Abstract
Background
Medication reconciliation (MR) is an effective method for reducing medication errors in health care settings. The literature regarding MR impact on patient length of stay is currently limited; as is evidence of the impact of MR in psychiatric patient populations.
Objective
The primary objective of this study was to determine if pharmacist-conducted MR has an effect on inpatient length of stay in a psychiatric patient population. Rates of medication errors on admission and discrepancies at discharge were also evaluated.
Methods
This single center pilot study evaluated the impact of MR by utilizing three study periods. The first was a retrospective period (RP) consistent with usual care without MR, the second was a first prospective period (PP1) in which MR was completed in psychiatric emergency services, and the third was a second prospective period (PP2) in which all patients admitted to an inpatient psychiatric unit had MR performed within 24 h of admission. For the primary outcome, medians were compared using Mann–Whitney U Test. For secondary outcomes, medians were compared using a generalized linear model for non-parametric data.
Results
A total of 198 patients were included between the three study periods. There was a non-statistically significant difference in median length of stay for PP1 and PP2 compared to RP (− 0.17; P = 0.455 and − 0.18; P = 0.168, respectively). A statistically significant decrease in both the number of medication errors and discrepancies between RP and PP1 (P < 0.001 for both outcomes) and between RP and PP2 (P < 0.001 for both outcomes), was observed.
Conclusion
MR in a psychiatric population either prior to admission or within 24 h of admission did not reduce inpatient length of stay, however it significantly reduced medication errors and discrepancies at discharge.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maidment ID, Lelliott P, Paton C. Medication errors in mental healthcare: a systematic review. Qual Saf Health Care. 2006;15(6):409–13.
NCC MERP. About medication errors: what is a medication error? 2019. https://www.nccmerp.org/about-medication-errors. Accessed 7 May 2019.
World Health Organization. Medication errors: technical series on safer primary care. Geneva: WHO; 2016. License: CC BY-NC-SA 3.0 IGO.
Härkänen M, Vehviläinen-Julkunen K, Murrells T, et al. Medication administration errors and mortality: incidents reported in England and Wales between 2007–2016. Res Social Adm Pharm. 2018;15:858–63.
Leguelinel-Blache G, Arnaud F, Bouvet S, et al. Impact of admission medication reconciliation performed by clinical pharmacists on medication safety. Med Eur J Intern. 2014;25(9):808–14.
The Joint Commission. National patient safety goals January 1, 2012. NPSG.03.06.01. www.jointcommission.org/assets/1/6/NPSG_Chapter_Jan2012_HAP.pdf. Accessed 30 Aug 2018.
Kwan J, Lo L, Sampson M, et al. Medication reconciliation during transitions of care as a patient safety strategy. Ann Intern Med. 2013;158(5-Part 2):397.
Mekonnen A, McLachlan A, Brien J. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128–44.
Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172:1057–69.
Karaoui LR, Chamoun N, Fakhir J, et al. Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals. BMC Health Serv Res. 2019;19(1):493.
Mergenhagen K, Blum S, Kugler A, et al. Pharmacist-versus physician-initiated admission medication reconciliation: impact on adverse drug events. Am J Geriatr Pharmacother. 2012;10(4):242–50.
Barrett P, Cooper J, Douglas J, et al. ASHP statement on the pharmacist’s role in medication reconciliation. Am J Health-Syst Pharm. 2013;70(5):453–6.
Karnon J, Campbell F, Czoski-Murray C. Model-based cost-effectiveness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation). J Eval Clin Pract. 2009;15(2):299–306.
Belda-Rustarazo S, Cantero-Hinojosa J, Salmeron-García A, et al. Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. Int J Clin Pract. 2015;69(11):1268–74.
Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122–6.
Mendes AE, Lombardi NF, Andrzejevski VS, et al. Medication reconciliation at patient admission: a randomized controlled trial. Pharm Prac. 2016;14(1):656.
Cadman B, Wright D, Bale A, et al. Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study. BMJ Open. 2017;7:e013647. https://doi.org/10.1136/bmjopen-2016-013647.
Maidment I, Haw C, Stubbs J, et al. Medication errors in older people with mental health problems: a review. Int J Geriatr Psychiatry. 2008;23(6):564–73.
Procyshyn R, Barr A, Brickell T, et al. Medication errors in psychiatry: a comprehensive review. CNS Drugs. 2010;24(7):595–609.
Bosworth H, Granger B, Mendys P, et al. Medication adherence: a call for action. Am Heart J. 2011;162(3):412–24.
Brownlie K, Schneider C, Culliford R, et al. Medication reconciliation by a pharmacy technician in a mental health assessment unit. Int J Clin Pharm. 2014;36(2):303–9.
Lizer M, Brackbill M. Medication history reconciliation by pharmacists in an inpatient behavioral health unit. Am J Health-Syst Pharm. 2007;64(10):1087–91.
Tang S, Jaward L, Ward K, et al. Impact of a student pharmacist driven medication reconciliation and antidepressant treatment history project at a depression clinic: a pilot study. Psychopharmacol Bull. 2017;47(12):36–41.
Lehnbom E, Stewart M, Manias E, et al. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother. 2014;48(10):1298–312.
Owens PL, Fingar KR, McDermott KW, et al. Inpatient stays involving mental and substance use disorders, 2016. HCUP statistical brief #249. Rockville: Agency for Healthcare Research and Quality; 2019.
Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No additional funding was received for this study.
Conflicts of interest/Competing interests
The authors disclose no conflicts of interest
Ethics approval
As quality improvement research, this project was exempt from review by the University of Michigan Institutional Review Board (IRB).
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Availability of data and material
Not applicable.
Code availability
SPSS.
Author contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MO. The first draft of the manuscript was written by MO and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Rights and permissions
About this article
Cite this article
O’Connell, M., VandenBerg, A. Impact of pharmacist driven medication reconciliation in psychiatric emergency services on length of stay, medication errors, and medication discrepancies. Drugs Ther Perspect 37, 175–180 (2021). https://doi.org/10.1007/s40267-021-00824-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-021-00824-3