Medication Reconciliation Across the Continuum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medication reconciliation is the process of identifying errors and acting on discrepancies in patients’ medication histories by obtaining and maintaining accurate and complete medication information for a patient and using this information to ensure safe and effective use. Medication reconciliation is a key aspect of patient safety as it engages providers and patients in the process of verifying the patient’s medication list at key transition points to identify which ones have been added, discontinued, or changed over time.

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According to WHO, medication reconciliation is the formal process in which healthcare professionals partner with patients to ensure accurate and complete medication information transfer at interfaces of care. The Joint Commission (TJC) defines the medication reconciliation process as the identification of the most accurate and up-to-date list of all medications a patient is taking, at the time of admission, transfer, and discharge within the healthcare environment, using the following five-step process to prevent or reduce medication (errors):

1. Develop a list of current medications including the medication’s name, dosage, frequency, and route of administration.

2. Develop a list of medications to be prescribed.

3. Compare the medications on the two lists.

4. Make clinical decisions based on the comparison.

5. Communicate the new list to appropriate caregivers and to the patient.

 

KEY FACTS

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A.  Medication Errors Resulting from Medication Reconciliation Failures

A medication error is defined as any preventable event that may cause or lead to inappropriate use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.46 The main types of medication errors that can be eliminated or significantly reduced with an effective medication reconciliation include:

• Drug interactions: when one medication, such as an over-the- counter medications, supplements, or herbals, affects the activity of another medication when both are administered together

• Drug duplications: the prescribing of multiple medications for the same indication without a clear distinction of when one agent should be administered over another

• Errors of commission: dispensing the wrong drug or dose, administering a drug incorrectly, prescribing the wrong dose, and/ or entering the drug incorrectly into the computer system

• Errors of omission: failing to administer a drug that was prescribed, not administering a drug in a timely manner, failing to counsel the patient, or omitting important medication information on the label

Medication reconciliation should be done at every transition of care when new medications are ordered or existing orders are rewritten, to prevent the interaction, duplication, commission, and omission (IDCO) errors. For medication reconciliation to become more than a paperwork exercise, TJC has added the following to step 3 of the five-step process: compare the medications on the two lists “with the patient and/or caregiver.” This is known as participatory reconciliation, which goes beyond the traditional patient-centered reconciliation process.

 

B.   Incidence of Medication Errors Resulting from Medication Reconciliation Failures

In three randomized controlled trials, readmissions and emergency department visits were significantly reduced by up to 23% when medication reconciliation was combined with other interventions specifically aimed at reducing readmissions. Based on the United States Pharmacopeia (USP) MEDMARX reporting program that captures errors involving medication reconciliation failures, between September 2004 and July 2005 there were 2,022 reports of medication reconciliation errors. Sixty-six percent occurred during the patient’s transition or transfer to another level of care, 22% occurred during the patient’s admission to the facility, and 12% occurred at the time of discharge. Of the types of medication reconciliation errors reported to MEDMARX, the majority involved improper dose/quantity, followed by omission error and prescribing error. The other less frequently reported types of errors included wrong drug, wrong time, extra dose, wrong patient, mislabeling, wrong administration technique, and wrong dosage form.

 

C.  Impact and Consequences When Medication Reconciliation Is Not Optimized

The Hospital Readmissions Reduction Program (HRRP) was implemented in 2012 by CMS to address the unacceptable rate of patients readmitted to hospitals. Hospitals face steep financial penalties if  they are unable to align readmission rates with the new quality standards.

In the program’s first year, about 66% of the 3,400 hospitals failed under HRRP and were penalized, totaling $280 million in losses. These penalties are expected to increase over time. Studies have shown that adverse drug events resulting from medication misuse and IDCO errors have significantly contributed to the increase in readmissions.

Erroneous medication histories can lead to discontinuity of therapy, recommencement of discontinued medicines, inappropriate therapy, and failure to detect a drug-related problem. Up to 27% of hospital prescribing errors can be attributed to inaccurate or incomplete medication histories on admission to a hospital, with the omission of a regular medicine being the most common error. Older patients (≥ 65 years) and those taking multiple medicines experience a higher incidence of errors. In fact, studies show that inconsistent knowledge and record keeping about medications directly threatens patient safety, causing up to 50% of all medication errors in the hospital and up to 20% of adverse drug events. These errors and adverse outcomes can be reduced or prevented through an effective medication reconciliation process and education.

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For More information about Medication Reconciliation, see the resources below: