Original ResearchMedication reconciliation: A qualitative analysis of clinicians' perceptions
Section snippets
Background/rationale
Medication management is a prevalent and critical component of health care delivery and the most common source of error in health care.1, 2, 3 The adverse effects of medications have staggering economic consequences, and for elderly patients, adverse drug events (ADEs) are a leading cause of morbidity and mortality.4, 5 ADEs, defined as “harm resulting from the use of a drug,”3, 6, 7 are frequent in hospitalized patients, with estimates ranging from less than 3%8 to more than 32%.9 Hospitalized
Overview of the study
This qualitative study consisted of focus groups of physicians, nurses, and pharmacists conducted in 2008-2009 to gather data on interprofessional communication and ADEs at 3 Department of Veteran's Affairs Health Administration (VA) hospitals in the United States. Although there was no specific intent to target the distinct process of medication reconciliation in the study, the topic emerged frequently, both directly in reference to activities to prevent ADEs and implicitly related to shared
Results
Two major thematic questions consistently emerged from the focus group discussions about medication reconciliation: (1) What does medication reconciliation really mean? and (2) Who is actually responsible for the process? Each is discussed below in more detail.
Discussion
The 2 overarching themes of what does medication reconciliation really mean and who is actually responsible for the process are consistent with experts who suggest successfully minimizing medication errors at patient transitions requires a clearer definition of medication reconciliation and more clearly defined roles.30 However, this study moves beyond medication reconciliation as a means to minimize error30, 31 by suggesting that when considered in the larger process of medication management,
Conclusion
Medication reconciliation has been at the forefront of national patient safety efforts for nearly a decade, yet health care institutions remain challenged with implementation. Recognizing that medication reconciliation is an important process that impacts medication management and overall patient safety is important to gaining momentum toward successful translation into practice. Acknowledging the limitations of technology as well as the contribution of each clinical role in the process of
Acknowledgments
This project was funded by VA Health Services Research & Development NRI 05-275.
References (41)
- et al.
Adverse drug reaction risk factors in older outpatients
Am J Geriatr Pharmacother
(2003) - et al.
Medication reconciliation during the transition to and from long-term care settings: a systematic review
Res Social Adm Pharm
(2012) - et al.
Making inpatient medication reconciliation patient centered, clinically relevant, and implementable: a consensus statement on key principles and necessary first steps
Jt Comm J Qual Patient Saf
(2010) - et al.
An effort to improve electronic health record medication list accuracy between visits: patients' and physicians'
Int J Med Inform
(2008) - et al.
Improving communication in the ICU using daily goals
J Crit Care
(2003) - et al.
Does the addition of a pharmacist transition coordinator improve evidence based medication management and health outcomes in older adults moving from the hospital to a long term care facility: results of a randomized, controlled trial
Am J Geriatr Pharmacother
(2004) - et al.
Provision of risk management and risk assessment information: the role of the pharmacist
Res Social Adm Pharm
(2006) To Err Is Human: Building a Safer Health System
(2000)- et al.
Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies
JAMA
(1998) Frequency, consequences and prevention of adverse drug events
J Qual Clin Pract
(1999)
Is age an independent risk factor of adverse drug reactions in hospitalized medical patients?
J Am Geriatr Soc
Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting
Ann Intern Med
Developing a taxonomy for research in adverse drug events: potholes and signposts
Proc AMIA Symp
Computerized surveillance of adverse drug events in hospital patients
JAMA
High rates of adverse drug events in a highly computerized hospital
Arch Intern Med
Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance
Jt Comm J Qual Patient Saf
Effect of admission medication reconciliation on adverse drug events from admission medication changes
Arch Intern Med
Adverse effects due to discontinuation in drug use and dosage changes in patients transferred between acute and long term care facilities
Arch Intern Med
Incidence and severity of adverse events affecting patients after discharge from the hospital
Ann Intern Med
Medication discrepancies on admission to a nursing home
Am J Hosp Pharm
Cited by (44)
Assessment of medication reconciliation practices among prescribers and pharmacy students
2023, Pharmacien ClinicienImplementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research
2022, Research in Social and Administrative PharmacyCitation Excerpt :MR was considered complex because it also involves, in the participants’ view, patient clinical assessment to understand medication discrepancies and identify other drug-related problems. Although checking for medication discrepancies is crucial, pharmacotherapy optimization during MR has been discussed, that is, it would also include the assessment of whether the medicines on the correct list are necessary, effective and safe.9,29,35,36 This can make the service less mechanistic and more cognitive, improving the relative advantage of MR.9,29 Such aspects refer to the importance of training the professionals who lead the MR service.
Medication Reconciliation: The Foundation of Medication Safety for Patients Requiring Dialysis
2020, American Journal of Kidney DiseasesCitation Excerpt :One potential solution to overcome this challenge may be integrating a process for systematic transfer of discharge medication lists from hospitals to dialysis units. Significant internal challenges to medication reconciliation may include resistance by leadership and clinicians to adequately resource medication reconciliation due to competing organizational priorities, limited resources, or confusion over who is responsible for performing medication reconciliation.29,30 It will be important to get leadership support to implement processes that facilitate medication reconciliation, including training staff and integrating medication reconciliation into the workflow.
Inter-facility communication barriers delay resolving medication discrepancies during transitions of care
2019, Research in Social and Administrative PharmacyUsing the Behaviour Change Wheel to identify interventions to facilitate the transfer of information on medication changes on electronic discharge summaries
2017, Research in Social and Administrative PharmacyCitation Excerpt :Despite this, doctors still reported that the information recorded in the EPR, during the patient's admission was unreliable or lacking. This is similar to previous findings29,44 and makes it difficult for junior doctors to write discharge summaries and transfer knowledge.46 In this study some doctors reported boxes were left blank on the discharge summaries.