Medication Reconciliation | Using Novel Canadian Resources to Improve Medication Reconciliation at Discharge

Medication Reconciliation research study

What is the primary objective of this study?

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.

Who is eligible to participate?

Inclusion Criteria: - 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 Exclusion Criteria: - none

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?

Medication Reconciliation

Adverse Drug Events

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Other:Electronic Medication ReconciliationAt 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 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 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

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

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

Usual practice medication reconciliationUsual 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.

Study Status

Active, not recruiting

Start Date: October 2014

Completed Date: October 2018

Phase: N/A

Type: Interventional


Primary Outcome: Adverse drug event

Secondary Outcome: Emergency room visit / Hospital readmission

Study sponsors, principal investigator, and references

Principal Investigator: Robyn Tamblyn, PhD

Lead Sponsor: McGill University

Collaborator: Canadian Institutes of Health Research (CIHR)

More information:

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