Medication reconciliation is commonly defined as the process by which a patient’s existing and previous medication lists are compared. This assessment is performed at admission and discharge, as well as when the patient moves from one level of care to another (transfer). Such a review is important to ensure favorable patient outcomes and risk mitigation of medication errors.
While the Joint Commission revised its national patient safety goal on reconciling medication information (previously NPSG 8, now NPSG 03.06.01, effective July 2011) and made it less prescriptive, implementation of medication reconciliation remains to be a challenge because of the complexity of this multifactorial process. Most commonly, lack of standardization in medication history taking and documentation, resulting in break-down of communication amongst healthcare providers (HCPs), are barriers to successful medication reconciliation.
In March 2012, the American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) collaboratively published a white paper1 providing guidance on optimization of medication reconciliation to improve care transitions. Recommendations from ASHP and APhA are highlighted through eight foundational concepts emphasizing the importance of pharmacists’ involvement in the medication reconciliation process and their interdisciplinary collaboration with other HCPs. They refer to a patient-centered process that is standardized and based on a culture of accountability and coordinated communication. Once the practice is well-established, it is crucial to regularly assess and monitor outcomes for continuous quality improvement. Integration of health information systems is also perceived as a way to reinforce appropriate medication documentation and information transfer across all HCPs involved in the patient’s care.
A study by Gleason et al.2 was conducted to identify risk factors and potential patient harm resulting from medication reconciliation errors. Interestingly, one-third of patients had a medication error at time of hospital admission, whereby 85% of those stemmed from inaccurate medication histories, half of which were omissions. Additionally, the geriatric population [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09 – 4.30] and the number of prescription medications (OR, 1.21; 95% CI, 1.14 – 1.29) were significantly associated with harmful errors requiring monitoring.
Vawdrey et al.3 assessed the effect of a fully electronic medication reconciliation process at hospital admission, which relied on an electronic health record and introduction of a “hardstop” alert for documentation of the patient’s medication list. An evaluation was conducted showing that before implementation of such an alert, the average number of medications entered on the medication list upon admission was less than 2. Post-adoption, the average number went up to 4.7, with regular updates being made to the list.
Although reliable systems, efficient workflows supported by integrated technologies and collaborative efforts of healthcare professionals are important to ensure accurate medication reconciliation, stress needs to be made that the process is to be patient-centered. Partnership with our patients is important to empower them to be proactively involved in their plan of care, specifically in obtaining an accurate medical problem and medication lists. Medication reconciliation is in fact ...