Medication Reconciliation Information
Background





Average hospital patient subject to at least 1 error/day
40% result from inadequate reconciliation (20% result in harm)
Medication Reconciliation. As per JCAHO see Toolkit
Added as patient Safety goal in 2005
Part of 100,000 lives campaign (Institute for Healthcare Improvement: INH)
MEDICATION RECONCILIATION





LIST SHOULD INCLUDE: ALL PRESCRIPTION MEDS.; Herbals; vitamins; nutritional supplements;
over-the-counter drugs; vaccines; diagnostic and contrast agents; radioactive meds; parenteral
nutrition; blood derivatives; IV solutions.
Steps include:
Newly hospitalized/admitted: verify and document patient medication history, write orders for
medication regimen and create a record (MAR)
At discharge (D/C) determine post D/C medication regimen; D/C instructions on medication
regimen with education and transmitting the regimen to patients follow up physician.
In ambulatory setting: documenting complete list of current medications; updating the list
whenever changes made (change, add or discontinue)
SAFETY VULNERABILITIES




No standard in what constitutes a list and where it is kept in the patient record(nursing
admission note; MAR; history and physical; Pharmacy profile.
Patient and/or family members lack of knowledge of their medications history
Health care info not integrated across settings ie. Hospital-outpatient clinic; MD. office –dialysis
Facility; etc.
25% prescription drugs used @ home not recorded on hospital record(LAU and Colleagues , Br J
Clinical Pharmacol 2000)
RECONCILIATION IN AMBULATORY SETTING
26.3% Charts of patients requesting prescription renewal had discrepancies, of these, 59% omitted
medications (Ernest and colleagues Am j health Syst Pharm,2001)
76% patients had prescribed medication and 87% of these charts –incomplete or no documentation of
these medications. ( Miller et. Al ;Fam Pract Res J, 1992) 3yrs. Later study showed 82% charts with
completed medication documentation after reconcile process instituted.
Medication Reconciliation Information continued:
EVIDENCE – BASED PRACTICE IMPLICATIONS
Define the steps in the process
1) Collect a list of prescribed meds., OTC meds., vitamins, nutritional supplements, herbs and
vaccines.
2) Clarify meds. And dosages are appropriate
3) Reconcile and document any changes
4) Who is responsible
5) How the process will be completed
Clearly identify team roles and responsibilities for the process
1)
2)
3)
4)
5)
6)
7)
8)
Evaluating existing process
Identify standard location in chart
Who will put it into chart
Timeframe for resolving variances
How to document changes
Use of a standardized medication form that is accessible and visible
Educate health care professionals
Design and implement a monitoring process for adherence to the process, possible ill effects if
process not followed (auditing tool such as Improvement Tracker on IHI web site)
9) Educate patients and family members