Medication reconciliation in a Swiss hospital: methods, benefits and pitfalls.

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Etat: Public
Version: de l'auteur
Licence: Non spécifiée
ID Serval
serval:BIB_CE3FAAF30ACC
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Medication reconciliation in a Swiss hospital: methods, benefits and pitfalls.
Périodique
European journal of hospital pharmacy
Auteur(s)
Nachar C., Lamy O., Sadeghipour F., Garnier A. (co-dernier), Voirol P. (co-dernier)
ISSN
2047-9956 (Print)
ISSN-L
2047-9956
Statut éditorial
Publié
Date de publication
30/01/2018
Peer-reviewed
Oui
Volume
26
Numéro
3
Pages
129-134
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
To assess the feasibility and main obstacles to the implementation of a medication reconciliation (MR) process in a Swiss hospital and to develop a standardised method which can be used in similar healthcare systems.
For this prospective, observational single-centre and single-ward study, a best possible medication history (BPMH) was established by a clinical pharmacist for 147 patients with heart failure based on two sources and a patient interview for each case. Identified discrepancies with medication histories established during emergency service were conveyed to the ward physician. At the end of each hospital stay, the planned discharge treatments were compared with the BPMHs to identify discrepancies and to propose modifications. After a final validation, the comparative treatment plans were distributed.
MR was conducted for 120 (82%) patients and the mean time needed was 74 min/patient. At least one discrepancy was identified among 94% of the patients on admission, with 4.1 discrepancies found per patient (mainly omissions). At discharge, 83% of the patients had at least one discrepancy, with 2.3 discrepancies found per patient (mainly unintentional substitutions). The majority (86%) of pharmaceutical interventions to adjust the discharge prescriptions were accepted by the physician.
A standardised method of MR which offers precise definitions of discrepancies and key tools for the process was developed. This method was applicable to most of our cohort and it effectively identified medication discrepancies. Two potential obstacles for its implementation are the time needed for MR and the questionable impact of pharmaceutical interventions on discrepancies.
Mots-clé
admission, clinical pharmacy, discharge, hospital, medication discrepancies, medication reconciliation
Pubmed
Web of science
Financement(s)
Autre / SGAIM-Foundation
Création de la notice
30/08/2019 17:01
Dernière modification de la notice
17/06/2020 6:20
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