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Impact of integrated medication management program on medication errors in a medical center: an interrupted time
Kuan-Lin Chen1,2, Chih-Fen Hunag2,3, Wang-Huei Sheng4
1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Background:
Medication errors (MEs) are harmful to patients during hospitalization, especially elderly patients. To reduce MEs, an integrated medication management (IMM) model was developed in a 2500-bed medical center, allowing a clinical pharmacist to participate in the daily ward round and perform medication reconciliation and medication reviews. This study aimed to evaluate the impact of the IMM model on MEs and medication utilization using a quasi-experimental design.
Methods:
We conducted an interrupted time-series study using the aggregated data of monthly admissions from two wards of a medical center, where one ward served as the intervention and the other served as the external control. The pre- and post-intervention phases comprised of 40 and 12 monthly observational units, respectively. The primary outcome was the mean number of ME reports, which were further investigated for different ME types. The mean number of daily inpatient prescriptions, mean number of daily self-prepared medications, and median daily medication costs were measured. All outcomes were measured per admission episode. Segmented regression was used to evaluate the level and slope changes in the outcomes after IMM model implementation, and subgroup analyses were performed to examine the effects on different groups.
Results:
After IMM model implementation, the mean number of ME reports increased (level change: 1.02, 95% confidence interval [CI]: 0.68 to 1.35, P < 0.001). The number of reports has shown a dramatic increase in omissions or medication discrepancies, inappropriate drug choices, and inappropriate routes or formulations. Furthermore, the mean number of daily inpatient prescriptions was reduced for patients aged ≥75 years (level change: -1.78, 95% CI: -3.06 to -0.50, P = 0.009). No significant level or slope change was observed in the control ward during the post-intervention phase.
Conclusions:
The IMM model improved patient safety and optimized medication utilization by increasing the reporting of MEs and decreasing the number of medications used.
Insights
The integrated medication management (IMM) model increased medication error reporting and reduced prescriptions for elderly patients, enhancing patient safety and optimizing medication use.
Area of Science:
- Pharmacoeconomics
- Patient Safety
- Health Services Research
Background:
- Medication errors (MEs) pose significant risks to hospitalized patients, particularly the elderly.
- An integrated medication management (IMM) model was implemented to mitigate MEs.
- The IMM model involves clinical pharmacists in daily ward rounds for medication reconciliation and reviews.
Purpose of the Study:
- To evaluate the impact of the IMM model on medication errors.
- To assess the effect of the IMM model on medication utilization.
- To analyze changes using a quasi-experimental design.
Main Methods:
- An interrupted time-series study design was employed.
- Data from two hospital wards (intervention and control) were analyzed over pre- and post-intervention phases (40 and 12 months).
- Segmented regression analysis assessed changes in ME reports, inpatient prescriptions, self-prepared medications, and medication costs.
Main Results:
- The IMM model led to a significant increase in ME reports (level change: 1.02, P < 0.001).
- Increases in ME reports were noted for omissions, discrepancies, inappropriate drug choices, and routes/formulations.
- A significant reduction in daily inpatient prescriptions was observed for patients aged ≥75 years (level change: -1.78, P = 0.009).
Conclusions:
- The IMM model enhances patient safety by increasing the reporting of medication errors.
- The IMM model optimizes medication utilization, particularly in elderly patients.
- Increased ME reporting signifies improved detection and management of potential patient safety issues.
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