Medication Reconciliation

September 2, 2015 | Healthcare Risk, Quality, & Safety Guidance

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Care transitions, such as those at admission and discharge, between care units, and from one care setting to another, are error-prone processes. As demonstrated by numerous studies, medication safety is particularly vulnerable during care transitions.

Consider just the risk of medication errors at admission and discharge. One in two admitted patients has at least one unintended medication discrepancy, of which almost 40% have the potential to cause harm, according to one study (Cornish et al.). Further, 3 out of 10 discharged patients have at least one medication discrepancy with the potential to cause harm (Kwan et al.). A discrepancy is an unexplained difference in documented medication regimens across different sites of care, such as differences in a patient's medications prior to admission (also referred to as "home medications") compared with the regimen in the admission orders for the patient.

One organization's audit of its performance in the medication-use process provides insights into the extent of medication errors associated with care transitions. The organization conducted chart audits over six weeks to establish a baseline of its performance in the medication-use process and found that nearly 60% of its medication errors were occurring during care transitions at admission, during level-of-care changes within the institution, and at discharge. (Rozich et al.)

Among the errors that can occur from medication discrepancies are the following:

The process of medication reconciliation is intended to prevent medication errors by systematically evaluating the medications a patient is taking to ensure that any medications that are added, changed, or discontinued are carefully reviewed, with the goal of maintaining an accurate list of the patient's medications. The process should be undertaken at every change in a patient's level of care along the continuum of care, 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. The challenges can include any of the following...

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