September 8, 2022 | Health System Risk Management
Care transitions, such as those at admission and discharge, between care units, and from one care setting to another, are complex and error-prone processes. As demonstrated by numerous studies, medication safety is particularly vulnerable during care transitions.
In a review of the literature, Tam et al. (2005) found that 67% of admitted patients have at least one unintended medication discrepancy, and between 11–59% of errors have the potential to cause harm. A study performed in children's hospitals found similar results: 45% of admissions resulted in an error and about one-third of them had an increased risk for harm (20% for moderate harm and 11% for severe harm) (Huynh et al.).
Similarly, Wong et al. (2008) determined that 70% of discharged patients had one or more medication discrepancies, almost 30% of which had the potential to cause harm. A comparison of errors in two pediatric hospitals found rates of 30% (0.7 errors/discharge) and 42% (1.6 errors/discharge), respectively (Morse et al.), while an evaluation showed discrepancies in 41% of medication lists for newly admitted or re-admitted nursing home residents (Patterson et al.).
The process of medication reconciliation is intended to detect and prevent medication errors by systematically evaluating the medications a patient is taking to ensure that any additions, changes, or discontinuations are carefully reviewed, with the goal of maintaining an accurate list. The process should be undertaken at every change in a patient's level of care along the continuum, such as at hospital admission and discharge, during level-of-care transitions within a healthcare facility, and before and after transfers to another facility. (Greenwald et al.)
Without a comprehensive approach to medication reconciliation, errors can arise as a result of the numerous challenges healthcare providers face in trying to get an accurate list of a patient's medications and reconciling that list with the medications a patient is to take at admission, throughout a stay, and at discharge. These challenges include the following (APA et...