Easy Medication Reconciliation at Hospital Admission: The EzMedRec Decision Support System.

Medication reconciliation (MR) aims at preventing medication errors at care transitions. It is a complex, time-consuming, cognitively demanding pharmacological task. We have developed a decision support system, EzMedRec, to assist retroactive MR at hospital admission. EzMedRec compares the best possible medication history (BPMH), i.e., all medications taken by the patient before hospitalization, to the list of admission medication orders (AMO). The process includes (i) the decomposition of BPMH and AMO drugs into their active ingredients (AIs), (ii) the detection of medication discontinuations and additions, and (iii) the identification of modified medication orders. The ATC classification is used to semantically enrich MR by comparing discontinued AIs and added AIs and suggesting a potential intentional drug substitution serving the same therapeutic objective. EzMedRec has been evaluated on a sample of 52 actual MRs involving 822 medication order lines, 406 in BPMHs, and 416 in AMOs with a global accuracy of 98,3%.

[Outpatient medication usage during hospitalization]. / Utilisation des médicaments achetés en ville par les patients hospitalisés: quelles mesures correctives proposer?

OBJECTIVE: To study the frequency and circumstances of patients' use of outpatient medications prescribed by their GP during hospitalization and to assess means of reducing this use. METHOD: A prevalence study of medication use was conducted at Saint Joseph's Hospital in Paris. On one day, we used a specific questionnaire to interview 151 patients in 11 different units about the type and amount of medications they had brought with them to the hospital and the type and amount they had used. RESULTS: Overall, 61% had brought their prescription medication with them, and 36% had used some of it, sometimes without informing the medical staff. In 75% of these cases, these drugs were available from the hospital pharmacy. DISCUSSION: Possible corrective steps include both technological improvements (computerized prescription) and organizational measures: systematic inquiry about and consideration of outpatient prescriptions at admission, use of validated prescription/substitution aids (Comedims), and patient information and education about drug substitutions and interactions.