An 80-year-old woman with multiple medical problems is admitted to the hospital for evaluation of syncope. Her heart rate is found to be 36/min. She was admitted to another hospital recently, then discharged to an acute rehabilitation facility, and then sent to a nursing home. Review of her history shows that the patient is taking high-dose diltiazem, metoprolol, and atenolol. Which of the following medication reconciliation interventions is most likely to result in a decrease in adverse drug events and health care utilization?

Question

An 80-year-old woman with multiple medical problems is admitted to the hospital for evaluation of syncope.  Her heart rate is found to be 36/min.  She was admitted to another hospital recently, then discharged to an acute rehabilitation facility, and then sent to a nursing home.  Review of her history shows that the patient is taking high-dose diltiazem, metoprolol, and atenolol.  Which of the following medication reconciliation interventions is most likely to result in a decrease in adverse drug events and health care utilization?

Quizplus · Accepted Answer

Transitions of care - between inpatient and outpatient facilities and between units within inpatient facilities - are potential sources of medical error. In particular, continuity of care for medications is especially problematic, and errors can lead to an increased risk of medical complications as well as cost. As a result, most inpatient facilities in the United States have instituted protocols to improve the accuracy of the medication record during transitions of care. Objective studies to identify best practices for medication reconciliation have been limited, with few interventions confirmed to improve quality of care (Choices A, B, C, and D). However, interventions that target pharmacy personnel and high-risk patients in particular appear to have the most impact on the quality of patient care. Educational objective: Continuity of care for medications at the time of transitions of care, between inpatient and outpatient facilities and within inpatient facilities, is a potential source of medical error. Interventions that target pharmacy personnel and high-risk patients appear to be the most effective in improving the quality of patient care. References: Hospital-based medication reconciliation practices: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/22733210)

An 80-Year-Old Woman with Multiple Medical Problems Is Admitted to the Hospital