Medication reconciliation

From HMCwiki

Medication reconciliation consists of creating a complete list of a patient's current medications, including herbal supplements and vitamins, and reconciling them with new medication orders to ensure that no duplications, adverse interactions, incorrect dosages or omissions occur. The Institute for Healthcare Improvement says that "Experience from hundreds of organizations has shown that poor communication of medical information at transition points is responsible for as many as 50 percent of all medication errors in the hospital and up to 20 percent of adverse drug events (ADEs)."

New Language for the Patient Safety Goal for 2007:

"Finally, new language in one of the two Requirements under the existing medication reconciliation Goal stipulates that a complete list of current medications be provided to the patient on discharge from care."^[1]

Steps for medication reconciliation from the Massachusetts Coalition

• Collect a complete list of current medications* (including dose and frequency along with other key information) for each patient on admission. (WHO, at WHAT POINT?)
• Validate the home medication list with the patient (whenever possible).
• Assign primary responsibility for collecting the home list to someone with sufficient expertise, within a context of shared accountability.
• Use the home medication list when writing orders.
• Place the reconciling form in a consistent, highly visible location within the patient chart (easily accessible by clinicians writing orders).
• Assign responsibility for comparing admission orders to the home medication list, identifying discrepancies, and reconciling variances to someone with sufficient expertise.
• Reconcile medications within specified time frames (within 24 hours of admission; shorter time frames for high-risk drugs, potentially serious dosage variances, and/or upcoming administration times).
• Adopt a standardized form to use for collecting the home medication list and for reconciling the variances (includes both electronic and paper-based forms).
• Develop clear policies and procedures for each step in the reconciliation process.
• Provide access to drug information and pharmacist advice at each step in the reconciliation process.

Joint Commission recommendations

• Placing the medication list in a highly visible location in the patient's chart and including dosage, drug schedules, immunizations, and allergies or drug intolerances on the list.
• Creating a process for reconciling medications at all interfaces of care (admission, transfer, discharge) and determining reasonable time frames for reconciling medications. Patients, and responsible physicians, nurses and pharmacists should be involved in the medication reconciliation process.
• On discharge from the facility, in addition to communicating an updated list to the next provider of care, provide the patient with the complete list of medications* that he or she will be taking after discharge from the facility, as well as instructions on how and how long to continue taking any newly prescribed medications. Encourage the patient to carry the list with him or her and to share the list with any providers of care, including primary care and specialist physicians, nurses, pharmacists and other caregivers.

Resources for medication reconciliation

There are several excellent resources for information regarding Medication Reconciliation including JCAHO, IHI, and the Massachusetts Coalition for the Prevention of Medical Errors.

Tools for medication reconciliation

The majority of the tools came from the Massachusetts Coalition for the Prevention of Medical Errors - the links lead directly to their website. Examples of forms for Med Rec

Patient Medication Card

What hospitals are doing to improve

• Make the same medication reconciliation form used in the medical records available on your website, and educate the public about filling out the form and keeping it with their identifying information.
• Having brightly colored medication lists that stand out from other information in a medical record.
• Surveyors are very interested in the hand-off of information from the ED to other units as part of the Tracer methodology. When a patient is sent to another unit for a procedure it is vital that the hospital must effectively receive this information (endoscopies, radiology, catherizations, bronchoscopies, etc.).
• In general, surveyors realize what a huge challenge Med Reconciliation is, and are favorably impressed by improvements over past processes, even if perfection is not yet achieved.

References and resources

^  Joint Commission, Joint Commission Announces 2007 National Patient Safety Goals, June 12, 2006

Related links

A small hospital's experiences with JCAHO
A medium hospital's experiences with JCAHO
A large hospital's experiences with JCAHO
Coping with JCAHO changes
JCAHO (definition)
JCAHO surveys by department
Pharmacy experiences with JCAHO
Preparing for an unannounced JCAHO survey
Preparing your staff for JCAHO
Unannounced Surveys for Hospitals Teleconference
Rehabilitation Services experiences with JCAHO
The morning of the survey

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