Reconciling Medications at Admission: Safe Practice Recommendations and Implementation Strategies

Rogers, Gina; Alper, Eric J.; Brunelle, Diane; Federico, Frank; Fenn, Clark A.; Leape, Lucian L.; Kirle, Leslie; Ridley, Nancy; Clarridge, Brian; Bolcic‐Jankovic, Dragana; Griswold, Paula; Hanna, Doris; Annas, Catherine L.

doi:10.1016/s1553-7250(06)32006-5

Cited by 80 publications

(62 citation statements)

References 10 publications

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“…1 These errors can increase the risk of adverse drug events (ADEs) during hospitalization or following discharge. [2][3][4] Hospitals attempt to avert medication errors and ADEs by implementing medication reconciliation, the process by which a clinician compiles an accurate list of all medications that an individual is currently taking [5][6][7] and uses that list to provide correct medications anywhere within the health care system. 8 Hospital-based medication reconciliation is to be completed upon admission, transfer, and at discharge.…”

Section: Introductionmentioning

confidence: 99%

“…6 To compile an accurate list of medications, clinicians may use several sources of information during the medication reconciliation process, including pill bottles, the patient and/or family members, outpatient records, electronic medical records (EMR), and pharmacy records. 5 At each point in the care continuum, patient characteristics and his/her medications may influence the medication reconciliation process. For example, health literacy and medication understanding may affect a patient's ability to accurately report the medication regimen, possibly leading to errors in medication reconciliation during admission.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

et al. 2012

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BACKGROUND:Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge. OBJECTIVE: To identify patient-and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list. DESIGN, PARTICIPANTS: We conducted a crosssectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacistassisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study. MAIN MEASURES:Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors. KEY RESULTS: On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR=1.46; 95% CI, 1.00-2.12) and number of pre-admission medications (IRR=1.17; 95% CI, 1.10-1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR=0.54; 95% CI, 0.30-0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR=1.31; 95% CI, 1.19-1.45) and number of medications changed prior to discharge (IRR=1.06; 95% CI, 1.01-1.11). CONCLUSIONS: Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

et al. 2012

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“…However, because organizations have had difficulty implementing the process, it stopped citing medication reconciliation deficiencies in its accreditation surveys. 6 Although regional and national initiatives have attempted to improve implementation of medication reconciliation-using provider education, workflow, and process reorganization, and organizational change 7 -a recent field review by the Joint Commission suggests that healthcare organizations remain unable to ensure effective medication reconciliation, citing factors beyond the organizations' control, especially unreliable patient histories. 8 Still, the process is slated to return as an accreditation requirement of the Joint Commission on July 1, 2011.…”

Section: Resultsmentioning

confidence: 99%

“…These suggestions are consistent with a study that suggested that physician engagement and an effective team are strongly correlated with successful implementation of medication reconciliation. 7 A strength of our study was its use of multiple methods (focus groups and cognitive task analysis) to collect data from key users individually while they interfaced with the system and in groups. Nevertheless, a limitation of the study is that it took place in a single hospital.…”

Section: Discussionmentioning

confidence: 99%

Medication reconciliation: Barriers and facilitators from the perspectives of resident physicians and pharmacists

Boockvar

Santos

Kushniruk

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Medication reconciliation can prevent medication errors and harm when patients transition between hospital and other care settings. Though a Joint Commission hospital Patient Safety Goal since 2006, organizations continue to have difficulty implementing the process.OBJECTIVE:To determine factors that influence performance of medication reconciliation in a hospital setting with a computerized medication reconciliation tool.DESIGN:Cognitive task analysis (CTA) and focus group interviews.SETTING:Urban, academic, tertiary‐care Veterans Affairs medical center.PARTICIPANTS:Internal medicine house staff physicians (n = 23) and inpatient staff pharmacists (n = 12).MEASUREMENTS:CTA participants verbalized their thoughts while they completed medication reconciliation with the computerized tool. Focus group participants described medication reconciliation's purpose and effectiveness, how they completed the task, and its barriers and facilitators. Interviews were recorded and analyzed using social science methods for analyzing qualitative data.RESULTS:Participants agreed that a central goal of medication reconciliation is to prevent prescribing errors, but disagreed about whether it achieves this goal. Computerization facilitated the task, but participants said that computers and patients can be unreliable sources of information. Participants varied in how they sequenced components of the task. When time was limited, physicians considered other responsibilities higher priority. Both physicians and pharmacists expressed low self‐efficacy, ie, low perceived capability to achieve the objectives of the process.CONCLUSION:Key barriers to medication reconciliation are unreliable sources of medication information and tasks that compete for providers' time and attention that they consider higher priority. Addressing these barriers while increasing providers' self‐efficacy might improve medication reconciliation and its outcomes. Journal of Hospital Medicine 2011;6:329–337. © 2011 Society of Hospital Medicine

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“…Medication discrepancies frequently occur surrounding an acute hospitalization, both at admission and at discharge., [1][2][3] Medication discrepancies are differences between medication regimens (i.e. between medications prescribed on discharge from the hospital and a patient's home regimen).…”

Section: Introductionmentioning

confidence: 99%

Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications

et al. 2011

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Reconciling Medications at Admission: Safe Practice Recommendations and Implementation Strategies

Cited by 80 publications

References 10 publications

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

Medication reconciliation: Barriers and facilitators from the perspectives of resident physicians and pharmacists

Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications

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