Avoiding a Med-Wreck: a structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources

Abstract

Background The incidence of preventable adverse drug events (ADE) is approximately one medication error per patient per hospital-day. A quality medication reconciliation (MedRec) process is a crucial intervention used to reduce ADE in the hospital and community setting. Amid the coronavirus disease 2019 (COVID-19) pandemic, preventing medication errors is vital to avoid patient readmission, reduce disease complications, and reduce cost and patient burden on the healthcare system. Objectives To develop a standardized MedRec framework that can be implemented in all healthcare settings to reduce patient and staff harm during COVID-19. Also, to create a standardized auditing tool used to assess the quality of the MedRec process and allow for continuous quality improvement. Methods A multi-site gap analysis (MGA) was performed to collect observational data that were collected from four different healthcare sites (two hospitals, a long-term care facility, and a community pharmacy). MGA consists of collecting data across several sites which answer a standardized questionnaire. A standardized MedRec framework and auditing tool were developed based on the gaps observed in each site and literature reviews. Results A standardized MedRec process was not implemented in any of the observed sites. The healthcare sites lacked a designated MedRec team and training related to the MedRec process leading to multiple discrepancies at discharge. Patients were not counselled on changes to home medications, and a discharge report was often not provided upon discharge. Communication mechanisms between community pharmacies and hospital physicians are not available or easily accessible. Conclusion The proposed structured MedRec framework is vital to reduce medication errors and patient harm amid COVID-19. Moreover, the comprehensive auditing tool developed in this study allows for continuous quality improvement resulting in superior quality care, reduction of workflow inefficiencies, cost savings on hospital readmissions, and overall enhanced healthcare system performance.

Revisiting acidosis in acetazolamide treatment of severe glaucoma: A case report

“…In the U.S., the incidence of preventable adverse drug events from medication errors in hospitalized patients is estimated to be approximately one medication error per patient per day. 12 , 13 These events can cause increased length of hospital stay, increased mortality risk, and higher costs. One technique for medical reconciliation is to include a pharmacist in the process.…”

Differences in medication reconciliation interventions between six hospitals: a mixed method study

“…interview with the patient occurred in less than half of all MedRec (45.7%) [ 29 ]. Moreover, a very recent study revealed no implementation of MedRec in any of the observed sites [ 30 ]. Important barriers for MedRec implementation mentioned were: lack of awareness, a designated MedRec team and insufficient knowledge of health care professionals [ 14 ].…”

Pharmacy driven medication reconciliation productivity and error reduction: results from a retrospective cohort study

“…Barriers to gathering a BPMH, include a lack of: trained and experienced medication history staff, complete medication history resources, patient acuity and compliance, pharmacy hours of operation, time to implement new BPMH best practices, and con icting accounts from the patient or caregivers as to which medications the patient is actively taking [9]. In addition to everyday challenges, there are many ways in which the COVID-19 pandemic forced hospital systems to change medication history clinical work ows, including conducting virtual medication history interviews with patients, as well as sta ng challenges due to clinician burnout [7,[9][10][11].…”

“…Perhaps the most important step to a productive and clinically accurate medication reconciliation, is a complete and accurate medication history assessment upon admission to the hospital, or a Best Possible Medication History (BPMH) [5]. Several studies have shown that the vast majority of inpatient medication errors stem from discrepancies within a patient's medication history list [2,[6][7][8]. Barriers to gathering a BPMH, include a lack of: trained and experienced medication history staff, complete medication history resources, patient acuity and compliance, pharmacy hours of operation, time to implement new BPMH best practices, and con icting accounts from the patient or caregivers as to which medications the patient is actively taking [9].…”

“…As health systems are constantly innovating on the most valuable and productive clinical work ows, one promising trend to emerge in the past few years is the role of pharmacy staff in the medication history process, speci cally leveraging pharmacists at the leadership level and pharmacy technicians as medication history stewards [2,7,9,[12][13][14]. Several studies have shown that predominantly using pharmacy staff for medication history gathering greatly reduces the number of admission medication errors, and leads to dramatic improvements in patient safety during the hospital stay [8,9,[12][13][14][15][16][17][18][19].…”