Implementation of medication reconciliation in outpatient cancer care
Background Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking...
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/2/e002211.full |
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| author | Ernie Mak Lucy Ma Vishal Kukreti Melanie Powis Ryan Kirkby Monika K Krzyzanowska Celina Dara Alyssa Macedo Saidah Hack Lyndon Morley Hemangi Dave |
| author_facet | Ernie Mak Lucy Ma Vishal Kukreti Melanie Powis Ryan Kirkby Monika K Krzyzanowska Celina Dara Alyssa Macedo Saidah Hack Lyndon Morley Hemangi Dave |
| author_sort | Ernie Mak |
| collection | DOAJ |
| description | Background Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy.Methods We conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles.Results Most institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec.Conclusions Realising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec. |
| format | Article |
| id | doaj-art-d83573e9e4e248ef92f5939b53440adf |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-d83573e9e4e248ef92f5939b53440adf2025-08-20T02:36:57ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-06-0112210.1136/bmjoq-2022-002211Implementation of medication reconciliation in outpatient cancer careErnie Mak0Lucy Ma1Vishal Kukreti2Melanie Powis3Ryan Kirkby4Monika K Krzyzanowska5Celina Dara6Alyssa Macedo7Saidah Hack8Lyndon Morley9Hemangi Dave10Department of Medicine, University of Toronto, Toronto, Ontario, CanadaDivision of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaCancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaDepartment of Radiation Medicine, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaPharmacy, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, CanadaBackground Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy.Methods We conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles.Results Most institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec.Conclusions Realising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec.https://bmjopenquality.bmj.com/content/12/2/e002211.full |
| spellingShingle | Ernie Mak Lucy Ma Vishal Kukreti Melanie Powis Ryan Kirkby Monika K Krzyzanowska Celina Dara Alyssa Macedo Saidah Hack Lyndon Morley Hemangi Dave Implementation of medication reconciliation in outpatient cancer care BMJ Open Quality |
| title | Implementation of medication reconciliation in outpatient cancer care |
| title_full | Implementation of medication reconciliation in outpatient cancer care |
| title_fullStr | Implementation of medication reconciliation in outpatient cancer care |
| title_full_unstemmed | Implementation of medication reconciliation in outpatient cancer care |
| title_short | Implementation of medication reconciliation in outpatient cancer care |
| title_sort | implementation of medication reconciliation in outpatient cancer care |
| url | https://bmjopenquality.bmj.com/content/12/2/e002211.full |
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