The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review

Figures & data

Table 1 Results of Different Phases of the Search Process

Database	Total in Each Database	Selection Based on Title Reading	Selection Based on Abstract Reading	Selection Based on Full-Text Reading/Appraisal
CINAHL	1012	14	4	2
PubMed [including Medline]	2283	13	4	3
Scopus	570	6	2	1
Web of Science	172	11	4	4
Manual search/backtracking references	0	0	0	0
Total of databases	4037	44	14	10

Figure 1 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Note: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. Available from: http://prisma-statement.org/PRISMAStatement/FlowDiagram.aspx. The PRISMA Statement distributed under the terms of the Creative Commons Attribution License.⁶⁵

Table 2 Characteristics of the Studies Selected for Data Analysis and Synthesis

Authors, Year, Country	Aim	Method/Full-Text Appraisal Score	Sample and Setting	The Role of the Nurse in Medicines Management During Transitional Care	Main Finding
Vogelsmeier, 2014, USA^Citation45	To explore the perceptions of leaders and staff nurses of nursing homes concerning the process of medication reconciliation, with a focus on recognizing the medication order discrepancies	Qualitative/17 out of 21	18 leaders, 13 registered nurses, and 28 licensed practical nurses in 8 mid-western nursing homes	Primary role in medication reconciliations and a main role in identifying discrepancies in the medication order	Nursing home physicians rely on nurses to know about medicines; active vs passive information seeking in medication history and diagnosis of discrepancies; making sense of medication orders to recognize discrepancies
Chan et al, 2015, Canada^Citation46	To compare the completeness and accuracy of best possible medication histories and reconciliation performed by a pharmacy technician (pilot study) and by nurses and/or pharmacists (baseline)	Prospective cohort comparison/25 out of 34	84 patients up to 18 years admitted to and/or transferred between the cardiac critical care unit and cardiology unit of a paediatric tertiary care teaching hospital	Transfer of medication reconciliation through obtaining best possible medication histories	No differences between the nurse and/or pharmacist and pharmacy technician in terms of the completion of best possible medication histories or completion of reconciliation within 24h of admission; transfer reconciliation completeness was higher in the pharmacy technician than nurse and/or pharmacist
Manias et al, 2015, Australia^Citation48	To explore how healthcare providers, patients, and their family members communicate about managing medicines across transitional care points	Qualitative/18 out of 21	10 patients, 10 family members, 27 nurses, 15 pharmacists and 11 physicians from two public hospitals	Clarifying medicines’ concerns and patients' clinical parameters with doctors; nurses situated in the nursing home organize medicines' changes with a phone call to a general practitioner in the hospital when a patient transfers to the nursing home; performing interpersonal communication with patients and interdisciplinary communication was crucial for medicines management	Major themes: contextual environment of care, competing responsibilities of care, awareness of responsibility for safety, and interprofessional communication
Lovelace et al, 2016, USA^Citation40	To investigate the impact of the McGuire veterans administration medical centre transitional care program on veteran emergency department and hospital utilization and costs	Retrospective review of medical records/24 out of 34	346 veterans from the Richmond, VA Hunter Holmes McGuire VAMC as a 399-bed facility	An initial assessment including an extensive medication review, collaboration with the pharmacist to provide an accurate discharge medication chart, making medication adjustments and order medications' renewals	Veterans who received transitional care program services had a 67% reduction in hospital admissions and a 61% reduction in emergency department visits in the 90 days after participation in the program
Reidt et al, 2016, USA^Citation43	To describe the interprofessional collaborative practice model and compare the outcomes of participants who received care based on the model and those individuals who received routine care from the geriatrician and nurse practitioner in transition from the skilled nursing facility to home	Experimental/24 out of 37	87 participants in the intervention group received care based on the model, and 189 individuals in the comparison group received routine care at a non-profit skilled nursing facility with 60 transitional care unit beds	Provision of consultation to the pharmacist when unexplained changes occurred in the effectiveness of and safety of all prescriptions, collaborating with the pharmacist to determine the discharge medication regimen, and recommending items to the pharmacist to address at follow-ups	There was no difference in hospitalizations 30 days after discharge from the skilled nursing facility; participants receiving the intervention according to the model had a lower risk of emergency department visits
Al-Hashar et al, 2017, Oman^Citation47	To investigate beliefs, responsibilities and perceived roles of nurses, pharmacists and physicians about the medication reconciliation process	Survey/18 out of 32	143 physicians, 47 pharmacists and assistant pharmacists and 274 nurses from a university tertiary care hospital with 450 beds	Nurses had a joint role with physicians and pharmacists in medication reconciliation in transitional care	A lack of clearness of current practices of medication reconciliation and a lack of agreement about other providers' role in medication reconciliation between the three healthcare professions
Chhabra et al, 2019, USA^Citation39	To compare time spent by nurses and pharmacists according to the location of a medication-focused interview	Prospective, unblinded, cohort observational/26 out of 34	72 patients were randomized based on the location of pharmacist to be interviewed in the emergency department or on the floor in a 435-bed community hospital	Collecting medication history and performing medication reconciliation with admitting physicians	Pharmacists and nurses spent a mean of 10 minutes less per patient in the emergency department than patients on the medical floor for collecting medication history. The discrepancy in the transcript was found by the rate of 1 in 4 medications
Otsuka et al, 2019, USA^Citation41	To examine the effect of an interprofessional transition of care facility on 30-day hospital reutilization	Retrospective cohort/28 out of 34	660 patients were in the interprofessional post-acute care clinic as in the intervention group and the comparison group from two outpatient clinics within an academic medical centre.	Performing the follow-up phone call to the patient or caregiver to begin the process of medication reconciliation by determining if patients were capable to fill their new prescriptions	30-day hospital readmission was lower in the intervention group, but for emergency department visits no difference between the groups was found
Tjia et al, 2019, USA^Citation44	To identify nurses' viewpoints about their role in hospice family caregivers' medication management	Secondary qualitative analysis/15 out of 21	6 home hospice nurses, 3 inpatient hospice nurses, and 1 medical home nurse coordinator for primary care from three hospice agencies and their referring hospital systems	Performing medication review as the key component of medication support and deprescribing process, providing education to increase medication knowledge to family caregivers, simplifying medication regimens as support to patient and family caregivers	Education, skill-building, support and counselling for family caregivers; need to an intervention to standardize patient-cantered medication review
Prusaczyk et al, 2020, USA^Citation42	To discover the transitional care measures provided to older adults with and without dementia	Mixed methods/5 out of 6	9 healthcare providers in the qualitative phase and reviewing 126 patients with dementia and 84 without dementia from an urban, large academic medical centre with 9000 employees	Primary provision of education about medications, medication safety and being highly involved in medication reconciliation and medication review	Healthcare providers at the hospital had distinguished roles in the provision of transitional care to patients with different roles for patients with and without dementia

Figure 2 The nurse role in medicines management of transitional care.

Moher D, Liberati A, Tetzlaff J, Altman DC, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097

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Chan C, Woo R, Seto W, Pong S, Gilhooly T, Russell J. Medication reconciliation in pediatric cardiology performed by a pharmacy technician: a prospective cohort comparison study. Can J Hosp Pharm. 2015;68(1):8–15.

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Manias E, Gerdtz M, Williams A, Dooley M. Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards. J Clin Nurs. 2015;24(1–2):69–80. doi:10.1111/jocn.12685

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Reidt SL, Holtan HS, Larson TA, et al. Interprofessional collaboration to improve discharge from skilled nursing facility to home: preliminary data on postdischarge hospitalizations and emergency department visits. J Am Geriatr Soc. 2016;64(9):1895–1899. doi:10.1111/jgs.14258

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Al-Hashar A, Al-Zakwani I, Eriksson T, Al Za’abi M. Whose responsibility is medication reconciliation: physicians, pharmacists or nurses? A survey in an academic tertiary care hospital. Saudi Pharm J. 2017;25(1):52–58. doi:10.1016/j.jsps.2015.06.012

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Chhabra A, Quinn A, Ries A. Evaluation of time spent by pharmacists and nurses based on the location of pharmacist involvement in medication history collection. J Pharm Pract. 2019;32(4):394–398. doi:10.1177/0897190017753783

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Otsuka S, Smith JN, Pontiggia L, Patel RV, Day SC, Grande DT. Impact of an interprofessional transition of care service on 30-day hospital reutilizations. J Interprof Care. 2019;33(1):32–37. doi:10.1080/13561820.2018.1513466

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Tjia J, DeSanto-Madeya S, Mazor KM, et al. Nurses’ perspectives on family caregiver medication management support and deprescribing. J Hosp Palliat Nurs. 2019;21(4):312–318. doi:10.1097/NJH.0000000000000574

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