Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps

Abstract

Executive Summary: Medication errors and adverse events caused by them are common during and after a hospitalization.The impact of these events on patient welfare and the financial burden, both to the patient and the healthcare system, are significant. In 2005, The Joint Commission put forth medication reconciliation as National Patient Safety Goal (NPSG) No. 8 in an effort to minimize adverse events caused during these types of care transitions. However, the meaningful and systematic implementation of medication reconciliation, as expressed through NPSG No. 8, proved to be extraordinarily difficult for healthcare institutions around the country.Given the importance of accurate and complete medication reconciliation for patient safety occurring across the continuum of care, the Society of Hospital Medicine convened a stakeholder conference in 2009 to begin to identify and address: (1) barriers to implementation; (2) opportunities to identify best practices surrounding medication reconciliation; (3) the role of partnerships among traditional healthcare sites and nonclinical and other community-based organizations; and (4) metrics for measuring the processes involved in medication reconciliation and their impact on preventing harm to patients. The focus of the conference was oriented toward medication reconciliation for a hospitalized patient population; however, many of the themes and concepts derived would also apply to other care settings. This paper highlights the key domains needing to be addressed and suggests first steps toward doing so. View this article online at wileyonlinelibrary.com. Journal of Hospital Medicine Vol 5 No 8 October 2010 477An overarching principle derived at the conference is that medication reconciliation should not be viewed as an accreditation function. It must, first and foremost, be recognized as an important element of patient safety. From this principle, the participants identified ten key areas requiring further attention in order to move medication reconciliation toward this focus.1. There is need for a uniformly acceptable and accepted definition of what constitutes a medication and what processes are encompassed by reconciliation. Clarifying these terms is critical to ensuring more uniform impact of medication reconciliation. 2. The varying roles of the multidisciplinary participants in the reconciliation process must be clearly defined. These role definitions should include those of the patient and family/caregiver and must occur locally, taking into account the need for flexibility in design given the varying structures and resources at healthcare sites. 3. Measures of the reconciliation processes must be clinically meaningful (i.e., of defined benefit to the patient) and derived through consultation with stakeholder groups. Those measures to be reported for national benchmarking and accreditation should be limited in number and clinically meaningful. 4. While a comprehensive reconciliation system is needed across the continuum of care, a phased approach to implementation, ...

Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form

“…Patient counselling is a key component of this process, providing an opportunity to inform patients of new medications, treatment modifications, and drug administration schedules [2,8,9]. Studies have shown that the reconciliation process of gathering, organising, and communicating medication information is time-consuming and can be affected by several factors [10], among which are the large number of professionals involved in the process, including clinicians, hospital pharmacists, nurses, general practitioners (GP), community pharmacists, and community caregivers [11][12][13]. A lack of communication, understanding, and collaboration between hospital and community caregivers also represents a significant barrier to successful implementation of a MedRec process [14,15].…”

Meaningful collaboration

“…5,6 Previous attempts to share responsibility for medication reconciliation have divided this collaborative work into an ineffective series of discrete tasks. 7 In a typical medication reconciliation process, nurses list current medications, physicians prescribe while referencing the list, and pharmacists periodically evaluate overall medication use. It isn't uncommon for one or more of these discrete tasks to be left incomplete or unintentionally duplicated.…”

Conciliation médicamenteuse : une expérience innovante dans un service de médecine interne pour diminuer les erreurs d’anamnèse médicamenteuses

“…La conciliation doit être intégrée à la démarche qualité de l'établissement. Des indicateurs doivent être définis et suivis régulièrement pour évaluer l'impact de la conciliation sur les erreurs médicamenteuses et montrer son utilité en matière de sécurité des patients [34]. Le développement dans les établissements de santé français de la conciliation médicamenteuse sera probablement facilité par l'utilisation des nouvelles technologies de l'information et des communications.…”