19 research outputs found
Effect of therapeutic interchange on medication reconciliation during hospitalization and upon discharge in a geriatric population
<div><p>Background</p><p>Therapeutic interchange of a same class medication for an outpatient medication is a widespread practice during hospitalization in response to limited hospital formularies. However, therapeutic interchange may increase risk of medication errors. The objective was to characterize the prevalence and safety of therapeutic interchange.</p><p>Methods and findings</p><p>Secondary analysis of a transitions of care study. We included patients over age 64 admitted to a tertiary care hospital between 2009–2010 with heart failure, pneumonia, or acute coronary syndrome who were taking a medication in any of six commonly-interchanged classes on admission: proton pump inhibitors (PPIs), histamine H<sub>2</sub>-receptor antagonists (H2 blockers), hydroxymethylglutaryl CoA reductase inhibitors (statins), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and inhaled corticosteroids (ICS). There was limited electronic medication reconciliation support available. Main measures were presence and accuracy of therapeutic interchange during hospitalization, and rate of medication reconciliation errors on discharge. We examined charts of 303 patients taking 555 medications at time of admission in the six medication classes of interest. A total of 244 (44.0%) of medications were therapeutically interchanged to an approved formulary drug at admission, affecting 64% of the study patients. Among the therapeutically interchanged drugs, we identified 78 (32.0%) suspected medication conversion errors. The discharge medication reconciliation error rate was 11.5% among the 244 therapeutically interchanged medications, compared with 4.2% among the 311 unchanged medications (relative risk [RR] 2.75, 95% confidence interval [CI] 1.45–5.19).</p><p>Conclusions</p><p>Therapeutic interchange was prevalent among hospitalized patients in this study and elevates the risk for potential medication errors during and after hospitalization. Improved electronic systems for managing therapeutic interchange and medication reconciliation may be valuable.</p></div
Medications of interest characterized by drug class, formulary status and therapeutic interchange.
<p>Medications of interest characterized by drug class, formulary status and therapeutic interchange.</p
Characteristics of patients in each cohort<sup>a</sup>.
<p>Characteristics of patients in each cohort<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0186075#t002fn001" target="_blank"><sup>a</sup></a>.</p
Novel Integration of Systems-Based Practice Into Internal Medicine Residency Programs: The Interactive Cost-Awareness Resident Exercise (I-CARE)
Association of jargon and medical team with completely understanding diagnosis (n = 336).
<p>Association of jargon and medical team with completely understanding diagnosis (n = 336).</p
Baseline characteristics of the study cohort (n = 374).
<p>Baseline characteristics of the study cohort (n = 374).</p
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Quality of discharge practices and patient understanding at an academic medical center.
ImportanceWith growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.ObjectiveTo conduct a multifaceted evaluation of transitional care from a patient-centered perspective.DesignProspective observational cohort study, May 2009 through April 2010.SettingUrban, academic medical center.ParticipantsPatients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.Main outcomes and measuresDischarge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care.ResultsThe 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day’s advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge.Conclusions and relevancePatient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care