Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge
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|ClinicalTrials.gov Identifier: NCT01179867|
Recruitment Status : Completed
First Posted : August 11, 2010
Last Update Posted : August 20, 2019
|Condition or disease||Intervention/treatment||Phase|
|Medication Reconciliation Adverse Drug Events||Other: Electronic Medication Reconciliation||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||4014 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge|
|Study Start Date :||October 2014|
|Actual Primary Completion Date :||March 2017|
|Actual Study Completion Date :||August 2019|
Experimental: Electronic Medication Reconciliation
Electronic medication reconciliation includes:
Other: Electronic Medication Reconciliation
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.
- Adverse drug event [ Time Frame: Withing the 30 days post-discharge from hospital ]
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 the 30 days post-discharge from hospital ]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 ]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 ]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 ]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: Withing the 30 days post-discharge from hospital ]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 prescribed to the same patient.
- Unplanned dose changes [ Time Frame: Withing the 30 days post-discharge from hospital ]We will measure the frequency at which unplanned dose changes occur in the discharge prescription, comparing intervention with control units. An unplanned dose change will be defined as a change in dose from that at admission that was not documented as such in the discharge prescription.
- Errors of omission [ Time Frame: Withing the 30 days post-discharge from hospital ]We will measure the frequency at which errors of omission occur in the discharge prescription, comparing intervention with control units. An omission will be defined as a community medication (i.e. dispensed in the 3 months prior to admission) that is not present on the discharge prescription.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01179867
|McGill University Health Centre|
|Montreal, Quebec, Canada, H3A 1A3|
|Principal Investigator:||Robyn Tamblyn, PhD||McGill University|