Improve quality of care in hospital-at-home by implementing medication reconciliation on admission: a retrospective observational study.

Abstract

Objectives: Medication reconciliation (MR) has been identified by the French High Health Authority (HHA) as an advanced criterion for improving the quality of care. Although this activity has been widely developed and evaluated in conventional establishments, few studies have looked at its implementation in 'hospitalisation at home' (HAH) settings. HAH is considered to be an alternative to conventional hospitalisation that requires slight changes to be made to the medication process, such as the prominent role of the patient and their caregivers, the intermittent presence of numerous members of multidisciplinary staff in the home environment, and the patient's own home. So, this study aims to provide an overview of the implementation of MR in our HAH using activity indicators, and to measure the clinical impact of the pharmaceutical procedures carried out as part of this activity.

Methods: A retrospective observational study was conducted. A process and MR materials were developed based on HHA tools. The clinical impact of the pharmaceutical procedure was determined using the Clinical Economic and Organisational (CLEO) scale.

Results: 29 patients benefited from MR on admission, carried out by a pharmacy intern with a pharmacy assistant. A total of 38 unintentional discrepancies were identified. The average number of unintentional discrepancies per patient with at least one unintentional discrepancy in their MR was 2.1. The mean time to complete MR was 2.5 hours. 30 (79%) pharmaceutical procedures were accepted by the clinicians, of which 6 (20%) were considered to have a major clinical impact.

Conclusion: MR for hospitalised patients at home is valuable to ensure safe medication management at this stage of the care pathway. Despite the small sample size of our study, each pharmaceutical procedure has a significant clinical impact. This activity contributed to the certification of our home care facility by the French HHA.