Intended for healthcare professionals Show
Filler When I use a word . . . BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i5336 (Published 13 January 2017) Cite this as: BMJ 2017;356:i5336
This website uses cookies. By continuing to use this website you are giving consent to cookies being used. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Just how important is medication reconciliation? A regularly referenced survey shows that hospital-based pharmacists considered medication reconciliation "… to be their most important role in improving care transitions." There's good reason for this sentiment: Every year, 7,000 to 9,000 Americans die due to a medication error. Medication errors also contribute to thousands of patients experiencing adverse drug events and billions of dollars in avoidable costs annually. These and other statistics should motivate providers to best ensure they are properly performing the necessary medication reconciliation The steps to complete medication reconciliation may seem, on the surface, to be straightforward. Yet we know through numerous studies, such as this study of Pennsylvania hospital data, that serious events related to the medication reconciliation process occur — and occur quite regularly. We also know that the medication reconciliation process is often delayed or skipped entirely. All discharged patients should receive a medication reconciliation post-discharge (MRP) within 72 hours of discharge, but statistics show that MRP is only occurring with half of these patients. Why is that the case?Steps to Complete Medication ReconciliationLet's review what are considered the five fundamental medication reconciliation steps and highlight some of significant challenges associated with each of them. 1. Develop a list of a patient's current medicationsThe first step is perhaps not only the most important but also the most challenging of the medication reconciliation steps: documenting all a patient's current medications. If even a single medication or critical detail about a medication (e.g., dosage, frequency, route of administration) is omitted from this list, the risk of an adverse drug event increases and the ability to effectively and appropriately complete the remaining medication reconciliation steps decreases. Here are just some of the reasons why developing a current medication list can prove so difficult:
2. Develop a list of medications to be prescribedThis step may seem easy, but that brings with it a potential for mistakes. A false sense of confidence can encourage the rushed completion of responsibilities and corner cutting. As an Academy of Managed Care Pharmacy article notes, these are just some of the ways preventable prescribing errors occur:
3. Compare the medications on the listsThis is essentially the "reconciliation step" in the medication reconciliation process. The comparison of the lists helps ensure discrepancies can be avoided and red flags can be identified, such as omitted medications, therapeutic duplications, dosing errors, drug-drug interactions, and drug-disease interactions. Considering that any of these issues can put a patient's health and wellness at risk, why is this step sometimes missed or not completed appropriately? Some of the top reasons include the following:
4. Make clinical decisions based on the comparisonThis is another one of the medication reconciliation steps that can suffer due to time issues. When those performing medication reconciliation lack the adequate time and resources to effectively complete the process, decision-making is likely to be rushed or cut short. One aspect of medication management that can be negatively affected concerns efforts around deprescribing, which, as we previously noted, "… has become one of the most effective ways to safely decrease inappropriate and unnecessary polypharmacy." Unfortunately, as a Health Affairs article states, "In many cases, medication reconciliation has devolved into a box-checking exercise to comprehensively catalog all medications a patient is taking, but the process may not make efforts to decrease the number of medications or stop potentially harmful drugs." 5. Communicate the reconciled medication list to the patient and appropriate caregiversIf the preceding four medication reconciliation steps are completed, this final step is typically completed in some fashion. At a minimum, a patient is usually provided with the revised medications list. But even this can experience problems. They include the following:
Communicating the revised list to appropriate caregivers is essential to reducing the likelihood for future medication reconciliation shortfalls. However, it too can be neglected if processes and systems that deliver the reconciled medication list directly into their EMR workflow are not in place that help make uptake by the provider simple and fast. Any obstacles for efficient, effective communication are likely to motivate providers to delay or even bypass completion of this final medication reconciliation step. Better Ways to Complete Medication Reconciliation StepsAt Cureatr, we understand the importance of medication reconciliation and the current challenges facing providers in completing their essential medication reconciliation steps. That's why we offer a range of solutions, including the Meds 360° medication management system that can lower medication reconciliation times by up to 70% and MPR tech-enabled clinical pharmacy service powered by Meds 360° that can help organizations achieve a 100% MRP completion rate. To learn more about how Cureatr is supporting organizations in their efforts to strengthen medication reconciliation processes, contact us today! Page 2Just how important is medication reconciliation? A regularly referenced survey shows that hospital-based pharmacists considered medication reconciliation "… to be their most important role in improving care transitions." There's good reason for this sentiment: Every year, 7,000 to 9,000 Americans die due to a medication error. Medication errors also contribute to thousands of patients experiencing adverse drug events and billions of dollars in avoidable costs annually. These and other statistics should motivate providers to best ensure they are properly performing the necessary medication reconciliation The steps to complete medication reconciliation may seem, on the surface, to be straightforward. Yet we know through numerous studies, such as this study of Pennsylvania hospital data, that serious events related to the medication reconciliation process occur — and occur quite regularly. We also know that the medication reconciliation process is often delayed or skipped entirely. All discharged patients should receive a medication reconciliation post-discharge (MRP) within 72 hours of discharge, but statistics show that MRP is only occurring with half of these patients. Why is that the case?Steps to Complete Medication ReconciliationLet's review what are considered the five fundamental medication reconciliation steps and highlight some of significant challenges associated with each of them. 1. Develop a list of a patient's current medicationsThe first step is perhaps not only the most important but also the most challenging of the medication reconciliation steps: documenting all a patient's current medications. If even a single medication or critical detail about a medication (e.g., dosage, frequency, route of administration) is omitted from this list, the risk of an adverse drug event increases and the ability to effectively and appropriately complete the remaining medication reconciliation steps decreases. Here are just some of the reasons why developing a current medication list can prove so difficult:
2. Develop a list of medications to be prescribedThis step may seem easy, but that brings with it a potential for mistakes. A false sense of confidence can encourage the rushed completion of responsibilities and corner cutting. As an Academy of Managed Care Pharmacy article notes, these are just some of the ways preventable prescribing errors occur:
3. Compare the medications on the listsThis is essentially the "reconciliation step" in the medication reconciliation process. The comparison of the lists helps ensure discrepancies can be avoided and red flags can be identified, such as omitted medications, therapeutic duplications, dosing errors, drug-drug interactions, and drug-disease interactions. Considering that any of these issues can put a patient's health and wellness at risk, why is this step sometimes missed or not completed appropriately? Some of the top reasons include the following:
4. Make clinical decisions based on the comparisonThis is another one of the medication reconciliation steps that can suffer due to time issues. When those performing medication reconciliation lack the adequate time and resources to effectively complete the process, decision-making is likely to be rushed or cut short. One aspect of medication management that can be negatively affected concerns efforts around deprescribing, which, as we previously noted, "… has become one of the most effective ways to safely decrease inappropriate and unnecessary polypharmacy." Unfortunately, as a Health Affairs article states, "In many cases, medication reconciliation has devolved into a box-checking exercise to comprehensively catalog all medications a patient is taking, but the process may not make efforts to decrease the number of medications or stop potentially harmful drugs." 5. Communicate the reconciled medication list to the patient and appropriate caregiversIf the preceding four medication reconciliation steps are completed, this final step is typically completed in some fashion. At a minimum, a patient is usually provided with the revised medications list. But even this can experience problems. They include the following:
Communicating the revised list to appropriate caregivers is essential to reducing the likelihood for future medication reconciliation shortfalls. However, it too can be neglected if processes and systems that deliver the reconciled medication list directly into their EMR workflow are not in place that help make uptake by the provider simple and fast. Any obstacles for efficient, effective communication are likely to motivate providers to delay or even bypass completion of this final medication reconciliation step. Better Ways to Complete Medication Reconciliation StepsAt Cureatr, we understand the importance of medication reconciliation and the current challenges facing providers in completing their essential medication reconciliation steps. That's why we offer a range of solutions, including the Meds 360° medication management system that can lower medication reconciliation times by up to 70% and MPR tech-enabled clinical pharmacy service powered by Meds 360° that can help organizations achieve a 100% MRP completion rate. To learn more about how Cureatr is supporting organizations in their efforts to strengthen medication reconciliation processes, contact us today!
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