Background: Determining the quality of medication reconciliation (MR) is a laborious and time-intensive process, often involving chart review and detailed patient interviews. Purpose: To identify meaningful, measurable process measures for high-quality MR obtainable from electronic health records (EHR), and to determine if performance on these measures responded to a campaign focused on improving MR. Description: [...]

Background: Adverse drug events (ADEs) are common during transitions from the hospital to the ambulatory setting, with approximately 20% of patients experiencing an ADE within 30 days of discharge. ADEs are often due to patient misunderstanding of the prescribed medication regimen or non-adherence to the regimen.  New approaches are needed to address this problem. Purpose: [...]

Background: Up to 67% of patients have at least one medication error on admission to the hospital with over a quarter of hospital prescribing errors attributed to incomplete medication histories at admission. Key aspects of successful interventions to date include intensive pharmacy staff involvement. However, pharmacists are in short supply in many hospitals. Methods: A [...]

Background: Patients are discharged home on medications different than those they were taking before admission.  New and discontinued medications as well as dosage changes contribute to medication-related adverse events.  Purpose: To help address this problem, interns in our program developed a standard process during their quality improvement (QI) curriculum to ensure that at least 95% [...]

Background: U.S. healthcare costs are rising due to the increase in polypharmacy, which is a potential risk factor for hospital readmission.1 In a cohort study of 5,507 patients with ≥10 discharge medications, more than 25% of them were readmitted.1 At one of the largest public county hospitals in the U.S., readmission rates for patients with high-volume home [...]

Background: Transitioning patient care between hospitals and skilled nursing facilities (SNFS) brings many challenges.  Patient and family anxiety, unfamiliarity and even misinformation about SNFs increase the opportunity for unsatisfactory outcomes and readmissions to the hospital..  Previous research has demonstrated frequent and potentially harmful medication discrepancies during hospital to nursing home transitions, and low frequency of [...]

Background: Patient understanding of prescription medication regimens is an important aspect of health literacy and inpatient medication reconciliation. There is a lack of data regarding patient knowledge of their own outpatient prescription medications. This study evaluated the ability of patients admitted to a community hospital medicine service to provide, from memory, their preadmission prescription medication [...]

Background: Up to forty-five percent of Americans do not fill prescriptions secondary to cost. Medication non-adherence leads to morbidity and mortality (~$100-300B annually). The majority of physicians cannot price medications within 25% of cost. Our institution alone sees more than 600 prescription-cash-pay patients (under/uninsured or no Part D) each month. Purpose: To empower clinicians to [...]

Case Presentation: A 58- year-old female presented with vomiting, dizziness, and a blood pressure of 80/60 mmHg. Laboratory: serum creatinine 3.1 mg/dl (baseline 1 mg/dl), BUN 34 mg/dl (baseline 10 mg/dl), corrected calcium 12.3 mg/dl, low PTH , normal 25-OH vitamin D, and normal PTH-related protein. Two months prior, serum calcium was normal and 25-OH [...]

Case Presentation: A 42-year-old African American woman with a history of hypertension, morbid obesity, and obstructive sleep apnea presented to the emergency department with a 12-hour history of left-sided abdominal pain, nausea and vomiting. At presentation her medications included hydrochlorothiazide, acetaminophen, ibuprofen, and lisinopril. Her first dose of lisinopril 5mg was 12 hours before the [...]