Impact of Medication Reconciliation upon Discharge on Reducing Medication Errors

Sara Al Khansa,Mohammed Aseeri,Amnah Mukhtar,Merryland Abduljawad

doi:10.4172/2329-6887.1000222

Abstract

Background: Medication errors at the time of hospital admission and discharge are common and can lead to preventable adverse drug events. Medication reconciliation is a technique for identifying discrepancies in drug regimens, forming prescribing decisions and preventing medication errors. Accurate and complete medication reconciliation is an important patient safety issue which can prevent harm. Objective: To determine the incidence and characteristics of unintentional medication discrepancies and to describe the potential impact of medication reconciliation to identify and rectify medication errors at the time of hospital discharge. Design and setting: Retrospective study conducted at King Faisal Specialist Hospital (KFSH) in Jeddah from the period of July 2010 till June 2011. Patients: 100 patients were selected from each month (February, March, April-2010) making a total of 300. Method: Data was retrieved from the outpatient pharmacy, discharge section where medication reconciliation is conducted and records are kept in a monthly filing system. Medication discrepancies at discharge were determined by comparing medications lists at discharge with pre-admission and in-patient medications. All variances were classified as intended or unintended (medication errors). The primary outcome was the number and type of these unintentional discrepancies. Results: Majority of patients where under internal medicine and lowest percentage being in pediatrics. Mean number of discharge medications was 8 (SD ± 3). Total number of discrepancies was 200 (8.6%). 108 (34.67%) patients had discrepancies. Out of these, 93 (86.1%) were adults and 15 (13.9%) were children. Omission error was the most common type of discrepancy (63%), and drug interactions (0.3%) was the least. Improper dose was the most common prescribing error (32.4%), and improper frequency (15.1%) was the least. 19.3% of patients had at least 1 discrepancy. Most of the discrepancies where under internal medicine and cardiology. Most discrepancies were noticed in the month of February. Conclusion: Unintended medication variances at the time of hospital discharge are common. Medication reconciliation was a successful tool in detecting and rectifying discharge medication errors.

Highlights

Medication Reconciliation is a process of identifying the most accurate list of all medications a patient is taking-including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system
Data was retrieved from the outpatient pharmacy, discharge section where medication reconciliation is conducted and records are kept in a monthly filing system
Data was retrieved from the outpatient pharmacy, discharge section, where medication reconciliation is conducted and records are kept in a monthly filing system

Summary

Introduction

Medication Reconciliation is a process of identifying the most accurate list of all medications a patient is taking-including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. This process comprises 7 steps: 1) Develop a list of current medications; 2) Develop a list of medications to be prescribed; 3) Compare the medications on the two lists with the goal of identifying, preventing, and resolving drug related problems; 4) Document discrepancies between the two lists, whether they are intentional or unintentional; 5) Make clinical decisions based on the comparison; 6) Contact the ordering prescriber and reconcile medications within a specified time frame; and 7) Communicate the new list to appropriate caregivers and to the patient in a clear concise form. Medication errors at the time of hospital admission and discharge are common and can lead to preventable adverse drug events. Medication reconciliation is a technique for identifying discrepancies in drug regimens, forming prescribing decisions and preventing medication errors. Accurate and complete medication reconciliation is an important patient safety issue which can prevent harm

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Conclusion