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

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

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

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

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

Care Management’s Challenges and Opportunities to Reduce the Rapid Rehospitalization of Frail Community-Dwelling Older Adults

Community-based frail older adults, burdened with complex medical and social needs, are at great risk for preventable rapid rehospitalizations. Although federal and state regulations are in place to address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling frail […]
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Community-based frail older adults, burdened with complex medical and social needs, are at great risk for preventable rapid rehospitalizations. Although federal and state regulations are in place to address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling frail older adults. Few studies have looked at interventions to prevent rehospitalizations in this large segment of the older adult population. Similarly, standardized disease management approaches that lower hospitalization rates in an independent adult population may not suffice for guiding the care of frail persons. Care management interventions currently face unique challenges in their attempt to improve the transitional care of community-dwelling older adults. However, impending national imperatives aimed at reducing potentially avoidable hospitalizations will soon demand and reward care management strategies that identify frail persons early in the discharge process and promote the sharing of critical information among patients, caregivers, and health care professionals. Opportunities to improve the quality and efficiency of care-related communications must focus on the effective blending of training and technology for improving communications vital to successful care transitions.
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http://gerontologist.oxfordjournals.org/content/50/4/451.abstract

August 7, 2019

Project BOOST: Care Transitions for Older Adults Implementation Guide

The Society of Hospital Medicine Care Transitions Implementation Guide: Project BOOST: Better Outcomes for Older adults through Safe Transitions
The Society of Hospital Medicine Care Transitions Implementation Guide: Project BOOST: Better Outcomes for Older adults through Safe Transitions
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https://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/html_CC/Implementation.cfm

August 7, 2019

NTOCC: Improving on Transitions of Care—How to Implement and Evaluate a Plan

The Executive Summary outlines for you the concepts, process and how to use the guidebook titled Improving on Transitions of Care: How to Implement and Evaluate a Plan. In using the guidebook each transition point is treated as an exchange. Each exchange is where communication occurs and where evaluation may […]
The Executive Summary outlines for you the concepts, process and how to use the guidebook titled Improving on Transitions of Care: How to Implement and Evaluate a Plan. In using the guidebook each transition point is treated as an exchange. Each exchange is where communication occurs and where evaluation may occur.
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http://www.ntocc.org/Portals/0/ImplementationPlan.pdf