Medication Reconciliation in an Emergency Department: How to Prioritize Patients ?

OPTICONCIL: Implementation of Medication Reconciliation Process in an Emergency Department : Which Patients Should be Prioritized and How to Optimize Patients' Therapeutics?

Medication reconciliation has proven its efficiency in improving patients' care, especially for emergency patients.

This study aimed to identify risk factors of unintended medication discrepancies (UMD) in an emergency department. Secondary objectives were to identify the number and type of UMD, correction rate of UMD and the impact of emergency department organisation on UMD.

Study Overview

• Status: Completed
• Conditions: Emergency Service, Hospital; Medication Reconciliation
• Intervention / Treatment: Other: Medication reconciliation

Detailed Description

Emergency patients are at high risk of medication errors, for different reasons: emergency admission, patients who don't know their at-home treatment (polymedicated, cognitive disorders, etc) and who don't have their medical prescriptions available.

Medication reconciliation has proven its efficiency in improving patients' care, especially for emergency patients. However, prioritization is essential to ensure a better efficiency of pharmaceutical resources.

In our center, a pharmacy resident has been assigned to medication reconciliation in the emergency department since November 2017, in collaboration with a clinical pharmacist. Every morning, 3 to 4 patients benefit from medication reconciliation (patients who will be transfered to another unit within our hospital).

The main objective was to identify risk factors of unintended medication discrepancies (UMD) in order to prioritize patients who will benefit from this newly implemented activity.

Secondary objectives were to identify the number and type of UMD, correction rate of UMD and the impact of emergency department organisation on UMD.

All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018 were included. Were not included patients with a medication reconciliation performed but transfered to another hospital right after the emergency department visit.

This was a retrospective, monocentric, observational study. Number of patients required was 200. Variables collected were:

• demographics (age, sex, lifestyle, comorbidities),
• emergency care variables (date and time of medical care beginning, ambulance arrival, adressing type, medical prescriptions availability, main diagnosis, date and hour of medical prescriptions in the emergency department, prescriber (pharmacy/doctor), destination unit of patients)
• organizational variables (number of daily emergency visits, number of patients hospitalized within the emergency department),
• medical notes information on at-home treatment (number of missing information, of incorrect information, number of prescriptions in at-home treatment)
• medication reconciliation variables (date of medication reconciliation, number of sources of information needed, number of actual prescriptions in at-home treatment, number of intended medication discrepancies, number and type of UMD, time needed for medication reconciliation).

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• France
  • Ile-de-France
    • Paris, Ile-de-France, France, 75014
      • Groupe hospitalier Paris saint Joseph

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018

Description

Inclusion Criteria:

• All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018

Exclusion Criteria:

• Patients transfered to another hospital right after the emergency department visit

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Emergency patients with medication reconciliation; All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018	Other: Medication reconciliation; No intervention was performed other than collecting data on patients' medical files

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Variables influencing the number of UMD in the emergency department	Variation of the number of UMD for each variable was measured to identify the impact of each factor on medication errors (linear regression). Variables measured were the variables described in the protocol section.	Nov2017-Apr2018

Secondary Outcome Measures

Outcome Measure	Time Frame
Number and type of UMD	Nov2017-Apr2018
Correction rate of UMD	Nov2017-Apr2018
Impact of organizational variables on the number of UMD	Nov2017-Apr2018

Collaborators and Investigators

• Sponsor: Groupe Hospitalier Paris Saint Joseph
• Investigators: Principal Investigator: Jennifer Corny, PharmD, Pharmacy Department

Publications and helpful links

Helpful Links

• Medication reconciliation official guidelines

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 1, 2018
• Primary Completion (ACTUAL): May 1, 2018
• Study Completion (ACTUAL): November 15, 2018

Study Registration Dates

• First Submitted: May 15, 2019
• First Submitted That Met QC Criteria: May 17, 2019
• First Posted (ACTUAL): May 20, 2019

Study Record Updates

• Last Update Posted (ACTUAL): May 20, 2019
• Last Update Submitted That Met QC Criteria: May 17, 2019
• Last Verified: May 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: OPTICONCIL

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No