Medication reconciliation
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Robert G. Badgett, M.D.[2]
Overview
Medication reconciliation is "the formal process of obtaining a complete and accurate list of each patient's current home medications including name, dosage, frequency, and route of administration, and comparing admission, transfer, and/or discharge medication orders to that list. The reconciliation is done to avoid medication errors."[1] Medication reconciliation may involve determining a "Best Possible Medication History" (BPMH).
Epidemiology
Frequency of reconciliation errors
In the inpatient setting, the following rates of medication errors have been found[2][3][4][5]:
In the outpatient setting, the following rates of medication errors have been found:[7][8][6][9]:
Frequency of harm from reconciliation errors
Harm from inadequate medication reconciliations includes ... and the frequency of this is...
Methods
Criteria for determining a medication problem
One proposed criteria is the "number of unintentional medication discrepancies per patient."[10] Because this measure requires a trained pharmacist to assess the gold standard, the authors of the measure suggest that "25 patients are sampled per month, or approximately 1 patient per weekday".[10] Problems with this proposal include unclear criteria used by the pharmacist and that measurement can not be automated or measured in the data routinely collected during patient care.
A medication reconciliation executed by a pharmacist may take over two hours.[11]; however, in the clinic a physician may have less than a minute to discuss medications[12].
Specific criteria
A study in the Washington DC VA proposed specific criteria for a medication reconciliation. It included internal medicine residents rotating through the hospital, using bi-monthly educational sessions directed by faculty/chief residents based on accuracy of discharge medication reconciliation. While some of the criteria showed significant change after an intervention, the reliability of these results were not tested.[3] The criteria used were:
- Medication duplicates
- Extraneous medications. In other studies, this is also called one-time medications, post-acute medications, or time-limited medications.
- Discrepancies from discharge summaries
- Omissions
- Grouping medication by indication or disease
Specific criteria for determining a successful medication reconciliation have also been developed by an interdisciplinary team at National Jewish Health (Denver) in an ambulatory practice serving patients with respiratory and related diseases[7]. This study assessed performance in medication reconciliation by the process of comparing patients’ medication lists at clinical transition points and demonstrated improvement in an outpatient setting, sustainable and valid measures are needed. Across 18 months
- Electronic attestation that med rec was completed at clinic visits increased from 9.8% to 91.3% (p < 0.0001)
- Medication duplication decreased from 4.0% to 2.6% (95% CI: 2.4%–2.8%) (p <0.0001)
- Significant improvement was noticed in missing doses, their frequencies
- Provision of medication safety handout with the patients’ medication lists
An additional finding in the study was that compliance remained a limiting factor in this study secondary to poor-buy in by participants due to redundancy of process.
Role of patient engagement and understanding
Role of regional health information exchanges
Use of data provided by a regional health information exchange has been advocated.[13][14] However, the clinical benefit of using a health information exchange is not established[15]. A randomized controlled trial found no reduction in adverse drug reactions.[15][16]
Quality measures
Medication reconciliation is a quality measure for Centers for Medicare & Medicaid Services (CMS)[17][18], it is also a quality measure for National Committee for Quality Assurance (NCQA).[19]
Public reporting
Medication reconciliation is part of the Centers for Medicare & Medicaid Services's (CMS) EHR Incentive Programs for the Measingful Use Stage 1[17] and the 2017 Modified Stage 2 Meaningful Use Program Requirements[18].
Interventions to promote the frequency of medication reconciliation
References
- ↑ "Medication Reconciliation- MeSH - NCBI". Retrieved 2017-06-05.
- ↑ 2.0 2.1 Phatak A, Prusi R, Ward B, Hansen LO, Williams MV, Vetter E; et al. (2016). "Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study)". J Hosp Med. 11 (1): 39–44. doi:10.1002/jhm.2493. PMID 26434752.
- ↑ 3.0 3.1 3.2 Arundel C, Logan J, Ayana R, Gannuscio J, Kerns J, Swenson R (2015). "Safe Medication Reconciliation: An Intervention to Improve Residents' Medication Reconciliation Skills". J Grad Med Educ. 7 (3): 407–11. doi:10.4300/JGME-D-14-00565.1. PMC 4597952. PMID 26457147.
- ↑ 4.0 4.1 Gallagher PF, O'Connor MN, O'Mahony D (2011). "Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria". Clin Pharmacol Ther. 89 (6): 845–54. doi:10.1038/clpt.2011.44. PMID 21508941.
- ↑ 5.0 5.1 Walker PC, Bernstein SJ, Jones JN, Piersma J, Kim HW, Regal RE; et al. (2009). "Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study". Arch Intern Med. 169 (21): 2003–10. doi:10.1001/archinternmed.2009.398. PMID 19933963.
- ↑ 6.0 6.1 6.2 Grant RW, Devita NG, Singer DE, Meigs JB (2003). "Improving adherence and reducing medication discrepancies in patients with diabetes". Ann Pharmacother. 37 (7–8): 962–9. doi:10.1345/aph.1C452. PMID 12841801.
- ↑ 7.0 7.1 Kern E, Dingae MB, Langmack EL, Juarez C, Cott G, Meadows SK (2017). "Measuring to Improve Medication Reconciliation in a Large Subspecialty Outpatient Practice". Jt Comm J Qual Patient Saf. 43 (5): 212–223. doi:10.1016/j.jcjq.2017.02.005. PMID 28434454.
- ↑ 8.0 8.1 Ashjian E, Salamin LB, Eschenburg K, Kraft S, Mackler E (2015). "Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center". J Am Pharm Assoc (2003). 55 (5): 540–5. doi:10.1331/JAPhA.2015.14214. PMID 26359964.
- ↑ 9.0 9.1 Bedell SE, Jabbour S, Goldberg R, Glaser H, Gobble S, Young-Xu Y; et al. (2000). "Discrepancies in the use of medications: their extent and predictors in an outpatient practice". Arch Intern Med. 160 (14): 2129–34. PMID 10904455.
- ↑ 10.0 10.1 Brigham and Women´s Hospital. Medication Reconciliation: Number of Unintentional Medication Discrepancies per Patient. National Quality Forum. Last updated Sep 09, 2014. Accessed July 2, 2017
- ↑ Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H; et al. (2009). "A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial". Arch Intern Med. 169 (9): 894–900. doi:10.1001/archinternmed.2009.71. PMID 19433702. Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-14
- ↑ van der Gaag S, Janssen MJA, Wessemius H, Siegert CEH, Karapinar-Çarkit F (2017). "An evaluation of medication reconciliation at an outpatient Internal Medicines clinic". Eur J Intern Med. doi:10.1016/j.ejim.2017.07.015. PMID 28693941.
- ↑ Askin E, Margolius D (2016). "A call for a statewide medication reconciliation program". Am J Manag Care. 22 (10): e336–e337. PMID 28557524.
- ↑ Dhavle AA, Joseph S, Yang Y, DiBlasi C, Whittemore K (2017). "A better way: leveraging a proven and utilized system for improving current medication reconciliation processes". Am J Manag Care. 23 (3): e98–e99. PMID 28385027.
- ↑ 15.0 15.1 Boockvar KS, Ho W, Pruskowski J, DiPalo KE, Wong JJ, Patel J; et al. (2017). "Effect of health information exchange on recognition of medication discrepancies is interrupted when data charges are introduced: results of a cluster-randomized controlled trial". J Am Med Inform Assoc. doi:10.1093/jamia/ocx044. PMID 28505367.
- ↑ Boockvar K. "Regional Data Exchange to Improve Medication Safety - Study Results". ClinicalTrials.gov. Retrieved 2017-06-05.
- ↑ 17.0 17.1 "Step 5: Achieve Meaningful Use Stage 1: When should I perform medication reconciliation?". HealthIT.gov. Retrieved June 5, 2017.
- ↑ 18.0 18.1 "Step 5: Achieve Meaningful Use Stage 2: Medication Reconciliation". HealthIT.gov. Retrieved June 5, 2017.
- ↑ "Medication reconciliation post-discharge: percentage of discharges from January 1 to December 1 of the measurement year for members 18 years of age and older for whom medications were reconciled the date of discharge through 30 days after discharge (31 total days)". National Quality Measures Clearinghouse. Retrieved 2017-06-05.
External links
- AHRQ: Medication Reconciliation
- HealthIT.gov: Medication Reconciliation
- HIMSS: HIMSS Electronic Medication Reconciliation (Med Rec) Resource Center
- IHI: Medication Reconciliation to Prevent Adverse Drug Events
- Joint Commission Resources and the American Society of Health-System Pharmacists; 2006. ISBN: 0866889566 (First edition) Google Books, AHRQ
- Leapfrog Group: Medication Reconciliation
- WHO:Action on Patient Safety - High 5s