N031 The Facts Vs. Fiction of Medication Reconciliation: A Medication Discrepancy Audit in an Ambulatory Heart Failure Clinic

Abstract

Medication errors represent one of the most common patient safety errors. Many of these errors would be averted if medication reconciliation (MR) processes were in place. MR is a formal process for creating the most complete and accurate list possible of a patients current medications and comparing the list to those in the patient record or medication orders to avoid medication errors. For patients in ambulatory settings, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed. A multitude of factors such as patient's lack of knowledge about their medications, care providers workflow, and lack of integration of patient health records across the continuum of care, can contribute to a lack of a complete medication reconciliation, which in turn creates the potential for error. The heart failure clinic team at St. Boniface Hospital provides medication teaching and performs MR at every patient visit. To evaluate causes of medication discrepancies and plan for reducing medication errors, a prospective three month audit was completed. The result of the audit of 253 patient encounters showed that 85 % of encounters were void of medication discrepancies. Medication discrepancies were identified in 15% of encounters. None of the discrepancies caused harm to patients. Further analysis of the data will be provided. Team collaboration through effective patient education, formal medication reconciliation process and medication discrepancy audit are important steps in ensuring reduction in medication error and patient safety.