Nursing-Pharmacy collaboration on medication reconciliation: Information management and quality improvement

In hospitals, limited members of a multidisciplinary team obtain medication histories from patients basing their treatment according to their home medication list. A quasi-experimental design was used to evaluate the effectiveness of the clinical coordination information team in preventing potential adverse drug events for two medicine services within 24 hours of admission and discharge. A generalized linear model using a log link was used to test for relationships between age, sex, time for initial interview, and time for the remainder of the protocol. Preliminary data show that 44% (95% CI, 37%-50%) of patients had at least one unintended discrepancy (defined as level of potential to cause harm to patient). The average age was 55.6 years (SD 16.6, range 19-89), 50.2% were male, and 66% of the patients are African Americans. 67% of the discrepancies were ranked as having the potential to cause moderate to severe harm (Level 3 discrepancy). The most common error of discrepancy was ‘dose' and the most common drug of discrepancy was ‘cardiovascular' associated with the largest number and most severe medication discrepancies. Complex medication use and education were predictors of having at least one discrepancy. The average interview time was 11.2 minutes and average protocol time to obtain the best medication list was 29.3 minutes. Hospitals should have team members assigned to obtain the best medication list from the patient to minimize the quantity and nature of these discrepancies. Team members should be particularly sensitive and aware of educational and age issues when determining a patient's medication list.