REPORT: September 2006

Research News You Can Use: Base Your Practice on Evidence

Take medication safety a step further with medication reconciliation

by Amy Wysoker, PhD, RN, APRN, BC; professor, C.W. Post Campus, Long Island University; member, Council on Nursing Research

In an article titled “Can technology prevent medication errors?” on page 12 of this issue, the author presents an excellent guide for direct care practitioners to avoid medication errors and provide safe medication administration. In it, the author notes “technology is only part of the solution.”

This article supplements that discussion by focusing on another aspect of medication safety — medication reconciliation.

“Medication reconciliation is a process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.” (Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2006).

What is the evidence?

At least 50% of hospital medication errors and 20% of adverse drug events occur during patient transition (Institute for Health Care Improvement [IHI], n.d.; IHI, n.d.; IHI, 2006).

Rozich and Resar (2001) reported that more than 50% of medication errors occurred during transitions. Forster and colleagues (2003, 2004) found that within two weeks post discharge 12% of patients experienced an adverse drug event. In another study by the same lead author and his associates, approximately 25% of patients experienced an adverse drug effect following discharge. Of that number, half of the adverse drug effects were “preventable or ameliorable.”

Evidenced-based practice

Research has begun to identify how medication reconciliation can decrease adverse drug effects. In one project, pharmacy technicians obtained medication histories. This initiative reduced potential adverse drug effects with surgical patients by more than 80% (Michels & Meisel, 2003). Another initiative, which included medication reconciliation, decreased medication errors by 70% and decreased adverse drug events by more than 15% (Whittington & Cohen, 2004).

What Can Be Done?

Nurses play a key role in medication reconciliation. The IHI’s 100,000 Lives Campaign offers the “Getting Starting Kit: Prevent Adverse Drug Events (Medication Reconciliation).” The kit provides an excellent resource for nurses and is available online at www.ihi.org/IHI/.

The following are a few examples of successful nursing interventions in the medication reconciliation process (IHI, 2006; JCAHO, 2006):

• Patients, nurses, physicians, and pharmacists should act as a team in the medication reconciliation process;
• Facilities should compile a medication history upon admission by interviewing the patient, a family member, friend, primary care provider, or pharmacist, or review previous medical records;
• Healthcare providers should obtain a full list of current medications;
• Providers should ask questions in lay terminology and encourage questions from patients. They should obtain the name, dosage form, dosage, and times of administration;
• Facilities should assign the responsibility for obtaining the medication list to someone with expertise;
• Facilities must communicate to the next provider of service the current list of patient’s medication when the patient is transferred to another setting, service, practitioner, or level of care, either within that facility or to another organization; and
• Upon discharge, healthcare providers should offer medication education to the patient and provide a complete list of current medications to the next facility.

By incorporating these guidelines into practice, the nursing profession will be in the forefront of medication reconciliation.

For additional information, readers should review the JCAHO recommendations at www.JACHO.com, the IHI’s 100,000 Lives Campaign at www.ihi.org/IHI/, the Institute for Safe Medication Practices at www.ismp.org, the Massachusetts Coalition for Prevention of Medication Errors at www.macoalition.org, and the American Nurses Association’s patient safety and advocacy information at www.nursingworld.org.

References

Forster, A.J.; Murff, H.J.; Peterson, J.F.; Gandhi, T.K.; & Bates, D.W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals of Internal Medicine 138(3),161-167.

Forster, A.J.; Clark, H.D.; Menard, A.; Dupuis, N.; Chernish, R.; Chandok, N., et al. (2004). Adverse events among medical patients after discharge from hospital. Canadian Medical Association Journal. Retrieved July 31, 2006 from www.cmaj.ca

Institute for Health Care Improvement (n.d.). Errors from unreconciled medications per 100 admissions. Retrieved on July 31 from www.ihi.org

Institute for Health Care Improvement (n.d.). Reconcile medications at all transition points. Retrieved on July 31 from www.ihi.org

Institute for Health Care Improvement (2006). 100,000 lives Campaign, Getting Starting Kit: Prevent Adverse Drug Events, (Medication Reconciliation). Retrieved on July 31 from www.ihi.org

Joint Commission on Accreditation of Health Care Organizations (Jan. 25, 2006). Using medication reconciliation to prevent errors. Retrieved on July 31 from www.jointcommission.org

Michels, R.D. & Meisel, S. (2003). Program using pharmacy technicians to obtain medication histories. American Journal of Health-System Pharmacy, 60(19),1982-1986.

Rozich, J.D., & Resar, R.K. (2001). Medication Safety: One organization’s approach to the challenge, Journal of Clinical Outcomes Management. 8(10), 27-34.

Whittington, J., & Cohen, H. (2004). OSF Healthcare’s journey in patient safety. Quality Management in Health Care. 13(1), 53-59.

This column is available for reprint in other publications. Copyright law protects the content, so permission must be obtained from NYSNA before reprinting. Contact the NYSNA Communications Department at 800-724-NYRN (6976), ext. 275, or communications@nysna.org.