Best Possible Medication History, Medication Discrepancy, Medication Reconciliation
Conditions
Brief summary
Taiwan's National Health Insurance Administration PharmaCloud provides cross-institutional medication access to reimbursed medication records to support best possible medication history (BPMH) compilation. However, its utility among internal medicine inpatients, who typically present with complex regimens and frequent medication changes, remains understudied. This study aims to evaluate the impact of PharmaCloud integration on pharmacist-led medication reconciliation (MedRec) efficiency and error detection among internal medicine inpatients at both admission and discharge. The non-randomized, single-center study was conducted from May to November 2024 at the Far Eastern Memorial Hospital in Taiwan. Internal medicine inpatients taking at least one pre-admission chronic medication were enrolled and assigned to standard medication reconciliation protocol (control) or PharmaCloud-integrated medication reconciliation (experimental). Best possible medication history compilation time was recorded across two stages: preparation and interview. Medication discrepancies were identified at admission and discharge and classified as intentional or unintentional.
Interventions
OTHERPharmaCloud-integrated medication reconciliation
The intervention entailed supplementing in-house electronic medical record with data from PharmaCloud, a platform launched by Taiwan's National Health Insurance Administration to enable cross-institutional access to reimbursed medication records.
Sponsors
Far Eastern Memorial Hospital
National Yang Ming Chiao Tung University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Use of at least one pre-admission medication for a chronic disease
Exclusion criteria
* If patient was discharged within 48 hours of admission * If patient was scheduled for surgery during their inpatient stay
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best possible medication history compilation efficiency | From patient's time of hospital admission to 72 hours post-admission. | The first outcome measure was best possible medication history (BPMH) compilation efficiency, which was measured in minutes as three metrics: preparation time (stage 1), measured from the start of electronic medical record (EMR) and PharmaCloud review to the completion of the preliminary BPMH; interview time (stage 2), measured from the start to the end of the face-to-face interview; and total BPMH compilation time, the sum of stage 1 and 2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Medication error detection rate | Admission: Unintentional discrepancies identified from patient's time of admission to 72 hours post-admission. Discharge: Unintentional discrepancies identified immediately prior to patient's departure from the facility. | Medication error detection rate was defined as the proportion of participants with at least one identified unintentional discrepancy at either admission or discharge. All identified discrepancies were categorized as either intentional or unintentional, depending on whether or not the medication changes were consciously made by the prescribers, respectively. |
Countries
Taiwan
Outcome results
None listed