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Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients

  • Systems-Level Quality Improvement
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Abstract

The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1–November 30, 2015) and post-intervention (October 1–December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68–1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03–0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.

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Acknowledgments

We acknowledge Mr. Che-Fu Tsai for his comments regarding this project implementation. In addition, we thank Pao-Lin Li, Tzu-Ting Huang, Wei-Chi Li, Zi-Cheng Wang, Yen-Tzu Liang, the Quality Control Center, all members of the Center for Geriatrics and Gerontology, Nursing Department, Emergency Department, and Information Technology Department at Kaohsiung Veterans General Hospital for their support in the implementation of this project.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    Pi-Lien Hung & Miao-Ting Chen

  2. Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist, Kaohsiung City, 80708, Taiwan

    Pi-Lien Hung & Pei-Chin Lin

  3. Department of Medical Education and Research, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    Pei-Chin Lin

  4. Department of Pharmacy, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, Taiwan

    Jung-Yi Chen

  5. Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    Ming-Yueh Chou & Yu-Te Lin

  6. Aging and Health Research Center, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan

    Ming-Yueh Chou

  7. Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    Wei-Chun Huang

  8. School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan

    Wei-Chun Huang

  9. Department of Physical Therapy, Fooyin University, No. 151, Jinxue Road Daliao District, Kaohsiung City, 83102, Taiwan

    Wei-Chun Huang

  10. Quality Management Center, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    Wang-Chuan Juang

  11. Department of Business Management, National Sun Yat-sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan

    Wang-Chuan Juang

  12. Division of Pharmacy Practice and Administrative Sciences, The James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, 45267-0004, USA

    Alex C. Lin

Authors
  1. Pi-Lien Hung
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  8. Yu-Te Lin
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  9. Alex C. Lin
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Contributions

Pi-Lien Hung: Conceptualization, Methodology, Writing - Original Draft. Jung-Yi Chen: Formal analysis, Investigation. Miao-Ting Chen: Methodology, Data Curation. Ming-Yueh Chou: Conceptualization, Data Curation. Wei-Chun Huang: Validation, Project administration. Wang-Chuan Juang: Validation. Yu-Te Lin: Resources, Supervision. Pei-Chin Lin, Alex C. Lin: Methodology, Writing - Review & Editing, Visualization.

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Correspondence to Pei-Chin Lin or Alex C. Lin.

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Appendices

Appendix 1-A

Fig. 2
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Personalized medication information integrated from PharmaCloud System

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Appendix 1-B

Fig. 3
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Pharmacists record drug related problems on a pharmaceutical-care platform

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Appendix 1-C

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Holistic care platform provided for discussing with multidisciplinary healthcare professionals

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Appendix 1-D

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Bedside electronic display providing alert precautions for patients

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Appendix 1-E

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Personalized BPMDP informed patients and caregivers Pharmacists

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Appendix 1-F

Fig. 7
figure 7

Pharmaceutical Care Registration System for track patients with poor medication adherence

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Hung, PL., Lin, PC., Chen, JY. et al. Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients. J Med Syst 45, 47 (2021). https://doi.org/10.1007/s10916-021-01717-8

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