Medication reconciliation at two teaching hospitals in Australia: a missed opportunity?

Abstract

Medication reconciliation prevents medication related harm at patient hospitalisation. This cross-sectional study demonstrated that the Hunter New England Health Admission Medication History Form that supports the two processes is underutilised in two hospitals in New South Wales with many doctors unaware of the form and pharmacists facing understaffing and time constraints for completing it. Triaging of patients and, more collaboration between doctors and pharmacists are required for efficient in-hospital medication reconciliation.

Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses’ perceptions of their roles and responsibilities

“…Nurses reported medication reconciliation at hospital discharge was a complex process involving numerous clinicians who completed similar tasks such as patient education (Penm et al, 2019; Siu, 2015). Confirming previous research (Aires‐Moreno et al, 2020; Athuraliya et al, 2017), nurses in our study identified medication discrepancies, checked the accuracy of discharge medications, delivered patient education, and coordinated the healthcare team to ensure patient safety and avoid discharge delays. Task duplication was considered both a barrier and a benefit in some circumstances.…”

“…Prior to hospital discharge, medication reconciliation tasks include reconciling previous and newly prescribed medications; documenting an accurate discharge medication list; prescribing, dispensing and checking discharge medications; patient and carer education; and disseminating medication information to community healthcare professionals involved in the patient's ongoing care (Latimer et al, 2020; Lee et al, 2015; World Health Organisation, 2006). However, evidence suggests more than half of hospital patients do not have their medications reconciled on admission or prior to discharge, which increases their risk of medication‐related harm (Athuraliya et al, 2017; Michaelsen et al, 2015; Stark et al, 2020). A 2015 systematic review of 15 quantitative research papers on medication reconciliation at hospital discharge found between 20–87% of patients had at least one medication discrepancy at discharge, mostly omissions, with polypharmacy increasing the risk for error (Michaelsen et al, 2015).…”

“…Globally, medication reconciliation roles and responsibilities vary in acute care hospitals (Aires‐Moreno et al, 2020; Al‐Hashar et al, 2017; Lee et al, 2015; Vogelsmeier et al, 2013). For example, medication reconciliation is generally undertaken by physicians in the United States (Boockvar et al, 2011; Lee et al, 2015), physicians and pharmacists in Brazil (Aires‐Moreno et al, 2020), physicians and nurses in Oman (Al‐Hashar et al, 2017) and pharmacists in Australia (Athuraliya et al, 2017; Meguerditchian et al, 2013). In some circumstances where pharmacists and physicians are not available, medication reconciliation may fall to nurses (Clinical Excellence Commission, 2019; Young et al, 2015).…”

Pharmacist involvement in combating the opioid crisis: A mixed‐methods approach revealing conflicting perceptions

“…Time constraints are known to be a recurring barrier to many innovative initiatives and scope‐advancing practices in pharmacy, such as medication reconciliation, vaccination administration, sexual and reproductive health services, continuing education, inclusion in a research network, and general research efforts . Pharmacists expressed concern with the amount of time needed for proper patient education on naloxone, noting that appropriate education on overdose risk, responding to an overdose, and the proper use of naloxone could require a significant time commitment.…”

Role of the patient in the process of the medication reconciliation

“…Średnia liczba leków przyjmowanych przez pacjenta liczona na podstawie wywiadu lekarskiego wyniosła 6,58. Dla wywiadu koncyliacyjnego była ona większa i wyniosła 8,52 [7]. W innym badaniu, tym razem z Arabii Saudyjskiej, autorstwa Abdulghani i wsp., całkowita liczba leków przyjmowanych przez pacjentów, w przypadku informacji uzyskanej przez osobę prowadzącą koncyliację wyniosła 3085, a przez lekarza -2548 [8].…”