When patients first arrive at a hospital emergency room, they are inevitably asked what medications they are taking. It’s important for hospital staff to have an accurate picture of the patient’s current medication information to avoid medication errors or adverse drug events. Medication reconciliation is defined by the Joint Commission as “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking.” The Joint Commission, a nonprofit organization that accredits and certifies healthcare organizations and programs, recommends that medication reconciliation take place at all transition points where the patient might be prescribed new medications. This could include changes in setting, service, practitioner or level of care. According to the Institute for Healthcare Improvement, poor communication at transition points is responsible for as many as 50 percent of medication errors and 20 percent of adverse drug events in hospitals.
Reconciliation can help prevent medical errors such as duplications, dosing errors or drug interactions. Trouble is, it can be difficult to get an accurate account from a patient who is a) feeling unwell, and b) in the middle of an emergency situation. Disabled, very young, severely ill, or critically injured patients may not be equipped to give a complete medication list. Elderly patients who are on a large number of medications may have difficulty remembering them all. A recent study conducted at Chicago’s Northwestern Memorial Hospital found that most medication discrepancies occur when obtaining the patient’s medical history. The study, published in the Journal of General Internal Medicine, suggests the need for more thorough interviews and for patients to keep better track of the medications they are taking.
Although a large part of the responsibility lies with the patient, medication reconciliation software can help organize patient medication information. The software can gather and document patients’ medication information from sources such as retail pharmacies. Features differ from one product to the next, but medication reconciliation programs can allow healthcare providers to issue electronic prescriptions, edit medication regimens, automatically check for drug interactions, and create a list of medications for the patient upon discharge from the hospital. The software may be able to interface with the patient’s electronic medical record. Vendors of medication reconciliation software include Mediware, Health Care Systems, Design Clinicals and DrFirst.
The Joint Commission lists medication reconciliation among its National Patient Safety Goals, although the goal is being reviewed due to the large number of healthcare organizations that are having trouble meeting its requirements. In your opinion, how can hospitals improve medication reconciliation to be in compliance with their guidelines?