Authors (including presenting author) :
Ng KH(1), Yick PK (1),Kng C(2), Lin KL(2), Po MY(3)
Affiliation :
(1) Department of Pharmacy, RTSKH (2) Department of Medicine & Geriatrics, RTSKH (3) Community Geriatric Assessment Team, RTSKH
Introduction :
Medication errors (ME) which include unintentional medication discrepancies (UMD) commonly occur at the transition of care. Previous studies of pharmacist-led medication reconciliation (MR) were found to be effective in identifying and reducing medication errors. The benefits of MR in improving clinical outcome had also been demonstrated. However, local studies and evidence of the impact of pharmacist-led MR on nursing home residents discharged from hospital are lacking.
Objectives :
This study aims to investigate the prevalence of ME, UMD and drug-related problems (DRP) for patient discharging to nursing home at hospital discharge. The impact of pharmacist-led MR programme was also investigated.
Methodology :
This study consisted of two part. The first part was a prospective observational study conducted in 2 geriatric wards of an acute care hospital from October 2018 to April 2019. The discharge medication of nursing home residents discharged from the 2 geriatric wards were assessed by the study pharmacist. The study pharmacist conducted detailed MR, recorded identified ME and recommended intervention to prescriber to rectify the ME. A medication liaison service was also provided to staff of nursing home in which a discharge medication summary with latest medication changes were recorded. The primary outcomes were the prevalence and characteristics of the UMD and DRP. The pharmacist’s intervention and its acceptance rate were also documented. Risk factors of MEs were identified by logistic regression analysis. The medication changes compliance rate after discharge was assessed. The second part of this study was a satisfaction survey. The feedback of nursing home staff about this service was collected by an anonymous survey.
Result & Outcome :
During the 6 months of study, 197 patients were included in the study. Overall, there were 65 MEs identified. 17.3% of prescriptions had at least one UMD or DRP. The most common ME was drug omission, followed by insufficient medication supply. The three most commonly involved drug classes in MEs were drugs for the nervous system, gastrointestinal system, and respiratory system. 83.1% of pharmacist’s intervention was accepted by prescriber. Length of stay and number of medication changes during hospitalization made by physician were found to be directly associated with MEs. Post-discharge medication compliance rate by nursing home staff was 99.8% and the nursing home staff was generally satisfied with the programme.
