Medication Reconciliation: Why it's Vital
Published: 19 February 2020
Published: 19 February 2020
Medication reconciliation is a formal process for reviewing a patient’s complete medication regimen at the time of admission, transfer, and discharge and comparing it with the regimen being considered for the new care environment (Patient Safety Network 2019).
In essence, medication reconciliation aligns the correct medication with the correct patient. It is closely tied to the concept of maintaining continuity of care.
Medication reconciliation is particularly important in transitional points of care such as during admission, transfer, and discharge.
When a person in care is moved between wards, hospitals or their home, a list of medicines which should be current and accurate (including reasons for change) will be provided to the health professional or carer in charge of that patient’s care (Health Vic n.d.).
Accidental changes to medications occur often and for a vast range of reasons. For example, hospital staff may be unable to access a patient’s complete pre-admission medication list or could be unaware of very recent changes in medication. Because of this, the new medication plan prescribed at discharge could accidentally exclude required medications, unnecessarily duplicate existing therapies, or list incorrect dosages (Patient Safety Network 2019).
These discrepancies make patients vulnerable to adverse drug events (ADEs), which are known to be one of the primary types of adverse events following hospital discharge (Patient Safety Network 2019).
The following is integral to effective medication reconciliation:
Developed by America’s Agency for Healthcare Research and Quality (AHRQ), the MATCH (Medications at Transitions and Clinical Handoffs) toolkit is designed to provide principles for an effective medication reconciliation process.
(Health Vic n.d.)
A systematic review conducted in 2016 found evidence that pharmacist-led processes could help to reduce medication discrepancies and potential ADEs at time of hospital admission, in-hospital transitions of care (for example moving a patient into or out of intensive care), and at hospital discharge (Patient Safety Network 2019).
Additionally, a review published in 2013 found that pharmacist involvement in medication reconciliation prevented discrepancies and potential ADEs after discharge (Patient Safety Network 2019).
These studies aside, there is a noticeable gap in research as to the direct relationship between medication reconciliation and adverse drug effects. While information technology solutions are being analysed, their influence in regards to preventing medication discrepancies and improving clinical outcomes are similarly underdeveloped (Patient Safety Network 2019).
Statistics show that medication error is prevalent and a common cause of harm to patients.
(Health Vic n.d.; Duguid 2012)
A 'best possible medication history' is an integral aspect of the medication reconciliation process. It is a comprehensive drug history obtained by a clinician that includes a thorough account of all regular medicines used, including non-prescription and complementary medicines, and is verified by multiple sources (Duguid 2012).
A structured process for taking this history, that involves the patient, carer and family, using a checklist to guide the interview, and that verifies the history with information from numerous sources, provides the most comprehensive assessment of the medicines a patient takes at home or in previous settings (Duguid 2012).
Applying a formalised and structured approach to medication reconciliation that is carried out in partnership with patients and carers, and is conducted in an environment of mutual accountability, has the potential to reduce the occurrence of medication errors that take place at cross-sections of care (Duguid 2012).
Medication reconciliation at transitional points of care: admission; transfer; and discharge, is an important element of patient safety and prevents our health services from incurring economic burden (Duguid 2012).
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