Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge

NCT01179867 | Completed DMC

• 1 other identifier: RN 0000086616 - 222163
• Study Type: interventional
• Target: 4,014
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Medication Reconciliation; Adverse Drug Events

Keywords

Medication reconciliation; Adverse drug events; Hospital readmission; Medication management

Outcome Measures

Primary Outcomes (1)

• Adverse drug event

  Adverse drug event: an injury resulting from medical intervention related to a drug. Assessed using: 1. self-reported patient information 30 days post-discharge 2. chart and administrative data on drugs that were started, stopped, or continued at discharge as well as acute and chronic health problems 3. 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.

  Withing the 30 days post-discharge from hospital

Secondary Outcomes (7)

• Emergency room visit / Hospital readmission

  Within the 30 days post-discharge from hospital

• Failure to re-start community medications used for chronic conditions after discharge from hospital.

  90 days after discharge from hospital

• Readiness for hospital discharge

  Within the 30 days post-discharge from hospital

• Time to complete medication history and discharge medication reconciliation with prescription.

  At admission to study unit, and upon discharge from hospital

• Therapy duplication

  Withing the 30 days post-discharge from hospital

Study Arms (2)

Electronic Medication Reconciliation

EXPERIMENTAL

Electronic medication reconciliation includes: 1. Electronic retrieval of the community drug list at admission 2. Generation of discharge prescription using the discharge reconciliation module at discharge 3. Transfer of information on discontinued and changed medication to respective dispensing pharmacies and prescribing physicians

Other: Electronic Medication Reconciliation

Usual practice medication reconciliation

NO INTERVENTION

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.

Interventions

Electronic Medication Reconciliation OTHER

1. At admission the community drug list will be electronically retrieved from the public drug insurance administrative databases using a real-time interface, and the admitting team/pharmacist will verify the list, adding over-the-counter medications 2. At discharge the attending physician/resident will write the discharge prescription using the discharge reconciliation module, allowing the physician to simultaneously view the validated community drug list and the hospital pharmacy drug list for the patient 3. The discharge communication module will facilitate identification and transfer of information on discontinued and changed medication to the respective dispensing pharmacies and prescribing physicians along with the reasons for these changes

Electronic Medication Reconciliation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• have public drug insurance: this includes all those 65 years and older in the province of Quebec, as well as those under 65 on social assistance or who do not have drug insurance available through their employer
• admitted to the hospital from the community
• admitted to a surgical or internal medicine unit
• discharged alive

You may not qualify if:

• \- none

Sponsors & Collaborators

• McGill University: lead
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (1)

McGill University Health Centre

Montreal, Quebec, H3A 1A3, Canada

Location

Related Publications (3)

• Kurteva S, Nassar N, Tamblyn R. Emerging lessons from experiences at transitions in care among hospitalised patients with cancer with postdischarge frequent emergency department use: a qualitative study using linked clinical and patient-reported interview data from Quebec, Canada. BMJ Open. 2024 Oct 18;14(10):e085219. doi: 10.1136/bmjopen-2024-085219.

  PMID: 39424388 DERIVED

• Tamblyn R, Abrahamowicz M, Buckeridge DL, Bustillo M, Forster AJ, Girard N, Habib B, Hanley J, Huang A, Kurteva S, Lee TC, Meguerditchian AN, Moraga T, Motulsky A, Petrella L, Weir DL, Winslade N. Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial. JAMA Netw Open. 2019 Sep 4;2(9):e1910756. doi: 10.1001/jamanetworkopen.2019.10756.

  PMID: 31539073 DERIVED

• Tamblyn R, Huang AR, Meguerditchian AN, Winslade NE, Rochefort C, Forster A, Eguale T, Buckeridge D, Jacques A, Naicker K, Reidel KE. Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial. Trials. 2012 Aug 27;13:150. doi: 10.1186/1745-6215-13-150.

  PMID: 22920446 DERIVED

MeSH Terms

Conditions

Drug-Related Side Effects and Adverse Reactions

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders

Study Officials

• Robyn Tamblyn, PhD

  McGill University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: August 10, 2010
• First Posted: August 11, 2010
• Study Start: October 1, 2014
• Primary Completion: March 1, 2017
• Study Completion: August 1, 2019
• Last Updated: August 20, 2019

Record last verified: 2019-08

Locations

CA (1)