Medicine Reconciliation News Flash

Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation, October 2010

Tamasine C. Grimes, Catherine A. Duggan, Tim P. Delaney, Ian M. Graham, Kevin C. Conlon, Evelyn Deasy, Marie-Claire Jago-Byrne & Paul O’ Brien.

Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety.The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.

Lack of reconciliation of medications on discharge from acute public hospital in Ireland is frequent and can contribute to patient harm or unplanned re-admission. Opportunities to facilitate reconciliation include eliminating the need for transcription through use of computerization and prioritizing delivery of care to patients on an increasing number of medications or experiencing chronic illness. There is evidence to support the delivery of medication reconciliation at both admission and discharge.

Medicines reconciliation: a guide for the foundation year doctor, 2010 (1.29 MB)

Key points:

1. Medicines reconciliation is more than just the traditional drug history

2. For patient safety, it is important to have an accurate, up-to-date and reliable account of medicines being taken

3. Patient's should receive the correct drugs...

Medication Reconciliation During Internal Hospital Transfer and Impact of Computerized Prescriber Order Entry (December, 2010). J. Lee et al. (PDF 220 KB)

Medication errors are one of the leading causes of injury to patients in hospitals. Errors that result in adverse drug events (ADEs) in hospitals have been shown to be associated with 1 out of every 5 injuries or deaths. More than half of these errors occur when new medication orders are written at an interface of care: on admission to the hospital, upon transfer from one unit to another, or upon discharge home or to another facility. Despite the best efforts of health-care professionals, preventable unintentional medication errors often lead to interrupted or inappropriate drug therapy. The principal cause of these medication errors is incorrect or incomplete communication of information to the patient and among health-care providers. Studies have shown that medication reconciliation, a process of maintaining, comparing, and reviewing a current and accurate list of medications that a patient has received at home and/or during a hospital stay, can significantly reduce medication errors occurring at interfaces of care. However, suboptimal reconciliation on admission and discharge may account for 46% of all medication errors and up to 20% of ADEs.

News from IHI (PDF 123KB)

More Patients, Less Payment: Increasing Hospital Efficiency In The Aftermath Of The Health Reform (2011).

Research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care processes.

This article outlines a plan for hospitals to accommodate more patients without increasing beds or staff, and for policy makers to require hospitals to make these changes or provide incentives for them to do so.

Medication Incidents Occurring in Long-Term Care

ISMP Canada Safety Bulletin, December 10, 2010 (PDF 52.2 KB)

The bulletin includes an overview of the medication incidents that had an outcome of harm or death and highlights the major themes identified through an aggregate analysis. Specific examples of the reported incidents are summarized to provide insights into opportunities for system-based improvement.

"To gain a deeper understanding of medication incidents occurring in the long-term care environment, data were extracted from voluntary reports submitted to ISMP Canada’s medication incident database.....Incorrect dose, dose omission, incorrect drug, and administration of one or more medications to the wrong patient accounted for almost 85% of the harmful incidents reported. Analysis revealed that 116 (88.5%) of the 131 incidents were associated with an outcome of harm and 11 (11.5%) with an outcome of death. Administration of an incorrect dose was the single most common type of incident, followed by dose omission, administration of the incorrect drug, and administration of a medication to the incorrect patient".

Legality of technicians’ involvement in medication reconciliation not clear, Cheryl A. Thompson

Am J Health-Syst Pharm—Vol 66 Mar 1, 2009 (PDF)

"Having pharmacy technicians in hospitals help with the medication reconciliation process is an idea that is gradually gaining supporters. Whether state boards of pharmacy consider this participation legal seems to depend on exactly what the technicians are doing....

Value of Medication Reconciliation in Reducing Medication Errors on Admission to Hospital, Susan E McLeod, Elaine Lum, Charles Mitchell

Journal of Pharmacy Practice and Research Volume 38, No. 3, 2008. (PDF)

Results: Medication history taking errors occur during transition points such as admission, transfer and discharge to hospital. The cited studies reviewing medication history errors are qualitative, study different population groups, use different methods to obtain medication history and do not always rate the clinical importance of the error. These limitations account for the range of medication history errors found in the cited studies (27–65%). Medication errors and subsequent adverse drug events are detected and reduced by a standardised process of reconciliation. Numerous large scale hospital initiatives in the US have outlined the implementation of a reconciliation process and the subsequent reduction in medication errors, adverse drug events and resultant economic benefits. Strategies for improving the medication reconciliation process include the use of a standardised form, improved communication, multidisciplinary approach, use of computerised physician or prescriber order entry with decision support and home medication lists.

Conclusion: Obtaining a detailed medication history and performing medication reconciliation reduces the incidence of medication errors and subsequent adverse drug events.

Results of the Medications At Transitions and Clinical Handoffs (MATCH) Study: An Analysis of Medication Reconciliation Errors and Risk Factors at Hospital Admission

FEB 2010 PDF

RESULTS: Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient’s age≥65 [odds ratio (OR), 2.17; 95% confidenceinterval (CI), 1.09–4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14–1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19–0.63) or bottles (OR, 0.55; 95% CI, 0.27–1.10) at admission was beneficial.

CONCLUSION: Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.

Medication reconciliation involves highly complex processes and is hampered by the disjointed nature of the American health care system. It is, however, a vital part of reducing2010 Society of Hospital Medicine ADE. If employed more broadly, it has the added benefits of enhancing communication among all providers of care and engaging patients and families/caregivers more consistently and meaningfully in their overall care. Despite the difficulty of maintaining an accurate medication record in real time across disparate settings, reconciliation is a goal to which our organizations are committed.

Given the wide range of healthcare organizations involved in providing medications to patients and the many agencies evaluating those efforts, we believed it would be helpful to provide an overarching set of goals to move medication reconciliation forward.

Our main message is this: ‘‘Patient safety and patient/family-centered care must be the principal drivers in the development and implementation of medication reconciliation systems.’’ Ultimately this process is about ensuring that patients are receiving the most appropriate medications no matter where they are treated. With this document, we hope to bring to light the importance of creating and implementing a medication reconciliation program, addressing some barriers to success, and identifying potential solutions that will ensure utility and sustainability of this critical patient safety issue.

The Scottish Patient Safety Programme (SPSP) requires improvement to medicine reconciliation as a national priority. Poor reconciliation is associated with medication errors and either potential or actual harm to patients. Medicine reconciliation should occur within 24 hours of hospital admission. Pharmacist involvement should occur as soon as possible after admission.