Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge
The purpose of this study is to determine if a physician's use of electronic medication reconciliation software when writing a patient's discharge prescription will prevent adverse drug events and readmissions to the hospital. This electronic medication software will provide the physician with the most up-to-date list of medications the patient was taking before being admitted to the hospital, through a real-time link to the provincial drug insurance agency's administrative databases. It will also provide the list of medications the patient has taken while admitted to the hospital. With these two pieces of information, the physician will write the discharge prescription using the medication management software, print the discharge prescription for the patient, and the software will fax a copy of any prescriptions that should be stopped to the patient's community pharmacist.
Adverse Drug Events
Other: Electronic Medication Reconciliation
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge|
- Adverse Drug Event [ Time Frame: 30 days after discharge from hospital ] [ Designated as safety issue: Yes ]
Adverse drug event: an injury resulting from medical intervention related to a drug.
- self-reported patient information 30 days post-discharge
- chart and administrative data on drugs that were started, stopped, or continued at discharge as well as acute and chronic health problems
- reviewing & adjudicating the presence of an adverse event and the probability of it being drug related by a blinded expert panel review of each patient's chart and post-discharge interview data using the Leape & Bates method, and the Naranjo criteria.
- Emergency Room Visit/Hospital Readmission [ Time Frame: within 30 days post-discharge ] [ Designated as safety issue: Yes ]All visits to the emergency room and/or hospital re-admission in the 30 days post-discharge will be measured using the provincial health insurance administrative databases. This approach ensures that all ER visits and re-admissions are included, not just those occuring at the study hospitals. Almost all hospital-based physicians in Quebec are remunerated on a fee-for-service basis, and are required to record accurately the treating establishment and location of service, as this information determines the level of remuneration.
- Failure to re-start community medications used for chronic conditions after discharge from hospital. [ Time Frame: 90 days after discharge from hospital ] [ Designated as safety issue: Yes ]Of all discharged patients who were on a medication used for a chronic condition in the community prior to their hospitalization, we will measure the proportion who do not re-start this medication within the 90 days after they are discharged from hospital. This will be measured through comparison of their dispensed community medications before and after hospitalization (from administrative insurance database).
- Readiness for hospital discharge [ Time Frame: Within the 30 days post-discharge from hospital ] [ Designated as safety issue: No ]This sub-study will examine the determinants and outcomes of patients' readiness for hospital discharge. Specifically, it will determine if: a) patient and hospital organizational characteristics are associated with patients' readiness for hospital discharge, b) lower levels of patients' readiness for hospital discharge are associated with an increased risk of ADEs and re-admissions 30-day post-discharge and, c) the effects of the medication reconciliation intervention on ADEs and readmissions 30-day post discharge is modified by level of patient's readiness for hospital discharge.
- Time to complete medication history and discharge medication reconciliation with prescription. [ Time Frame: At admission to study unit, and upon discharge from hospital. ] [ Designated as safety issue: No ]We will measure the time it takes clinicians to complete the patient's medication history at admission, which includes time spent speaking with patients about medications, contacting patients' pharmacies for information on patients' community medications, and documenting the community medication list. We will also measure the time it takes clinicians to complete a medication reconciliation at discharge and write the discharge prescription. We will compare the intervention and control groups, to see if the intervention reduces the time it takes clinicians to complete either of these two tasks.
- Therapy Duplication [ Time Frame: during the 30 days post discharge from hospital ] [ Designated as safety issue: Yes ]We will measure the frequency at which therapy duplications occur in the discharge prescription, comparing intervention with control units. A therapy duplication will be defined as two or more drugs in the same therapeutic class being dispensed to the same person within the 30 days post-discharge from hospital.
|Study Start Date:||May 2013|
|Estimated Study Completion Date:||December 2016|
|Estimated Primary Completion Date:||December 2013 (Final data collection date for primary outcome measure)|
|Experimental: Electronic Medication Reconciliation||
Other: Electronic Medication Reconciliation
Electronic medication reconciliation includes:
No Intervention: Usual practice medication reconciliation
Usual practice in dealing with medication reconciliation. This includes viewing the hospital medications through the hospital electronic pharmacy system, and viewing the community drugs in the patient's chart, if it was collected at admission (not always the case). However not all physicians view the community drugs before writing the discharge prescription. The physician will write a paper discharge prescription to be given to the patient, but communications are generally not made directly to the community pharmacist or previous prescribing physicians.
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|Contact: Robyn Tamblyn, PhD||514-934-1934 ext email@example.com|
|Contact: Pamela Doran, MSc||514-934-1934 ext firstname.lastname@example.org|
|McGill University Health Centre||Not yet recruiting|
|Montreal, Quebec, Canada, H3A 1A3|
|Contact: Robyn Tamblyn, PhD 514-934-1934 ext 32997 email@example.com|
|Principal Investigator: Robyn Tamlbyn, PhD|
|Principal Investigator:||Robyn Tamblyn, PhD||McGill University|