Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order [...]

Background: In medical care for older patients, the presence of potentially inappropriate medications (PIMs) is associated with increased adverse outcomes [1, 2]. A wide range of medications with anticholinergic properties affects cognitive states of older patients have been regarded as PIMs [1, 3]. We purposed to assess clinical impact of anticholinergic cognitive burden on clinical [...]

Background: Despite the consistently proven benefits of cardioprotective medications, medication adherence (MA) remains a challenge in coronary artery disease (CAD) patients. Studies suggest that up to 50% of patients with CAD are nonadherent to medications, with patient knowledge, beliefs, and expectations playing a vital role. We aimed to assess patient-related medication non-adherence (MNA) factors in [...]

Background: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to [...]

Background: Hospital readmissions are an important marker of healthcare quality, reflecting worse patient outcomes and resulting in millions of dollars of penalties annually. Medication nonadherence is an important driver of hospital readmissions, with one significant factor being difficulty obtaining medications after discharge. The difficulty could be due to copays, availability, or transportation to a local [...]

Background: Acutely-ill and multimorbid patients are frequently exposed to unintended medication errors after admission and their impacts on patient safety are profound. Designated ward-pharmacists as team members of our Hospital Medicine Center reconcile medications of hospitalized patients by identifying discrepancies in patients’ current medications and the medication used in acute care in emergency departments or [...]

Background: Rest is critical to healing, yet a child’s sleep during an inpatient hospital admission is often disrupted. One such disruption is oral medication administration, which is commonly scheduled around the clock (q6h, q8h, q12h) by default, despite comparable efficacy during waking hours. Previous studies suggest that flexible medication times help inpatients sleep longer and [...]

Background: The hospital discharge process is challenging and opportune for human error. Medication discrepancies continue to be a patient-safety problem, exacerbated with the multiple sources of discharge medication documentation. Medication discrepancies may lead to medication errors and may contribute to adverse drug events with potential subsequent healthcare utilization and cost. Discharge medications can be listed [...]

Background: Obtaining the Best Possible Medication History (BPMH) is the protocolized gold standard in obtaining medication histories and well known to decrease the total number of medication errors during transitions in care. Trained technicians require an average of 15-30 minutes to collect a BPMH [2]. Our facility conducted a categorical analysis and within subject study [...]

Background: Medication reconciliation programs are a well-recognized important tool in reducing medication discrepancies and subsequently decreasing patient harm, particularly at transitions of care. Medication reconciliation programs have demonstrated error reductions upward of 66% [1-4]. 39% of prescription medication history errors have the potential to cause moderate or severe discomfort or deterioration in a patient’s condition [...]