Admission Medication Reconciliation Research Articles

OP0169 INPATIENT DISCONTINUATION OF ALLOPURINOL – A QUALITATIVE IMPROVEMENT (QI) INITIATIVE

BackgroundGout is a chronic inflammatory arthritis induced by hyperuricemia and manifested by recurrent acute flares of debilitating joint pain, when left untreated. Allopurinol is often used as long-term urate lowering therapy. Discontinuation of allopurinol leads to worsening flares, disability, poor quality of life, and frequent use of acute care facilities. Recent data revealed that 56% of hospitalized patients had allopurinol discontinued during an episode of acute gout flare, suggesting an unmet need for ongoing provider education (1). Gout flares are 14 times more likely to develop in patients who have allopurinol discontinued upon admission to the hospital (2).ObjectivesWe performed a qualitative analysis of the current rate of discontinuation of allopurinol during hospitalizations at an academic hospital in order to develop a continuous improvement model.MethodsWe leveraged our electronic health records (EHR) to obtain data on gout patients admitted to the university hospital from 2019-2020, with IRB approval. Patients on allopurinol as an active home medication that was discontinued during hospitalization and/or after hospital discharge were included to calculate the rate of discontinuation. Lean thinking methodology with A3 process mapping for root cause analysis (RCA) was utilized. We first identified stakeholders involved in medication reconciliation – nurses and various providers, including trainees, and invited them to participate in an anonymous survey to understand the rationale behind allopurinol discontinuation during hospitalization. Next, we created countermeasures and actionable recommendations that could be implemented at an institutional level.ResultsA total of 2138 patients who were hospitalized had allopurinol listed as an active home medication. Of these, 364 (17%) did not receive allopurinol during hospitalization. Based on the survey data, providers chose to discontinue allopurinol due to the following factors – acute gout flare, renal impairment, gastrointestinal issues, cytopenia, drug interactions, NPO status, and always discontinued the medication. The RCA revealed layers of reasoning at various levels of the medication reconciliation process which impacted the decision-making algorithm. This in turn led to discontinuation during the admission and subsequent omission of allopurinol on the discharge medication list. Several actionable and high-impact recommendations emerged as countermeasures, including – a) pharmacy involvement at admission medication reconciliation, b) creation of a clinical practice guideline, and c) automated routing by EHR to standardized guidelines when allopurinol was discontinued on admission (Figure 1).Figure 1.Countermeasures and Implementation PlanConclusionThere is evidence of inappropriate discontinuation of allopurinol that leads to gout flares in the outpatient setting and unnecessary resource utilization. We developed an implementation plan to mitigate this systematically at an institutional level. Testing these recommendations next to devise a standardized protocol as a continuous improvement strategy may help improve gout care and patient outcomes.

Admission Medication Reconciliations in Pediatric Patients Admitted to an Inpatient Psychiatry Unit.

Medication errors resulting in adverse drug events may occur during transition of care. Most can be prevented with a medication reconciliation. California Senate Bill 1254 requires a pharmacist to perform an admission medication reconciliation (AMR) to obtain an accurate medication list for each high-risk patient upon hospital admission. Adult patient literature reveals that antidepressant, antipsychotic, and mood-stabilizing drugs are high-risk medications likely to cause errors. Therefore, the purpose of this analysis is to determine if pediatric psychiatry inpatients should be considered high risk, meriting an additional AMR by the pharmacy team. This was a retrospective, single-center analysis of pediatric patients admitted to the inpatient psychiatry unit at Rady Children's Hospital, San Diego between January 1 and 31, 2021. All newly admitted patients had an AMR performed by the medical team (physician-led AMR). High-risk patients (prescribed a high-risk medication or 3 or more medications of any kind prior to admission) had an additional AMR by the pharmacy team (pharmacy-led AMR). Differences between these 2 AMRs were examined. Of the 58 patients admitted during the study period, 39 (67.2%) were identified as high risk, warranting an AMR by the pharmacy team. From the 170 medications reviewed, 51 differences (30%) were found between physician-led and pharmacy-led AMR, with 4 (2.4%) of the differences involving high-risk medications. No medications were incorrectly ordered, and no adverse drug events occurred. Given that physician-led and pharmacy-led AMRs of high-risk prescription medications were only marginally different and no medications were incorrectly ordered, the existing AMR methodology used by psychiatrists at our institution is effective at creating a safe medication list.

The Impact of Medication Reconciliation on Continuityof Drug Therapy during Perioperative Period

Background. Medication errors and resultant adverse drug events (ADEs) often occur during transitions of care. Up to 67% of in-patients prescriptions have at least one unintentional medication discrepancy with previously prescribed therapy. The proportion of clinically significant medication discrepancies is 1159%. Studies from the developed countries demonstrated the effectiveness of medication reconciliation in reducing medication errors, ADEs and healthcare resource utilization. There is a necessity to conduct medication reconciliation studies within Russian current clinical practice to develop effective medical care quality and patients safety programs. Aims to evaluate the impact of pharmacologist-led medication reconciliation on the frequency and structure of unintentional medication discrepancies and potential ADEs at hospital admission and discharge. Methods. Standard care was compared to medication reconciliation led by a clinical pharmacologist in a prospective randomized trial of 410 elective surgical patients. Medication discrepancies at hospital admission and discharge were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records. Results. In the intervention group the frequency of unintentional discrepancies at hospital admission decreased from 32.68 to 16.86%, the proportion of patients with at least one unintentional discrepancy decreased from 64.9 to 44.9%, the number of discrepancies per patient decreased from 1.5 to 0.66. The incidence of discrepancies at hospital discharge decreased from 82.90 to 43.29%, the proportion of patients with discrepancies decreased from 95.61 to 52.68%, the average number of discrepancies per patient decreased from 2.79 to 1.67. Medication reconciliation led by clinical pharmacologist decreased the frequency of unscheduled out-patient visits after discharge from 7.32 to 2.93%. The determined risk factors for unintentional discrepancies at hospital admission were: prescribing of cardiovascular, endocrine drugs and those affecting the central nervous system. Both at admission and discharge medication reconciliation was the significant factor reducing the risk of unintentional discrepancies. Conclusions. Medication reconciliation at hospital admission and discharge reduces the frequency of unintentional discrepancies in drug prescriptions by 16 and 40%, respectively. The implementation of medication reconciliation into clinical practice reduces unscheduled out-patient visits after hospital discharge.

De la conciliation médicamenteuse au bilan partagé de médication : étude pilote intégrant un accompagnement des pharmaciens d’officine au sein d’un parcours de soins pharmaceutiques

Medication reconciliation at hospital and the shared medication review are two complementary activities for securing the medication management of the elderly patient. We are experimenting with a pharmaceutical care pathway including a support approach to promote continuity between these two activities and the initiation of shared medication review. An admission and discharge medication reconciliation has been set up in a geriatric follow-up care and rehabilitation service. A drug assessment was also carried out during the hospital stay. Support for community pharmacists following conciliation was provided by phone calls. Medication discrepancies at admission and discharge, pharmaceutical interventions (PI) as well as satisfaction and difficulties encountered by community pharmacists were collected. Thirty-three patients were included in the study. On admission, 33% of patients had an unintentional discrepancy and 15% on discharge. On average 1.15 PI per patient were notified. The support was propounded to 13 pharmacists. Eight pharmacists (62%) accepted it. Among them, 5 (62.5%) had never performed a medication review. Lack of time was the main difficulty encountered by pharmacists. Our pathway enables to integrate hospital and primary care activities and specifically support the delicate transition between them. This enables to facilitate the implementation of these activities and to maintain a relevant and secure continuity of pharmaceutical care.

Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events and Improves Satisfaction in a Community Hospital.

Pharmacy-led medication reconciliation identifies and corrects medication errors that can potentially cause moderate to severe harm. This research sought to identify the impact of pharmacy-led medication reconciliation on patient outcomes and describe the changes in healthcare workers' perceptions of the program. A pharmacy-led admission medication reconciliation program pilot started in July 2019, and a discharge medication reconciliation proof of concept was tested in September 2020 at a 432-bed hospital. The following periods were compared: August 2018 to February 2019 (pre-program implementation) and August 2019 to February 2020 (post-program implementation). Endpoints included patient outcomes, workforce productivity and interdisciplinary healthcare team satisfaction through program surveys. Patient outcomes were assessed with chisquared tests. Survey responses were assessed using the Likert scale. Descriptive statistics were used for productivity outcomes and the number of discharge medication reconciliations completed. Approximately 18,000 admissions were recorded for each period. The adverse drug event (ADE) rate decreased 49% (p < 0.001), and the complication rate decreased 29.7% (p = 0.001). During post-pilot implementation, 6,530 medication histories were completed, and 70,050 medications were reviewed. Of medication histories completed, 22.6% of patient allergies/adverse drug reactions were updated, 52.3% of medications were clarified, and 54.7% of preferred outpatient pharmacies were updated. Pharmacy services completed medication histories in 38.8% of inpatients. In the proof of concept, 168 discharge medication lists were drafted. Survey results showed statistically significant improvement in healthcare team satisfaction. A pharmacy-led medication reconciliation program involving designated pharmacists and pharmacy technicians has shown to decrease ADEs and complications while improving interdisciplinary healthcare team satisfaction.

Addressing Medications Definitively By Avoiding “Medication Management”

Addressing Medications Definitively By Avoiding “Medication Management”

Drug-related problems identified by clinical pharmacists in nephrology department of a tertiary hospital in China-a single center study.

There is a lack of data on drug-related problems (DRPs) occurring in nephrology department in China. The objective of this study was to identify and categorize the types and causes of DRPs and to assess their severity. DRPs were examined by clinical pharmacists and the results of their interventions were rated. Clinical pharmacists reviewed all medication orders for patients and documented clinical pharmacy services within a nine-month study period. The Pharmaceutical Care Network Europe (PCNE) classification (Version 9.00) was used to identify DRPs. Our Primary outcomes measured the number, causes, types, potential hazards of DRPs and the types and success rate of intervention. Admission medication reconciliation data of 113 patients with chronic kidney disease (CKD) were collected and all of the medications were reviewed retrospectively. Exclude 26 patients who did not occurred DRPs, 87 patients (77%) identified 101 DRPs. The average DRP number per patient was 1.16. The most common type of problem was "treatment effectiveness P1" (84.16%; 85/101). The most common causes were "drug selection C1" (36.00%; 45/125), "dose selection C3" (29.60%; 37/125), and "patient related C7" (26.40%; 33/125). Clinical pharmacists totally proposed 249 interventions, of which 190 (76.31%) were fully accepted and implemented. DRPs are common among CKD patients in the nephrology department. Hence the necessity for pharmaceutical care to be improved to ensure the ongoing safety of patients.

Clinical pharmacists’ services, role and acceptance: a national Swedish survey

AimDescribe, and between regions, compare the services provided, and the pharmacists’ perceptions of their role and its importance.MethodOnline survey involving active clinical pharmacists in Sweden.ResultThe survey was completed by 118...

Improving admission medication reconciliation at a tertiary cancer center.

e18686 Background: Accurate medication reconciliation (MedRec) is a pivotal step ensuring patient safety during transition of care, yet one of the most challenging aspects in healthcare quality and safety. Inaccurate MedRec leads to 40 % of medications errors, 20% of which results in harm. Our aim is to increase rate of accurate MedRec completion at MD Anderson Cancer Center (MDACC), within 24 hours of admission, from 85% to &gt;95% through Best Possible Medication History (BPMH) Methods: During pre-intervention phase, we audited medication review and reconciliation of 50 randomly selected patients within 24 hours from admission to MDACC. Our intervention included: conducting several brain-storming sessions with nursing staff, providers, pharmacists; creating fish bone diagram and process maps; designing educational presentations for nursing staff on how to practice BPMH; educating providers on how to complete medication reconciliation within 24 hours of admissions; assigning nursing champions; and sending email reminders to provider on a daily basis. We audited another 50 patients post intervention. In our project, BPMH accuracy was measured by percentage of patients with zero discrepancies (incorrect dosage, frequency or route; extra medication; discontinued medication not removed from list). Significance was tested for BPMH completion, and MedRec completion using a Binomial Test, while significance for number of discrepancies and audit completion time was tested using a Two Sample t-Test. Results: We collected data on 50 patients pre and 50 post intervention. Our results indicate statistically significant improvement in MedRec rate (100%), reduction of number of discrepancies and audit completion time. Conclusions: Medication review and reconciliation are multi-phased processes. Nurses, Pharmacists and medical providers are the cornerstone of accurate and complete MedRec. Reminder emails to medical providers played a key role in MedRec rate improvement. Additional root cause analysis is needed to further address the medication review completion process in our institution.[Table: see text]

A prospective assessment of the Medicaid Web portal for admission medication reconciliation at a community hospital in Montana.

Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients' discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient's medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission. A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient's current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care. EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission.

Association between admission medication reconciliation by pharmacists on the accuracy of hospital discharge medication lists

AbstractIntroductionMedication errors upon hospital discharge can lead to patient harm. Medication reconciliation during the admission process can potentially impact discharge medication lists. This study aimed to determine the extent to which a pharmacist medication reconciliation on hospital admission affects the accuracy of discharge medication lists.MethodsA prospective observational study was conducted in a major metropolitan tertiary hospital in Sydney, Australia. Patients in the hospital discharge lounge were recruited to evaluate the accuracy of their medication list in the discharge letter. Patients were categorized into two groups: (a) those who received a pharmacist admission medication history (PHARM) and (b) those who did not (non‐PHARM). The primary outcomes were the proportion of patients with medication errors in their discharge letter.ResultsThere were 102 patients included in the study (51 in each group). Patients in the PHARM group were less likely to have one or more medication errors in the discharge letter compared to the no‐PHARM group (70.6% [n = 36/51] versus 92.2% [n = 47/51] [P = .010]). When restricted to prescription only errors (i.e. excluding over the counter [OTC] or herbal medications) the proportion with errors was 51.0% (n = 26/51) in the PHARM group versus 84.3% (n = 43/51) in the no‐PHARM group (P = .001). Patients in the PHARM group were less likely to have errors that were of moderate or greater risk (31.4% [n = 16/51] versus 68.6% [n = 35/51] [P &lt; .001]). After adjusting for confounders in the Poisson regression analysis, patients in the PHARM group had a lower error rate compared to the non‐PHARM group (incidence rate ratio 0.51, 95% confidence interval 0.38–0.69, P &lt; .001).ConclusionA pharmacist‐completed medication history and reconciliation on hospital admission improves the accuracy of discharge medication lists. This study highlights that medication errors during the admission process may be propagated to hospital discharge.

Persistence of Effect of Medication Review on Potentially Inappropriate Prescriptions in Older Patients Following Hospital Discharge.

Potentially inappropriate prescriptions (PIPs) can lead to adverse drug reactions and should be avoided whenever possible. Our objective was to assess the PIP resumption rate 6months after discharge from our geriatric unit and to compare it with data in the literature. This single-center observational study included patients aged ≥ 70years with at least one PIP that had been stopped during hospitalization (according to Screening Tool for Older Persons Prescriptions [STOPP] and Screening Tool to Alert doctors to Right Treatment [START] criteria, version 2) between May 2018 and October 2018. We collected sociodemographic data, medication reconciliation data, and descriptive data during a comprehensive geriatric assessment. Each patient's medication history after discharge was determined in collaboration with their usual community pharmacist. A total of 125 patients (females 70%, mean age 87.1years) were included. Data for the admission and discharge medication reconciliations were available for 44 patients (35%). On admission, 121 of the 125 patients (97%) were taking cardiovascular medication. Of the 336 treatments withdrawn, 61 (18.2%) had been re-prescribed at 6months post-discharge-including half within the first month. The most frequent STOPP criterion was lack of indication (32%), and the overall PIP resumption rate was 22%. According to the anatomical therapeutic chemical (ATC) classification, the main organ system affected by PIPs was the cardiovascular system (47%, with a resumption rate of 17%). Our results highlighted a low PIP resumption rate at 6months and showed that a collaborative medication review is associated with persistent medium-term medication changes.

A comparison between medication reconciliation by a pharmacy technician and the use of an online personal health record by patients for identifying medication discrepancies in patients’ drug lists prior to elective admissions

AimMedication discrepancies (MDs), defined as unexplained differences among medication regimens, cause important public health problems with clinical and economic consequences. Medication reconciliation (MR) reduces the risk of MDs, but is time consuming and its success relies on the quality of different information sources. Online personalized health records (PHRs) may overcome these drawbacks. Therefore, the aim of this study is to determine the level of agreement of identified MDs between traditional MR and an online PHR and the correctness of the identified MDs with a PHR. MethodsA prospective cohort study was conducted at the cardiology, neurology, internal medicine and pulmonary department of the Amphia Hospital, the Netherlands. Two weeks prior to a planned admission all patients received an invitation from a PHR to update their medication file derived from the Nationwide Medication Record System (NMRS). At admission MR was performed with all by a pharmacy technician, who created the best possible medication history (BPMH) based on the NMRS data and an interview. MDs were determined as discrepancies between the available information from the NMRS and the input and alterations patients or pharmacy technician made. The number, correctness of patients’ alterations, type and severity of identified MDs were analysed. ResultsOf 488 patients approached, 155 (31.8 %) patients who both used the PHR and had received MR were included. The mean number of MDs identified with MR and PHR was 6.2 (SD 4.3) and 4.7 (SD 3.7), respectively. 82.1 % of the drug information noted by the patient in the PHR was correct compared to the BPMH and 98.6 % had no clinically relevant differences between the lists. ConclusionPatients who used an online PHR can relatively accurately record a list of their medication. Further research is required to explore the level of agreement and the correctness of a PHR in other (larger) hospital(departments).

Quality Improvement Incorporating a Feedback Loop for Accurate Medication Reconciliation.

Medication reconciliation errors on hospital admission can lead to significant patient harm. A pediatric intermediate care unit initiated a quality improvement project and aimed to reduce errors in admission medication reconciliation by 50% in 12 months. From August 2017 to December 2018, a multidisciplinary team conducted a quality improvement project with plan-do-study-act methodology. Continuous data collection was achieved by reviewing medications with home caregivers within 18 hours of admission to identify errors. Cycle 1 consisted of nursing training in accurate and thorough medication history documentation. Cycle 2 was aimed at improving data collection. Cycle 3 was aimed at improving pediatric housestaff processes for medication reconciliation. In cycle 4 intervention, the reconciliation process was redesigned to incorporate the bedside nurse reviewing final medication orders with the patient's home caregivers once the medication reconciliation process was complete. Intermittent maintenance data collection continued for 12 months thereafter. Cycle 1 and 2 interventions resulted in improvement in the medication reconciliation error rate from 9.8% to 4.7%. In cycle 2, the data collection rate improved from 61% to 80% of admissions sustained. Cycle 3 resulted in a further reduction in the medication error rate to 2.9%, which was sustained in cycle 4 and over the 12-month maintenance period. A patient's number of home medications did not correlate with the error rate. Reductions in admission medication reconciliation errors can be achieved with staff education on medication history and process for medication reconciliation and with process redesign that incorporates active medication order review as a closed-loop communication with home caregivers.

Assessment of the impact of pharmacy learners on admission medication reconciliation in Toronto, Canada

AbstractIntroductionCurrently there is a lack of published data examining the clinical impact of pharmacy learners on patient care outcomes in acute care. A collaborative of hospital pharmacists in Canada established consensus on eight clinical pharmacy key performance indicators (cpKPIs) representing essential patient processes of care. Of the eight cpKPIs, admission medication reconciliation has been established as a cornerstone patient care process. The implementation of cpKPI measurement creates an opportunity to quantify pharmacy learner contribution to patient care.AimTo determine if the presence of pharmacy learners partnering with pharmacists is associated with an increased number of patients receiving admission medication reconciliation (AMR).MethodsIn this prospective observational study, pharmacists and learners (on 5‐week rotations) tracked patients receiving AMR in the electronic health record from 25 January to 17 July 2016. The number of patients receiving AMR were compared during timeframes when a learner was present (intervention) to when a learner was not present (control).ResultsIn the main analysis of 30 learner‐pharmacist pairs with 4684 patients, 1136 patients received AMR in the intervention group versus 887 patients in the control group (adjusted for 5 weeks). The number of patients receiving AMR in the presence of a pharmacy learner partnered with a pharmacist (median = 43, IQR = 23–59) was significantly increased compared to the presence of a pharmacist alone (median = 36, IQR = 17–53, p &lt; 0.001). Learners partnered with pharmacists to perform AMR for 41% of the patients.ConclusionOverall, pharmacy learners partnering with pharmacists increased the number of patients receiving AMR.

Congestive Heart Failure Readmission and Guideline Based Therapy Rates Improvement At Safety Net Hospital Heart Health Center

Introduction The 2017 HFSA co-sponsored guidelines on heart failure (HF) focus on developing strategies to lower readmission rates and increase adherence to guideline directed medical therapy (GDMT), specifically beta blockers (BB), ACE inhibitors and Angiotensin II receptor blockers (ACEi/ARB), spironolactone, Bidil or combined hydralazine/isosorbide dinitrate (Hydral/ISDN), and ARB with neprilysin inhibitor (ARNI). Patients with HF at a disproportionately elevated risk for readmission are those in median-low income, often minority populations, at public safety net hospitals. The Heart Health Center (HHC) at NYC Health + Hospitals, Kings County, the largest public hospital in Brooklyn, New York, was established in October 2017 to provide comprehensive integrated inpatient-outpatient HF care coordinating the management of patients hospitalized on the inpatient cardiology primary service and the outpatient multidisciplinary HF clinic. Hypothesis High-risk patients hospitalized at public medical centers and safety net hospitals with HF have improved rates of rehospitalization GDMT utilization when admitted to dedicated cardiology inpatient primary services and care teams. Methods Retrospective review was conducted of patients admitted with HF from November 2017 - November 2018 referred for post-discharge HHC HF clinic follow up, with readmission monitored through November 2019. Patients admitted to cardiology telemetry service (CT), the inpatient arm of the HHC, were compared to patients admitted to general medicine service (GM). Two-proportion z testing was performed for analysis for 30-day and 1-year overall, HF, and non-HF readmission. Odds ratio (OR) and confidence interval (CI) via McNemar were used for analysis of admission and discharge GDMT changes. Results CT patients (n=125) exhibited lower 30-day and 1-year overall, HF, and non-HF readmission rates than GM (n=69) patients, with 30-day overall readmission rates being significant (24% v 39.1%, p=0.04). When comparing admission and discharge medication reconciliations, CT patients had significantly increased likelihood of being discharged on all classes of GDMT, BB (OR 22.5, CI 5.9 - 191.5, p Conclusions Among HF patients at a public safety net medical center at high risk for readmission, hospitalization under a primary cardiology care team in an integrated inpatient-outpatient HF service was associated with improvement in readmission outcomes and GMT adherence. This study has important implications for strategies for safety net hospitals and medical centers serving broader populations.

Impact of the addition of a clinical pharmacist to a community hospital psychiatric consult liaison team.

The objective of this data analysis was to assess the impact of the addition of a clinical psychiatric pharmacist to a community hospital inpatient psychiatric consult liaison team. Consult liaison psychiatry deals with medically ill patients in general hospital settings and involves the timely recognition and treatment of mental health conditions while coordinating with other medical providers. Each patient consulted to the psychiatry team was reviewed by the clinical pharmacist. Recommendations made by the clinical pharmacist were tracked over a 9-month period. During that time frame, 596 opportunities for intervention were identified. The largest proportion of identified opportunities for intervention were related to admission medication reconciliation, equating to roughly 30%. Optimization of safe medication use had the second largest number of opportunities for intervention at approximately 27%. Additional data, such as time spent on patient care, reason for consultation, and number of accepted recommendations based on medication class/type of intervention, were collected.

Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study

Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Characterization of Admission Medication Reconciliations Performed by Pharmacists in a Pediatric Institution: Resource Allocation.

Compared with adults, children may be at greater risk of medication errors and potential adverse effects. The American Academy of Pediatrics recommends developing mechanisms for proactively identifying patients at risk for medication-related adverse events and failed reconciliation. This study's primary purpose was to evaluate pediatric patients admitted to identify risk factors requiring pharmacist intervention during medication reconciliation (MedRec). This prospective study included pediatric patients admitted during the study time frame until the target population of 500 patient encounters was achieved. During each admission, pharmacy staff completed a medication history, after which a pediatric pharmacist completed a MedRec, as is standard hospital practice. The primary outcome was identification of factors for high-risk transitions of care during pediatric admissions based on the need for pharmacist interventions during the MedRec process. In total, 331 interventions were made for 127 patients (median 2; range, 1-12). Of the 331 interventions, 196 (59.2%) were classified as being of moderate or significant severity. Although patients with at least 2 home medications were significantly more likely to require any intervention (p < 0.0001), patients with 5 or more home medications were more likely to have a significant intervention. Identifying patients with home medications could allow for focused efforts to intervene. Also, patients admitted to the PICU or those with cardiology- or endocrinology-related diagnoses should be prioritized for MedRec process, because of the likelihood of requiring multiple home medications. This strategy should be tailored to individual pediatric institutions based on internal quality control assessments and available resources.