Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions

Hassan Tahir^1, , Nagadarshini Ramagiri Vinod¹, Vistasp Daruwalla², Muhammad Umair Malik¹, Nikath Zeeshan¹, Lavanya Vuppu¹, Thomas Simunich³ and Medha Joshi¹

¹Temple University, Conemaugh Memorial Hospital, Johnstown, PA, USA

²Wyne State University, Detroit Medical Center, Detroit, MI, USA

³Statistitician, Conemaugh Memorial Hospital

Cite this paper

Hassan Tahir, Nagadarshini Ramagiri Vinod, Vistasp Daruwalla, Muhammad Umair Malik, Nikath Zeeshan, Lavanya Vuppu, Thomas Simunich and Medha Joshi. Decreasing Unintended Medication Discrepancies in Medication Reconciliation through Simple Yet Effective Interventions. American Journal of Public Health Research. 2017; 5(2):30-35. doi: 10.12691/AJPHR-5-2-1

Abstract

Background: Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. Unfortunately, medication errors are common in our health system accounting for significant proportion of patient harm. The main objective of our study was to explore the effect of self-designed intervention in improving the accuracy of patient current medication list in the outpatient settings. Methods: The study designed entailed collection of data from October 2013 to March 2014. The data collected in October (The pre-intervention) was compared to the post-intervention data in March 2014. Following interventions were performed: Education of residents, nurses and patients, frequent reminders to the residents to perform medication reconciliation, sending notifications to the residents who failed to perform medication reconciliation, reminding the patients get all refills at the time of appointment and reminding the patients to bring pill bottles at each appointment. The pre-intervention data was compared with the post-intervention data for different types of medication errors. Normality of the variables was pre assessed. Non-parametric analysis using Fisher’s exact test was performed for comparison of categorical variables. Conclusion: In conclusion, our intervention improved the accuracy of patient current medication list in the electronic records as accurate as possible. For clinics and hospitals, medication reconciliation can enhance delivery of high value cost conscious care to the patients by reducing medication errors.

Keywords

medication reconciliation, medication error, patient harm

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Thomsen LA, Winterstein AG, Søndergaard B, Haugbølle LS, Melander A. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother. 2007 Sep; 41(9): 1411-26. Epub 2007 Jul 31.
[2]	Boockvar KS, Carlson LaCorte H, Giambanco V, et al. Medication reconciliation for reducing drug-discrepancy adverse events. Am J Geriatr Pharmacother 2006; 4: 236.
[3]	Greenwald JL, Halasyamani L, Greene J, et al. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med 2010; 5:477.
[4]	Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 2012; 172:1057.
[5]	Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother 2008; 42:1373.
[6]	Lee JY, Leblanc K, Fernandes OA, et al. Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry. Ann Pharmacother 2010; 44: 1887.
[7]	Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005; 165: 424.
[8]	Vira T, Colquhoun M, Etchells EE. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care 2006; 15: 122-6.
[9]	Institute of Medicine. Preventing Medication Errors. Washington, DC: The National Academies Press; 2007.
[10]	Barnsteiner JH. Medication reconciliation: transfer of medication information across settings: keeping it free from error. J Infus Nurs. 2005; 28(2 suppl):31-6.
[11]	Rozich J, Roger R. Medication safety: one organization’s approach to the challenge. J Clin Outcomes Manag. 2001; 8: 27-34.
[12]	Murphy EM, Oxencis CJ, Klauck JA, et al. Medication reconciliation at an academic medical center: implementation of a comprehensive program from admission to discharge. Am J Health Syst Pharm. 2009; 66: 2126-31.
[13]	Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006; 166: 565-71.
[14]	Feldman, Costa Et al. Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. Journal of Hospital Medicine. 2012 May-Jun: 7(5): 396-401.
[15]	Schuetz B, Mann E, Everett W. Educating health professionals collaboratively for teambased primary care. Health Affairs. 29 No. 8 (2010): 1476-1480.
[16]	Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D, et al. Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med 2010; 25: 441-7.
[17]	Nassaralla CL, Naessens JM, Chaudhry R, Hansen MA, Scheitel SM. Implementation of a medication reconciliation process in an ambulatory internal medicine clinic. Quality & Safety in Health Care. 2007; 16(2): 90-94.
[18]	Kripalani S1, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, Shintani A, Sponsler KC, Harris LJ, Theobald C, Huang RL, Scheurer D, Hunt S, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Bates DW, Williams MV, Schnipper JL; PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012 Jul 3; 157(1): 1-10.
[19]	Orrico KB. Sources and types of discrepancies between electronic medical records and actual outpatient medication use. J Manag Care Pharm. 2008 Sep; 14(7):626-31.
[20]	Hawes EM, Maxwell WD, White SF, Mangun J, Lin FC. Impact of an outpatient pharmacist intervention on medication discrepancies and health care resource utilization in posthospitalization care transitions. J Prim Care Community Health. 2014 Jan 1; 5(1): 14-8.
[21]	Stewart AL, Lynch KJ. Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care. Pharm Pract (Granada). 2014 Jan; 12(1):360. Epub 2014 Mar 24.