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Medication reconciliationis it possible to speed up without compromising quality? A before–after study in the emergency department
  1. Monica Hermann1,
  2. Markus Dreetz Holt2,3,4,
  3. Reidun L S Kjome4,5,
  4. Arna Teigen2,3
  1. 1Department of Health and Caring Sciences, Western Norway University of Applied Sciences – Stord Campus, Stord, Norway
  2. 2Western Norway Hospital Pharmacy in Stavanger, Stavanger, Rogaland, Norway
  3. 3Stavanger University Hospital, Stavanger, Norway
  4. 4Centre for Pharmacy, University of Bergen, Bergen, Norway
  5. 5Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  1. Correspondence to Dr Monica Hermann, Dept of health and caring sciences, Western Norway University of Applied Sciences – Stord Campus, Stord, Norway; monica.hermann{at}hvl.no

Abstract

Objective The aim of this study was to investigate whether it was possible to decrease the time used for medication reconciliation (MR) in the emergency department without compromising quality. A more efficient method will enable more patients to receive MR as early as possible after admission to hospital.

Methods Potential key factors for improvement of the standard method of MR by clinical pharmacists were identified through an observational period. A revised method was developed, focusing on decreasing time spent on the patient interview by use of a condensed checklist and probing questions based on information from a prescription database. Non-inferior quality (proportion of patients with at least one identified medication discrepancy and number of identified medication discrepancies per patient) of the revised method was evaluated using a before–after study design with 200 individuals in each group. Non-inferiority limit was set at 10%. The Mann-Whitney U test was used for statistical evaluation of the difference in time use per patient in the MR process between the before and after group.

Results Mean age of the included patients was 78 years in both groups. The time used for MR in the after group was 34% shorter (37 min vs 56 min, p<0.0001) compared with the before group. The revised method was shown to be non-inferior compared with the original method with respect to the proportion of patients with at least one identified discrepancy (81%, 95% CI 76% to 86% vs 79%, 95% CI 73% to 84%). Also, non-inferiority was shown for the number of identified discrepancies per patient, where the average number of discrepancies per patient was 1.9 (95% CI 1.7 to 2.1) in both groups.

Conclusion This study showed that it was possible to speed up the MR process without compromising its effectiveness in identifying medication discrepancies.

  • emergency medicine
  • pharmacy service
  • hospital
  • quality of health care
  • safety
  • medication systems
  • hospital

Data availability statement

Data are available upon reasonable request. Data are available upon a reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available upon a reasonable request.

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