Impact of pharmacy-led medication reconciliation on admission to internal medicine service

LAUR Repository

Show simple item record

dc.contributor.author Karaoui, Lamis R.
dc.contributor.author Chamoun, Nibal
dc.contributor.author Fakhir, Jessica
dc.contributor.author Abi Ghanem, Wael
dc.contributor.author Droubi, Sarah
dc.contributor.author Marzouk, Abdul Rahman Diab
dc.contributor.author Droubi, Nabila
dc.contributor.author Masri, Hiba
dc.contributor.author Ramia, Elsy
dc.date.accessioned 2019-11-06T07:50:01Z
dc.date.available 2019-11-06T07:50:01Z
dc.date.copyright 2019 en_US
dc.date.issued 2019-11-06
dc.identifier.issn 1472-6963 en_US
dc.identifier.uri http://hdl.handle.net/10725/11494
dc.description.abstract Background The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. Methods This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The “total number of unintended discrepancies” was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05. Results During the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03–1.19) p = 0.007). Conclusions Pharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes. en_US
dc.language.iso en en_US
dc.title Impact of pharmacy-led medication reconciliation on admission to internal medicine service en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle experience in two tertiary care teaching hospitals en_US
dc.author.school SOP en_US
dc.author.idnumber 200101817 en_US
dc.author.idnumber 200201071 en_US
dc.author.idnumber 200302267 en_US
dc.author.department Pharmacy Practice en_US
dc.description.embargo N/A en_US
dc.relation.journal BMC Health Services Research en_US
dc.journal.volume 19:493 en_US
dc.journal.issue 1 en_US
dc.article.pages 1-9 en_US
dc.keywords Medication reconciliation en_US
dc.keywords Hospital admission en_US
dc.keywords Drug safety en_US
dc.keywords Patient safety en_US
dc.keywords Transition of care en_US
dc.keywords Quality improvement en_US
dc.keywords Hospital pharmacy en_US
dc.keywords Lebanon en_US
dc.identifier.doi https://doi.org/10.1186/s12913-019-4323-7 en_US
dc.identifier.ctation Karaoui, L. R., Chamoun, N., Fakhir, J., Ghanem, W. A., Droubi, S., Marzouk, A. R. D., ... & Ramia, E. (2019). Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals. BMC health services research, 19(1), 493, 1-9. en_US
dc.author.email lamis.karaoui@lau.edu.lb en_US
dc.author.email nibal.chamoun@lau.edu.lb en_US
dc.author.email elsy.ramia@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url https://link.springer.com/article/10.1186/s12913-019-4323-7 en_US
dc.orcid.id https://orcid.org/0000-0002-7857-7374 en_US
dc.orcid.id https://orcid.org/0000-0002-0987-296X en_US
dc.orcid.id https://orcid.org/0000-0001-6447-4377 en_US
dc.author.affiliation Lebanese American University en_US

Files in this item

This item appears in the following Collection(s)

Show simple item record

Search LAUR

Advanced Search


My Account