Medication Reconciliation: Doing What's Right for Safe Patient Care (original) (raw)
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Medication Reconciliation: Abeneficial tool in patient safety
Bharati Vidyapeeth Medical Journal
This is a narrative review developed after referring to 20 original research papers, two review articles, and the latest WHO guide related to the concept of medication reconciliation. Medication reconciliation plays an important role in reducing medication errors. Various errors happen while prescribing drugs to patients, leading to discrepancies such as the omission of drugs from medication orders, incorrect dosage, and frequency of administration of the drug. All these incidences can affect patients' health and have the potential for adverse drug events. By reconciling medications at admission, transfer, and discharge, it has been observed that a lot of discrepancies have been resolved, and adverse drug events have been prevented, thus securing proper treatment outcomes and enhanced patient safety. Documenting drugs that the patient has already been taking and prescribing drugs for the current condition in accordance with past ones is the basic outline of medication reconcilia...
Medication reconciliation: a practical tool to reduce the risk of medication errors
Journal of Critical Care, 2003
Preventable adverse drug events are associated with one out of five injuries or deaths. Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. This study was performed to reduce medication errors in patient's discharge orders through a reconciliation process in an adult surgical intensive care unit (ICU). A discharge survey was implemented as part of the medication reconciliation process. The admitting nurse initiated the survey within 24 hours of ICU admission and the charge nurse completed the survey on discharge. Baseline data were obtained through a random sampling of 10% of discharges in first 2 weeks of the study (July 2001-May 2002). Medical and anesthesia records were reviewed, allergies and home medications verified with patient/family and findings compared with orders at time of ICU discharge. Baseline data revealed that 31 of 33 (94%) patients had orders changed. By week 24, nearly all medication errors in discharge orders were eliminated. In conclusion, use of the discharge survey in this medication reconciliation process resulted in a dramatic drop in medications errors for patients discharged from an ICU. The survey is now a part of our electronic medical record and used in 4 adult ICUs and 2 medicine floors.
Medication reconciliation is an essential role for the pharmacist
SA Pharmaceutical Journal, 2016
Adverse drug events (ADEs) have been found to be a major cause of morbidity and mortality in healthcare systems around the world. More than 50% of ADEs are preventable, and have been demonstrated to be the result of an incomplete medication history, prescribing or dispensing error, and the over- or underuse of prescribed pharmacotherapy. The main aim of implementing medication reconciliation in a hospital setting is to avoid ADEs, a prevalent patient safety issue. Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking, including drug name, dosage, frequency and route, and then comparing that list against the admission, transfer, and/or discharge orders. Medication reconciliation is one of World Health Organization’s High 5s initiative to improve patient safety. The implementation of the International Standard Operating Procedure for Medication Reconciliation led to a 50% reduction in medication discrepancies in dev...
ASHP Statement on the Pharmacist’s Role in Medication Reconciliation
American Journal of Health-System Pharmacy, 2013
The American Society of Health-System Pharmacists (ASHP) believes that an effective process for medication reconciliation reduces medication errors and supports safe medication use by patients. ASHP encourages hospitals and health systems, including community-based providers and managed care systems, to collaborate in organized, multidisciplinary medication reconciliation programs to promote continuity of patient care. ASHP further believes that pharmacists, because of their distinct knowledge, skills, and abilities, are uniquely qualified to lead interdisciplinary efforts to establish and maintain an effective medication reconciliation process in hospitals and across health systems. Pharmacists should lead or assume key roles in the following essential components of medication reconciliation: developing policies and procedures, implementing and continuously improving medication reconciliation processes, training and assuring the continuing competency of those involved in medication reconciliation, providing operational and therapeutic expertise in the development of information systems that support medication reconciliation, and advocating for medication reconciliation programs in the community. Pursuant to their leadership role, pharmacists share accountability with other hospital and health-system leaders for the ongoing success of medication reconciliation processes across the continuum of care.
Medication reconciliation in the emergency department
American Journal of Health-System Pharmacy, 2008
Patients are at risk of having their medication histories inaccurately documented while being admitted to an emergency department (ED). Allowing a pharmacist to access patient medication history is an effective way of reducing the number of errors. We sought to determine if having a pharmacist (as opposed to the admitting clinical team) verify patients' medication histories would result in fewer discrepancies in inpatient medication regimens. We performed a prospective cohort comparison study of adult ED patients admitted to general medicine floors for continuing care. In the intervention group, pharmacists in the ED performed a brief inquiry into the patients' medication history, a process called medication reconciliation. In the control group, the admitting clinical team conducted the medication reconciliation. Both groups received a second reconciliation by a trained pharmacy team and all discrepancies were recorded. Our cohort had 172 intervention and 172 control subjects. In the control group, 561 medication discrepancies were recorded while no medication discrepancies were observed in the intervention group. Having pharmacists consult with patients in the ED about their medication histories led to fewer discrepancies than when admitting clinical teams performed the same inquiry.
Improving Medication Reconciliation in the 21st Century
Current Drug Safety, 2008
Approximately 7000 deaths occur yearly in the United States as a result of medication errors, and 1.5 million people are harmed by adverse drug events at a cost of $3.5 billion per year. Computerized order entry has been shown to decrease the number of medication errors by 55% to 80 % in the hospital. This has led many to advocate the use of electronic medical records in both the inpatient and outpatient setting. However, there is little evidence at present that electronic medical records reduce adverse drug events in the outpatient setting. This may be largely due to the quality of medication lists in the medical record: Among complicated patients, complete agreement between the medication list and what the patient is actually taking occurs in only 5% of patients. Unless there is improved medication reconciliation, it will be difficult to realize the potential safety benefits of information technology. An accurate medication list requires a healthcare team dedicated to obtaining and maintaining this information.
European Journal of Clinical Pharmacology, 2014
Purpose To study differences in outcomes of medication reconciliation (MR) when performed by clinical pharmacists compared to nurses. Methods 201 patients (21-92 years) admitted to the Department of Cardiology at the University Hospital of North Norway, autumn 2012, were randomized into a pharmacist group (PG) and a nurse group (NG). The nurses and the pharmacists were trained for performing the MR process by an independent clinical pharmacist. Medication discrepancies (MDs) were discussed with the physicians. Time spent during the MR was recorded. An independent expert group rated clinical relevance of the MDs retrospectively. Results At least one MD was identified in 78 % and 84 % of patients in PG and NG, respectively (P=0.269) with a mean number of MDs per patient 3.1 (SD 2.1) and 2.8 (SD 2.2), respectively (P=0.528). Mean time spent/patient on the MR process was 22.9 min (SD 11.6) in the PG and 32.2 min (SD 20.3) in the NG (P<0,001). Physicians agreed significantly more often to act upon the MDs presented by pharmacists compared to nurses (P=0.001). The expert group finally assessed 48 % and 49 % of the MDs to be of the clinical relevance in the PG and the NG, respectively. Conclusions By applying a structured method for MR, a small however not statistically significant difference in identified MDs between nurses and clinical pharmacists was revealed. The pharmacists spent significantly less time than the nurses, and physicians agreed significantly more often with the pharmacist that action should be taken on the MDs. This is important in the discussion of who to perform MR.
Implementation of a medication reconciliation process in an ambulatory internal medicine clinic
Quality and Safety in Health Care, 2007
To evaluate the causes of medication list inaccuracy, implement intervention to enhance overall accuracy of medication lists and measure the sustainability of the intervention. Methods: A prospective study of patients seen in an academic, ambulatory primary care internal medicine clinic. Before the intervention, baseline data were analysed, assessing completeness of medication documentation in the electronic medical record. The intervention consisted of standardising the entire visit process from scheduling of the appointment to signing of the final clinical note by the physician. Each healthcare team member was instructed in her role to enhance accuracy of the documented medication list. Immediately after the intervention, a second data collection was undertaken to assess the effectiveness of the intervention on the accuracy of individual medications and medication lists. Finally, a year later, a third data collection was undertaken to assess the sustainability of the intervention. Results: Completeness of individual medications improved from 9.7% to 70.7% (p,0.001). However, completeness of the entire medication lists improved only from 7.7% to 18.5%. The incomplete documentation of medication lists was mostly due to lack of route (85.8%) and frequency (22.3%) for individual medications within a medication list. Also, documentation of over-the-counter and ''as needed'' medications was often incomplete. The incorrectness in a medication list was mostly due to misreporting of medications by patients or failure of clinicians to update the medication list when changes were made. Conclusion: To improve the accuracy of medication lists, active participation of all members of the healthcare team and the patient is needed.