Impact of Medication Reconciliation on Medication Error Rates in Community Hospital Cardiac Care Units

Abstract

Background/Objective Medication reconciliation has become a practice standard across the country. We conducted a prospective study to measure the impact of medication reconciliation on the rates of medication error in cardiac care units. Methods We used 2 cardiac care units of similar size and case mix index (a measure of patient acuity) at separate hospitals to measure the difference in changes in medication error rates when medication reconciliation was implemented in the study unit, but not the control unit. A total of 457 patients were enrolled. Medication histories were recorded and compared with medication orders at admission to the units and upon transfer or discharge from the units. Errors were categorized as omission, incorrect drug order details, therapeutic duplication, missing information, medication allergy, drug interaction, incorrect therapeutic substitution, or contraindication. Adjudication of errors was done by a 3-pharmacist panel that was blinded to study group. A Poisson regression model was used to determine the significance of the difference in error rate changes between the study and control units. Results Errors were found in 325 of 7,203 orders reviewed (4.5%). Medication error rates decreased from 7.2% to 3.4% in the study group (3.8% absolute error reduction) and from 4.3% to 3.3% in the control group (1% absolute error reduction). The difference in changes in error rates between groups was statistically significant ( P < .0001). Conclusion Medication reconciliation has been one of the most costly and difficult health care quality improvement initiatives in recent history. Based on our findings, it appears that significant reductions in medication errors, the primary purpose for its implementation, can be achieved.