted to 2 academic hospitals. Nursing home and hospital medical records were reviewed to identify changes in medication regimens between sites. Medications were matched and compared regarding dosage, route, and frequency of administration. Two physician investigators used structured implicit review to identify ADEs attributable to transfer-related medication changes. Results: During a total of 122 admissions, the mean numbers of medications altered during transfer from nursing home to hospital and hospital to nursing home were 3.1 and 1.4, respectively (P<.001 for comparison). Most changes in drug use were discontinuations, followed by dose changes and class substitutions. Of 71 bidirectional transfers that were reviewed by 2 physician investigators, ADEs attributable to medication changes occurred during 14 (20%). The overall risk of ADE per drug alteration (n = 320) was 4.4% (95% confidence interval, 2.5%-7.4%). Although most medication changes (8/14) implicated in causing ADEs occurred in the hospital, most ADEs (12/14) occurred in the nursing home after nursing home readmission. Conclusions: Medication changes are common during transfer between hospital and nursing home and are a cause of ADEs. Research is needed on interinstitutional patient care and systems interventions designed to prevent ADEs.
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http://archinte.ama-assn.org/cgi/content/abstract/164/5/545

August 7, 2019

Continuity of Outpatient and Inpatient Care by Primary Care Physicians for Hospitalized Older Adults

Sharma G, Fletcher K, Zhang D, et.al. JAMA. 2009;301(16):1671-1680. http://jama.jamanetwork.com/article.aspx?articleid=183797 . Accessed August 1, 2014. Continuity of Outpatient and Inpatient Care by Primary Care Physicians for Hospitalized Older Adults. Context Little is known about the extent of continuity of care across the transition from outpatient care to hospitalization. Objectives To […]
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Sharma G, Fletcher K, Zhang D, et.al. JAMA. 2009;301(16):1671-1680. http://jama.jamanetwork.com/article.aspx?articleid=183797 . Accessed August 1, 2014. Continuity of Outpatient and Inpatient Care by Primary Care Physicians for Hospitalized Older Adults. Context Little is known about the extent of continuity of care across the transition from outpatient care to hospitalization. Objectives To describe continuity of care in older hospitalized patients, change in continuity over time, and factors associated with discontinuity.
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http://jama.ama-assn.org/cgi/content/abstract/301/16/1671

August 7, 2019

Organizational relationships between nursing homes and hospitals and quality of care during hospital-nursing home patient transfers

OBJECTIVES: To identify organizational factors and hospital and nursing home organizational relationships associated with more-effective processes of care during hospital–nursing home patient transfer. DESIGN: Mailed survey. SETTING: Medicare- or Medicaid-certified nursing homes in New York State. PARTICIPANTS: Nursing home administrators, with input from other nursing home staff. MEASUREMENTS: Key predictor […]
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OBJECTIVES: To identify organizational factors and hospital and nursing home organizational relationships associated with more-effective processes of care during hospital–nursing home patient transfer. DESIGN: Mailed survey. SETTING: Medicare- or Medicaid-certified nursing homes in New York State. PARTICIPANTS: Nursing home administrators, with input from other nursing home staff. MEASUREMENTS: Key predictor variables were travel time between the hospital and the nursing home, affiliation with the same health system, same corporate owner, trainees from the same institution, pharmacy or laboratory agreements, continuous physician care, number of beds in the hospital, teaching status, and frequency of geriatrics specialty care in the hospital. Key dependent variables were hospital-to–nursing home communication, continuous adherence to healthcare goals, and patient and family satisfaction with hospital care. RESULTS: Of 647 questionnaires sent, 229 were returned (35.4%). There was no relationship between hospital–nursing home interorganizational relationships and communication, healthcare goal adherence, and satisfaction measures. Geriatrics specialty care in the hospital (r=0.157; P=.04) and fewer hospital beds (r=-0.194; P=.01) were each associated with nursing homes more often receiving all information needed to care for patients transferred from the hospital. Teaching status (r=0.230; P=.001) and geriatrics specialty care (r=0.185; P=.01) were associated with hospital care more often consistent with healthcare goals established in the nursing home. CONCLUSION: No management-level organizational relationship between nursing home and hospital was associated with better hospital-to–nursing home transfer process of care. Geriatrics specialty care and characteristics of the hospital were associated with better hospital-to–nursing home transfer processes.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2007.01235.x/abstract

August 7, 2019

Rationale and Design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD)

Schnipper J, Roumie C, Cawthon C, et.al. Rationale and Design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study. Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 212-219. http://circoutcomes.ahajournals.org/content/3/2/212.abstract . Accessed August 1, 2014. Background— Medication errors and adverse drug events are common after hospital discharge due to […]
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Schnipper J, Roumie C, Cawthon C, et.al. Rationale and Design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study. Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 212-219. http://circoutcomes.ahajournals.org/content/3/2/212.abstract . Accessed August 1, 2014. Background— Medication errors and adverse drug events are common after hospital discharge due to changes in medication regimens, suboptimal discharge instructions, and prolonged time to follow-up. Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy.
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http://circoutcomes.ahajournals.org/content/3/2/212.abstract

August 7, 2019

Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network

Confusion about patients’ medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by […]
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Confusion about patients’ medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.
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http://jamia.bmj.com/content/13/6/581.abstract

August 7, 2019

Clinical Handover and Patient Safety Literature Review Report

The Australian Council for Safety and Quality in Health Care was established in January 2000 by the Australian Government Health Minister with the support of all Australian Health Ministers to lead national efforts to improve the safety and quality of health care, with a particular focus on minimizing the likelihood […]
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The Australian Council for Safety and Quality in Health Care was established in January 2000 by the Australian Government Health Minister with the support of all Australian Health Ministers to lead national efforts to improve the safety and quality of health care, with a particular focus on minimizing the likelihood and effects of error. The Council reports annually to Health Ministers. This document provides a report of the Clinical Handover and Patient Safety Literature Review which was prepared by the Australian Resource Centre for Healthcare Innovations on behalf of the Council.
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https://www.safetyandquality.gov.au/sites/default/files/migrated/Clinical-Handover-Literature-Review-for-release.pdf

August 7, 2019

The University of Kansas Hospital Corporate Policy Manual. Subject: Medication Reconciliation.

The University of Kansas Hospital Corporate Policy Manual. Subject: Medication Reconciliation. Formulated 5/1/2007. Accessed 7/9/2014. http://www.learningace.com/doc/2126652/d79631db906484626d18f77f4d4945bd/medication-reconciliation-hospital-policy. This short Policy from the University of Kansas Hospital includes definitions, policy, and procedures.
The University of Kansas Hospital Corporate Policy Manual. Subject: Medication Reconciliation. Formulated 5/1/2007. Accessed 7/9/2014. http://www.learningace.com/doc/2126652/d79631db906484626d18f77f4d4945bd/medication-reconciliation-hospital-policy. This short Policy from the University of Kansas Hospital includes definitions, policy, and procedures.
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http://www.learningace.com/doc/2126652/d79631db906484626d18f77f4d4945bd/medication-reconciliation-hospital-policy

August 7, 2019

Medication Use Across Transition Points from the Emergency Department: Identifying Factors Associated with Medication Discrepancies

BACKGROUND As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress. OBJECTIVE To identify the patient-, […]
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BACKGROUND As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress. OBJECTIVE To identify the patient-, environment-, and medication-related factors involving unexplained medication discrepancies across transition points after ED presentation. METHODS Using a retrospective chart review design, a stratified, random sampling of data was undertaken over a 12-month period. Information was obtained from an electronic administrative database and medical records as patients moved from the ED to another transition point of care. Medication discrepancies were classified into 2 outcome groups: (1) no discrepancies and situations in which discrepancies were adequately explained and (2) discrepancies that had no adequate explanation. RESULTS For the 12-month period, 210 randomly selected patients were included; 73 (34.8%) had at least one unexplained medication discrepancy. Binary logistic regression modeling showed 4 factors that were statistically significant in determining the incidence of at least one unexplained medication discrepancy. Benefit card holders (individuals who receive benefits from government insurance programs comparable to the US-based Medicare and Medicaid initiatives, which include the elderly, the disabled, low income earners, and unemployed persons) had 3.73 greater odds of experiencing an unexplained medication discrepancy (95% CI 1.72 to 8.07; p = 0.001). Patients prescribed 5 or more drugs at discharge from the ED had 12.22 greater odds of having at least one unexplained medication discrepancy (95% CI 5.52 to 27.08; p < 0.001). Patients who were first seen by a physician within 1 hour of a change in working shift had 3.70 greater odds of having an unexplained medication discrepancy (95% CI 1.67 to 8.18; p = 0.001). For each additional minute of wait time for a physician, the odds of having an unexplained medication discrepancy increased by a factor of 1.01 (95% CI 1.00 to 1.01; p = 0.042). CONCLUSIONS Patient-, environment-, and drug-related factors contribute to the risk of medication discrepancies across transition points from the ED. Key Words: care transition, communication, emergency department, medication discrepancy, medication reconciliation
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http://www.theannals.com/cgi/content/abstract/43/11/1755

August 7, 2019

North Carolina Center for Hospital Quality and Patient Safety: Medication Safety Reconciliation Toolkit

The Medication Reconciliation Toolkit helps hospitals establish and implement a standardized medication reconciliation process. The toolkit provides guidance, sample forms, and tips. The toolkit includes the following sections: Introduction Assessment The project Performance improvement model Spreading and formalizing Reference materials
The Medication Reconciliation Toolkit helps hospitals establish and implement a standardized medication reconciliation process. The toolkit provides guidance, sample forms, and tips. The toolkit includes the following sections: Introduction Assessment The project Performance improvement model Spreading and formalizing Reference materials
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http://www.safetyandquality.health.wa.gov.au/mwg-internal/de5fs23hu73ds/progress?id=qS6gRipduK

August 7, 2019

NTOCC Policy Considerations: Improving Transitions of Care

Learn which policy considerations NTOCC believes are important to better transitions of care.
Learn which policy considerations NTOCC believes are important to better transitions of care.
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http://www.ntocc.org/Portals/0/PolicyConsiderations.pdf