Bakgrund: Antalet personer med multisjuklighet och polyfarmaci ökar i samhället. Läkemedelsrelaterade vårdskador och problem är vanligt förekommande i vården och polyfarmaci ökar risken. Läkemedelsgenomgångar är viktiga för att främja en säker läkemedelsanvändning och förebygga vårdskador. WHO beskriver läkemedelsgenomgångar som ett interprofessionellt teamarbete där ansvaret är delat mellan yrkesutövarna. Sjuksköterskor beskrivs kunna ha en egen och viktig roll i arbetet med läkemedelsgenomgångar. Syfte: Syftet med denna systematiska litteraturgranskning är att belysa sjuksköterskors erfarenheter av att utföra läkemedelsgenomgångar.  Metod: Studien är en systematisk litteraturgranskning och bygger på 16 kvalitativa vetenskapliga artiklar. Datainsamlingen genomfördes genom strukturerade databassökningar i Cinahl, Pubmed och Web of Science. Dataanalysen genomfördes enligt tematisk syntes av Thomas & Harden. Tillförlitligheten av sammanvägningen bedömdes enligt CERQual. Resultat: Två tredje nivå teman utgör resultatet med underliggande andra nivå teman. Utmaningar och brister vid läkemedelsgenomgångar: resursbrister vid genomförande av läkemedelsgenomgångar, brist på kompetens hos sjuksköterskor vid genomförande av läkemedelsgenomgångar, utmaningar i det professionella samarbetet vid läkemedelsgenomgångar, utmaningar vid läkemedelsgenomgångar i vårdens övergångar, organisatoriska utmaningar och brister vid läkemedelsgenomgångar, bristande delaktighet och kunskap hos patienter vid läkemedelsgenomgångar. Underlättande faktorer vid läkemedelsgenomgångar: fördelar med samarbete vid läkemedelsgenomgångar samt fördelaktiga utfall och gynnsamma faktorer vid läkemedelsgenomgångar.   Konklusion: Förekomsten av utmaningar och fördelaktiga utfall vid läkemedelsgenomgångar bland sjuksköterskors erfarenheter belyser behovet av patientens delaktighet, kompetensutvecklingen hos sjuksköterskor och att utveckla riktlinjer och den organisatoriska strukturen kring arbetet med läkemedelsgenomgångar. Genom att studera sjuksköterskors bidragande roll vid läkemedelsgenomgångar kan sjuksköterskans roll i arbetet formaliseras. / Background: The number of people living with multimorbidity and polypharmacy increases in society. Drug-related health care misses and problems are common and the risk increases with polypharmacy. Medication reviews are important to facilitate safe drug use and to prevent medical errors. WHO describes medication reviews as a multiprofessional teamwork where response is shared between the professionals. Nurses are described to be able to have their own important role within the work of medication reviews.    Aim: The aim of this systematic literature review is to illustrate nurses experiences of performing medication reviews. Method: The study is a systematic literature review and is constructed of 16 qualitative scientific articles. Data collection was made through structured database searches in Cinahl, Pubmed and Web of Science. For the data analysis a thematic synthesis of Thomas and Harden was performed. To evaluate the confidence in the evidence CERQual was performed. Result: Two third level themes constitute the result with underlying second level themes. Barriers and deficits in medication reviews: resource shortages while performing medication reviews, lack of competence among nurses performing medication reviews, barriers within the interprofessional teamwork while performing medication reviews, barriers in medication reviews at care transitions, organizational barriers and deficits in medication reviews and lack of participation and knowledge in patintens while performing medication reviews. Facilitators in medication reviews: apportioning with teamwork in medication reviews and facilitating outcomes and factors of medication reviews.   Conclusion: The presence of challenges and beneficial outcomes in medication reviews among nurses' experiences highlights the need for patient involvement, the development of nurses' skills, and the development of guidelines and the organizational structure around the work of medication reviews. By studying the contributing role of nurses in medication reviews, the role of the nurse can be clarified and formalized.

<p>En ofullständig eller inaktuell dokumentation av läkemedel i Receptregistret och läkemedelslistorna kan leda till en sämre vetskap om vilka läkemedel som är aktuella att administrera samt till felmedicinering.</p><p>Syftet med denna studie är att hos patienter med diagnosen artros undersöka förekomsten av avvikelser mellan recept i Receptregistret på apotek, vårdcentralens läkemedelslista från ordinationsjournalen samt patienternas egen uppfattning om aktuell läkemedelsbehandling.</p><p>Studien genomfördes dels som registerstudie genom avstämning av journaldata på aktuella läkemedelsordinationer från Stensö Hälsocentral mot sparade recept i Receptregistret och dels som telefonintervju med patienterna om vilka recept som utgör hans/hennes aktuella ordinationer.</p><p>Av artrospatienternas recept i Receptregistret var 89 % aktuella och av artrospatiernas ordinationer i läkemedelslistorna på hälsocentralen var 69 % aktuella. Av alla artrospatienters ordinationer var det 52 % som var aktuella och som förekom i både Receptregistret och läkemedelslistorna.</p><p>Trots att studien är begränsad i storlek och att patienterna bara rekryterades från en vårdcentral indikerar resultaten att det finns betydande skillnader mellan artrospatienternas aktuella medicinering, deras läkemedelslistor på vårdcentral samt Receptregister från apotek. Genom att förbättra och göra regelbundna läkemedelsavstämningar efter ändringar i patientens läkemedelsbehandling, såväl på apotek som inom sjukvården, kan antalet avvikelser reduceras, följsamheten hos patienterna kan ökas genom att det blir lättare för dem att veta vilka läkemedel som är aktuella att administrera och medicineringsfel kan reduceras.</p> / <p>Misuse of drugs is a growing problem and a major cause of both morbidity and mortality in today's society. This may be a result of an incomplete or outdated medication history of patients and it is therefore important that all medical records are updated with the current drugs for the patient to use to prevent medication errors.</p><p>The ultimate effect of any drug therapy depends on the patient's decision to take their medicines as the doctor has prescribed, to have so-called adherence to their prescription medicines, which in turn depends in particular on the patient's knowledge of the drugs at issue. To assist the patient there are two kinds of printing, a list with the doctor’s prescriptions from the electronic patient record (EMR) and also a list from the national prescription repository (NPR) of all the saved prescriptions at pharmacies by the patient. Discrepancies may exist between what is documented in the patient's EMR and that in the pharmacy record, which both also may differ from the drugs that the patient actually is using. These discrepancies between the documents, which can both include valid and outdated prescriptions so as prescription duplicates, can cause a worsening of compliance and medication errors especially in patients with multiple drugs that may have difficult to keep track of their current drug treatment.</p><p>The aim of the study was compare the national prescription repository (NPR), the electronic medical records (EMR) and patient’s knowledge of the prescribed treatment for people with a diagnosis of osteoarthritis.</p><p>The study was conducted both as registry study by reconciliation of journal data on current drug prescriptions from a health centre (HCC) with saved recipes in the Swedish national prescription repository (NPR) and partly by telephone interview with patients about the prescriptions that represent his / her current prescriptions. The participation rate was 58 %. Twenty-nine patients with osteoarthritis were included in the study.</p><p>Of the osteoarthritis patients 89 % the recipes in the NPR were found to be valid and 11 % were outdated. Duplicates of recipes were estimated to 5 %, and double-medication occurred in 1 % of the recipes.</p><p>Of the patients' prescriptions in the medical records at the health centre 69 % were found to be valid. The outdated prescriptions were estimated to 31 % while 4 % was duplicates.</p><p>For all of the osteoarthritis patients' 247 drugs, only 52 % was valid and occurred both in the NPR and in the EMR.</p><p>There were major discrepancies between the prescriptions in the EMR, the NPR and what the patients with osteoarthritis are seeing as their current prescriptions. Through regular medical reconciliations after changes in the patients' treatment, in both health care and pharmacies, the discrepancies can be reduced, the patient can be surer of what to administrate and therefore medication errors can be reduced.</p>

En ofullständig eller inaktuell dokumentation av läkemedel i Receptregistret och läkemedelslistorna kan leda till en sämre vetskap om vilka läkemedel som är aktuella att administrera samt till felmedicinering. Syftet med denna studie är att hos patienter med diagnosen artros undersöka förekomsten av avvikelser mellan recept i Receptregistret på apotek, vårdcentralens läkemedelslista från ordinationsjournalen samt patienternas egen uppfattning om aktuell läkemedelsbehandling. Studien genomfördes dels som registerstudie genom avstämning av journaldata på aktuella läkemedelsordinationer från Stensö Hälsocentral mot sparade recept i Receptregistret och dels som telefonintervju med patienterna om vilka recept som utgör hans/hennes aktuella ordinationer. Av artrospatienternas recept i Receptregistret var 89 % aktuella och av artrospatiernas ordinationer i läkemedelslistorna på hälsocentralen var 69 % aktuella. Av alla artrospatienters ordinationer var det 52 % som var aktuella och som förekom i både Receptregistret och läkemedelslistorna. Trots att studien är begränsad i storlek och att patienterna bara rekryterades från en vårdcentral indikerar resultaten att det finns betydande skillnader mellan artrospatienternas aktuella medicinering, deras läkemedelslistor på vårdcentral samt Receptregister från apotek. Genom att förbättra och göra regelbundna läkemedelsavstämningar efter ändringar i patientens läkemedelsbehandling, såväl på apotek som inom sjukvården, kan antalet avvikelser reduceras, följsamheten hos patienterna kan ökas genom att det blir lättare för dem att veta vilka läkemedel som är aktuella att administrera och medicineringsfel kan reduceras. / Misuse of drugs is a growing problem and a major cause of both morbidity and mortality in today's society. This may be a result of an incomplete or outdated medication history of patients and it is therefore important that all medical records are updated with the current drugs for the patient to use to prevent medication errors. The ultimate effect of any drug therapy depends on the patient's decision to take their medicines as the doctor has prescribed, to have so-called adherence to their prescription medicines, which in turn depends in particular on the patient's knowledge of the drugs at issue. To assist the patient there are two kinds of printing, a list with the doctor’s prescriptions from the electronic patient record (EMR) and also a list from the national prescription repository (NPR) of all the saved prescriptions at pharmacies by the patient. Discrepancies may exist between what is documented in the patient's EMR and that in the pharmacy record, which both also may differ from the drugs that the patient actually is using. These discrepancies between the documents, which can both include valid and outdated prescriptions so as prescription duplicates, can cause a worsening of compliance and medication errors especially in patients with multiple drugs that may have difficult to keep track of their current drug treatment. The aim of the study was compare the national prescription repository (NPR), the electronic medical records (EMR) and patient’s knowledge of the prescribed treatment for people with a diagnosis of osteoarthritis. The study was conducted both as registry study by reconciliation of journal data on current drug prescriptions from a health centre (HCC) with saved recipes in the Swedish national prescription repository (NPR) and partly by telephone interview with patients about the prescriptions that represent his / her current prescriptions. The participation rate was 58 %. Twenty-nine patients with osteoarthritis were included in the study. Of the osteoarthritis patients 89 % the recipes in the NPR were found to be valid and 11 % were outdated. Duplicates of recipes were estimated to 5 %, and double-medication occurred in 1 % of the recipes. Of the patients' prescriptions in the medical records at the health centre 69 % were found to be valid. The outdated prescriptions were estimated to 31 % while 4 % was duplicates. For all of the osteoarthritis patients' 247 drugs, only 52 % was valid and occurred both in the NPR and in the EMR. There were major discrepancies between the prescriptions in the EMR, the NPR and what the patients with osteoarthritis are seeing as their current prescriptions. Through regular medical reconciliations after changes in the patients' treatment, in both health care and pharmacies, the discrepancies can be reduced, the patient can be surer of what to administrate and therefore medication errors can be reduced.

Background: Discrepancies in patient’s medication list can lead to medication errors which is a major cause of both morbidity and mortality today. The aim of the study was to examine the frequency of discrepancies in the Swedish prescription list “My saved prescriptions” regarding noncurrent treatment, incorrect dosages, double prescriptions, and missing prescriptions. Additionally, the purpose was to examine the type of source of information the patients used regarding their drug treatment.   Methods: Collection of data was conducted through interviews at three different pharmacies over a period of four weeks in Stockholm 2020. Patients 18 years or older with at least three prescribed drugs were asked to participate in the study.   Results: Of 157 patients, 74 patients were included. More than 70% of the patients had one or more discrepancies in their prescription list: a noncurrent, a duplicate or an incorrect dosage. 17.6% had at least one missing prescription. About half of the patients had a noncurrent prescription, which was the most common discrepancy among the patients. More than a third, 35.1%, of the patients used the prescription list as a source of information for their drug treatments. Furthermore, 31.1% of the patients used the drug packaging and 17.6% of them only used their memory. 10.8% of the patients used the medication list from healthcare.  Conclusions: The results suggest that discrepancies were quite common in the prescription list, which can increase the risk of medication errors for patients who use the prescription list as a source of information. The implementation of the Swedish National List (NLL) (launching in 2021) will provide the caregivers, pharmacies, and patients with access to the same information about patient’s prescribed drugs. NLL will hopefully reduce the risk of medication errors and it should lead to a reduced necessity of using several different sources for prescribed drugs.

Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm.  Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index.  Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases.  Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.

Impact on accuracy in elderly patients’ medication list, introducing pharmacy-led medical reconciliation at the Emergency department in a Swedish hospital. Background and objective: Discrepancies in patients‘ medication list is a well-known problem and contribute to preventable medication errors. Medication errors could increase morbidity and mortality and are cost-driving to the Health Care System. The primary objective was to investigate if a pharmacist-led medical reconciliation at the Emergency department could increase the accuracy in medication lists for patients at the age of 75 years and older, with five or more drugs in their initial medication list. The second objective was to categorize the discrepancies and the drugs causing them. Study design: Intervention study with retrospective control group. In the intervention group, patients received a medical reconciliation at the Emergency department. In conformity with the retrospective control group, the intervention group also received a medical reconciliation at the hospital ward. All medical reconciliations where pharmacy-led. Discrepancies identified at the medical reconciliation at the ward, were quantified and categorized. Drugs causing discrepancies were categorized by the ATC-index. Descriptive statistics, Chi2-tests and T-tests were performed.  Setting: The Emergency department at the hospital of Kristianstad, four wards at the larger emergency hospital in Kristianstad and two wards at the smaller local hospital in Hässleholm in Sweden Main outcome measures: Numbers of discrepancies in patients ‘medication list identified at medical reconciliation at hospital ward after having an initial medical reconciliation at the Emergency department (intervention) or not (control). Category of discrepancy and ATC-index of the substance causing the discrepancy. Results: In control group (n=65), 170 discrepancies were identified, on average 2,6 discrepancies/medication list. In intervention group (n=65), corresponding figures were 44 and 0,7 respectively. The difference between the groups was significant (p &lt;0,0001).  The main category of discrepancy was “commission of a medication” in the control group and “route of administration” in the intervention group. Paracetamol was the most common drug to cause discrepancies in the control group, zopiklon and furosemid in intervention group. Conclusion: Pharmacy-led medical reconciliation at the Emergency department significantly reduced the number of discrepancies in patients´medication list.

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced. / Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen