Title
Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan.
Abstract
Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined.Patients admitted between May 2008 and September 2009 were recruited. The type and class of medication discrepancies reported by pharmacists, the medication discrepancy rate, physician acceptance rate, and time taken for the intervention were studied. The degree of harm that could have resulted from the discrepancies was independently evaluated by four pharmacists. The association between selected variables and the occurrence of drug discrepancies was analyzed.Among 3013 patients interviewed, the pharmacists identified 243 patients (8%) with at least one medication discrepancy between the patient's medication history and admission orders. There were 576 discrepancies identified. About 19% of the errors prevented could have potentially caused moderate to severe harm. The average time for one intervention was 18±9.8min. The number of preadmission medications, age, frequency of outpatient visits within 3 months prior to this hospital admission, and the number of specialist outpatient clinics the patient had visited within 3 months before the admission were determined to be risk factors for drug discrepancies.This medication reconciliation program, conducted by pharmacists, was made more efficient by medication usage data from the Taiwan NHI. Pharmacists can reconcile medications more effectively by selecting patients at high risk for unintentional drug discrepancies.
Year
DOI
Venue
2013
10.1016/j.ijmedinf.2013.01.006
International Journal of Medical Informatics
Keywords
Field
DocType
Medication reconciliation,Health information technology
Medication Reconciliation,Emergency medicine,Family medicine,Health information technology,Pharmacist,Acceptance rate,Outpatient visits,Medicine,National health insurance
Journal
Volume
Issue
ISSN
82
6
1386-5056
Citations 
PageRank 
References 
3
0.58
0
Authors
7
Name
Order
Citations
PageRank
Yen-Ying Lee130.58
Li-Na Kuo262.03
Yi-Chun Chiang3143.29
Jing-Yi Hou430.58
Tzu-Ying Wu530.58
Min-Huei Hsu6347.51
Hsiang-Yin Chen762.73