ENHANCING PATIENT SAFETY THROUGH MEDICATION RECONCILIATION IN SMALL HOSPITAL SETTINGS: A PROSPECTIVE ANALYSIS
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Keywords
Medication Reconciliation, Patient Safety, Patient Discharge, Hospital Pharmacy Service, Pharmaceutical Assistance.
Abstract
Background: Medication reconciliation and discharge advice play crucial roles in identifying and mitigating medicine-related risks, particularly during transitions of care. Despite their significance, the extent of clinical pharmacy involvement in small hospitals remains underexplored.
Objective: To conduct a prospective study assessing medication reconciliation and pharmacy advice provision upon patients' discharge from a small hospital setting.
Methods: A pilot, prospective, descriptive, and exploratory study involved thirty hospitalized patients. Their medication regimens were monitored from admission through discharge, including the matching of medications and provision of pharmaceutical instructions.
Results: The majority of patients were female (57%) with an average age of 71, hospitalized for an average of three days. Pyelonephritis was the primary admission diagnosis (23%), while high blood pressure was the most prevalent comorbidity (60%). Medications predominantly targeted the nervous and circulatory systems (37%). Discrepancies in medication records totalled 100, with 10% intentional changes, primarily through drug substitution (70%), and 90% unintentional, mainly involving omitted medications (98%). 95% of pre-hospitalization drugs were implicated in discrepancies, with the coronary system most affected (42%). Documentation gaps were noted in medical records regarding patients' comorbidities, with omissions observed in both physician (50%) and nursing (25%) entries. The discharge medication list only accounted for 43% of administered drugs. Therapeutic discrepancies were prevalent, mainly due to unintentional omissions, highlighting the risk of medication omission during transitions of care.
Conclusion: Medication reconciliation and discharge advice play pivotal roles in enhancing patient safety during transitions of care. However, the study underscores significant gaps in clinical pharmacy involvement and documentation practices in small hospital settings, emphasizing the need for improved strategies to ensure medication safety and continuity of care.
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Ayesha Erum Hadi
Junior Resident, Dr. "D.Y" Patil Medical College, Hospital and Research Centre, Pune Department of Diagnostic Radiology, India,
Waheed Ur Rahman
House Officer, Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan,
Nijam Uddin Sarkar
Undergraduate Student (Applied Statistics), Institute of Statistical Research and Training, University of Dhaka
Mohamed Afzana Mohamed Ismail
FY2/Junior Doctor in Oncology, Dr. Rai Memorial Medical Centre, and ERCP in Emergency Medicine Dept., 108 Ambulatory Services, DMS Campus, Chennai
Dr. Shams Ullah
MBBS, Baqai Medical University, Karachi, Pakistan,
Aksa Alina Joy
Doctor, Mes Medical College, General Medicine, India
Abdullah Tariq
Medical Officer, Department of Medicine, Amin Welfare and Teaching Hospital, Pakistan,