Medication reconciliation

Patients, in particular the elderly, are moved between different settings in the health care system. Medicines are involved in most of the stages of the journey. This includes home to hospital, home to care home or hospice, home to day centre, hospital to home, hospital to care home or hospice, ward to ward in hospital, hospital to hospital, care home to home, care home to care home. Especially on admission to, and discharge from, hospital there are several factors that can lead to errors. 

Experience from hundreds of organisations has shown that poor communication of medical information at transition points is responsible for as many as 50% of all medication errors in the hospital and up to 20% of adverse drug events (IHI MedReconcilliation 2008). In our different settings at a university and county hospitals, we had errors in 40-85% of the elderly patients before starting a new practice. 

Each time a patient moves from one setting to another, clinicians should compare previous medication orders with new orders and plans for care and reconcile any differences. If this process does not occur in a standardised manner designed to ensure complete reconciliation, medication errors may lead to adverse events and harm (IHI MedReconcilliation 2008). Several national organisations round the world have now produced help to reduce errors with medication reconciliation. Some examples are given below. 

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Risk Medication, Medication Review, Medication Reconciliation, Adverse Drug Events, Trigger tools. 

Prevent Adverse Drug Events (ADEs)... by implementing medication reconciliation... 

Keywords Pharmaceutical care Medicines management Medication reconciliation Medication review Information technology Personalised... 

Examples of guidance on medication and elderly are Medication reconciliation, and also Medication concordance. 

IHI has produced a full package for improvement with tool kits, follow up measures on all aspects on Medication Reconciliation. Based on different strategies and settings they also report an error rate reduction of at least 50% (IHI MedReconcilliation 2008)... 

The professional and team approach should be targeted in the same direction and appropriate systematic approaches such as trigger tools, medication- reconciliation and review should be used... 

Compliance incl. communication ), medication reconciliation (10), calculating benefits and risks (3)... 

Schnipper, J.L., Hamann, C., Ndumele, C.D. et al. (2009) Effect of an electronic medication reconciliation apphcation and process redesign on potential adverse drug events a cluster-randomized trial. Archives of Internal Medicine, 169(8), 771-780. 

Because there was no objective standard against which to measure error, the team created a tool for data collection the medication reconciliation form. This tool provided a means for evaluating the extent to which medication discrepancies or gaps in information were present in a patient s discharge orders at the time of the patient s discharge and transfer. The team reduced the amount of work involved in reviewing... 

The medication reconciliation tool was then pilot-tested and revised. On the basis of its findings, changes were made, and this tool was incorporated into the ICU discharge process. As all nurses became trained and engaged in the reconciliation of medications at the time of a patient s discharge and transfer, the form was further revised. 

A 2012 systematic review of inpatient medication reconciliation studies did find some evidence supporting pharmacist-led medication reconciliation processes. However, the study did not reach any firm conclusions regarding the most effective strategies. 

Why is medication reconciliation an important aspect of patient safety efforts ... 

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation, based on the MATCH website, incorporates the experiences and lessons learned by healthcare facilities that have implanented MATCH strategies to improve their medication reconciliation processes for patients as they move through healthcare settings (AHRQ Publication No. ll(12)-0059). 

Cutler, T.W. Medication reconciliation victory after an avoidable error. WebM M, February/March 2009. 

Kwan, J., Lo, L., Sampson, M., and Shojania, K. Medication reconciliation during transitions of care as a patient safety strategy A systematic review. Annals of Internal Medicine 158(5 Pt. 2) 397 03, 2013. 

Medication Reconciliation Handbook. Oakbrook Terrace, IL Joint Commission Resources and the American Society of Health-System Pharmacists, 2006. 

Poon, E. Medication reconciliation Whose job is it WebM M, September 2007. 

Weber, R. Medication reconciliation pitfalls. WebM M, February 2010. 

A 60-year-old woman is admitted to the hospital for treatment of hypercalcemia. During the medication reconciliation process, the patient states that she is taking the medications listed below. Which one of these medications is most significant to the patient s diagnosis of hypercalcemia ... 

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