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APHA Scientific Session and Event Listing

Melissa C. Bartick, MD, MS¹, David Baron, MD¹, Steven Cano, MS, RPh², Claire Paras, RN, MBA, CPHQ³, and Kathyrn Babel, RN⁴. (1) Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, 617 546 -0794, melissabartick@earthlink.net, (2) Department of Phamacy, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, (3) Nursing Administration, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, (4) Addictions Unit, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139

Background: Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. Research shows that reconciling medications can reduce many of these errors. Medication reconciliation is a process by which an accurate history of a patient's home medications is obtained, and then each medication is accounted for at admission, transfer and discharge. Before its conception in 2001, reconciliation did not routinely occur in most hospitals, leading to omitted medications, as well as orders for discontinued medications or dosages. The Joint Commission for Accreditation of Hospitals Organization mandated that all hospitals reconcile medications by January 1, 2006. This challenging process requires cooperation across many disciplines, and leads to new levels of accountability for nurses, pharmacists, and physicians.

A collaborative of hospitals organized by the Massachusetts Coalition for the Prevention of Medical Errors has led our state, and the nation, in medication reconciliation. Most hospitals initiate the process with a worksheet. Many hospitals eventually adopt a medication reconciliation order form, upon which the initial medications are entered and the physician indicates whether each medication will be continued or discontinued. Cambridge Health Alliance (CHA) has three community hospitals, all with sizable underserved populations and barriers to care. Each hospital has its own culture, making implementation especially challenging.

Methods: Since the beginning of the state-wide collaborative, CHA set an objective to reduce errors on admission. CHA began with a reconciliation worksheet, which resulted in improvement in obtaining an accurate medication list. By June 2005, we had fully implemented a reconciliation worksheet on admission. In September 2005, CHA began to pilot its first medication reconciliation order form on selected units of all three campuses. Subsequent phases of the process will include reconciliation at transfer and discharge, utilizing inpatient pharmacy profiles.

Results: We discovered many challenges in implementing the process across three separate campuses simultaneously, but we also found that implementation has led to greater awareness around preventing medication errors. Data for this period shows a 43% reduction in adverse drug events. We also found that medication reconciliation impacts many other processes, such as implementation of Computerized Physician Order Entry. Conclusion: Medication reconciliation is an important but challenging strategy to prevent medication errors and their complications.

Learning Objectives: At the end of this session, the participant will be able to

• Define "medication reconciliation."
• Recognize the unique challenges in implementing medication reconciliation.
• Describe the significance of medication reconciliation as a quality improvement tool.

Keywords: Hospitals, Quality Improvement

Related Web page: www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/Medication+Reconciliation+Review.htm

Presenting author's disclosure statement:

Not Answered