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Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial

BACKGROUND: Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication...

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Autores principales: Tamblyn, Robyn, Huang, Allen R, Meguerditchian, Ari N, Winslade, Nancy E, Rochefort, Christian, Forster, Alan, Eguale, Tewodros, Buckeridge, David, Jacques, André, Naicker, Kiyuri, Reidel, Kristen E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502593/
https://www.ncbi.nlm.nih.gov/pubmed/22920446
http://dx.doi.org/10.1186/1745-6215-13-150
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author Tamblyn, Robyn
Huang, Allen R
Meguerditchian, Ari N
Winslade, Nancy E
Rochefort, Christian
Forster, Alan
Eguale, Tewodros
Buckeridge, David
Jacques, André
Naicker, Kiyuri
Reidel, Kristen E
author_facet Tamblyn, Robyn
Huang, Allen R
Meguerditchian, Ari N
Winslade, Nancy E
Rochefort, Christian
Forster, Alan
Eguale, Tewodros
Buckeridge, David
Jacques, André
Naicker, Kiyuri
Reidel, Kristen E
author_sort Tamblyn, Robyn
collection PubMed
description BACKGROUND: Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem. METHODS/DESIGN: Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units. DISCUSSION: The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors. TRIAL REGISTRATION: NCT01179867
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spelling pubmed-35025932012-11-22 Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial Tamblyn, Robyn Huang, Allen R Meguerditchian, Ari N Winslade, Nancy E Rochefort, Christian Forster, Alan Eguale, Tewodros Buckeridge, David Jacques, André Naicker, Kiyuri Reidel, Kristen E Trials Study Protocol BACKGROUND: Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem. METHODS/DESIGN: Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units. DISCUSSION: The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors. TRIAL REGISTRATION: NCT01179867 BioMed Central 2012-08-27 /pmc/articles/PMC3502593/ /pubmed/22920446 http://dx.doi.org/10.1186/1745-6215-13-150 Text en Copyright ©2012 Tamblyn et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Study Protocol
Tamblyn, Robyn
Huang, Allen R
Meguerditchian, Ari N
Winslade, Nancy E
Rochefort, Christian
Forster, Alan
Eguale, Tewodros
Buckeridge, David
Jacques, André
Naicker, Kiyuri
Reidel, Kristen E
Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title_full Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title_fullStr Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title_full_unstemmed Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title_short Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
title_sort using novel canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502593/
https://www.ncbi.nlm.nih.gov/pubmed/22920446
http://dx.doi.org/10.1186/1745-6215-13-150
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