Medicine Reconciliation

There are often changes to a patient's medicine when their care is handed over to other health professionals, such as during admission to, transfer or discharge from hospital. Some of these medicine changes are unintentional due to poor information and some are intentional but not clearly documented.  Both types of change can result in medication errors and/or patient harm.

We know:

• between 10 to 67 percent of medication histories have at least one error [1]
• up to one-third of these errors have the potential to cause patient harm [2]
• more than 50 percent of medication errors occur at transitions of care [3][4]
• patients with one or more medicines missing from their discharge information are 2.3 times more likely to be readmitted to hospital than those with correct information on discharge. [5]

Medicine reconciliation is about obtaining the most accurate list of patient medicines, allergies and adverse drug reactions and comparing this with the prescribed medicines and documented allergies and adverse drug reactions.  Any discrepancies are then documented and reconciled.

Medicine reconciliation is everybody’s business. Strong collaboration, communication and teamwork between medical, nursing, ambulance and pharmacy staff involved in the patient’s care and the patient, their carer or family members is vital for its success.

In the January–March 2015 quarter the Commission began reporting the baseline of a new set of quality and safety markers (QSMs) relating to electronic medicine reconciliation (eMR). These are based on the implementation of eMR in DHB hospitals.

The structural markers are:

• eMR implemented anywhere in the DHB
• Number and percentage of relevant wards with eMR implemented

The process markers are:

• percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMR was undertaken within 72 hours of admission
• percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMR was undertaken within 24 hours of admission
• percentage of patients aged 65 and over (55 and over for Māori and Pacific patients) discharged where medicine reconciliation was included as part of the discharge summary.

References

 [1] Tam VC, Knowles SR, Cornish PL, et al. 2005. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ 173(5): 510-5.

 [2] Cornish PL, Knowles SR, Marchesano R, et al. 2005. Archives of Internal Medicine 165: 424 -9.

 [3] Sullivan C, Gleason KM, Rooney D, et al. 2005. Medication reconciliation in the acute care setting: opportunity and challenge for nursing. Journal of Nursing Care Quality 20: 95-98.

 [4]Stowasser DA, Stowasser M, Collins DM. 2002. A randomised controlled trial of medication liaison services - acceptance and use by health professionals. Journal of Pharmacy Practice and Research 32: 133-40.

 [5] Gleason KM, McDaniel MR, Feinglass J, et al. 2010. Results of the Medications At Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. Journal of General Internal Medicine 25(5):441-447.