Medication Reconciliation: A Case Study
The Institute for Safe Medication Practices Canada (ISMP Canada) defines medication reconciliation as “a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care.”1 It is based on “a systematic and comprehensive review of all the medications were taking by patient and to ensure that medications being added, changed or discontinued are carefully evaluated. Medication reconciliation has been endorsed by patient safety organizations and implemented in many institutions around the world to ensure accurate communication on admission, on transfer, and at discharge
Medication errors are common when patients transfer across healthcare boundaries (McCullagh M, O'Kelly P, Gilligan P. 2015)
More than 40% ofmedication errors can be traced to inadequate reconciliation (Monte AA1, Anderson P2, Hoppe JA3, Weinshilboum RM4, Vasiliou V2, Heard KJ3, 2015)
Medication errors are among the most common medical errors, and they may be related to professional practice, health care products and system, including prescribing, order communication, product labeling, packaging and compounding, dispensing, distribution, …show more content…
administration, education, monitoring and use.
Those errors can be defined as any preventable event that may cause or lead to inappropriate use or patient harm while the medication is in the control of the health care professionals or patient. However, polypharmacy in geriatrics is one of the most causes which lead to such types of errors.
This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care (Admission, Transfer and/or Discharge). This process comprises five 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; 4) make clinical decisions based on the comparison; and 5) communicate the new list to appropriate caregivers and to the patient.
Moreover, medication reconciliation has three steps, as described by the Institute for Healthcare Improvement (IHI): 1) Verification (collection of the patient’s medication history); 2) Clarification (ensuring that the medications and doses are appropriate); and; 3) Reconciliation (documentation of changes in the orders).
Lastly, medication reconciliation is a substantial process to reducing medication errors among geriatrics patients because of their high number of diseases and medications usage.
The possible causes that contribute to this phenomenon include inadequate and erroneous handoffs during patient admission, transfer and discharge. These errors may harm the patients, especially older patients; hence, medication reconciliation is necessary to correct the mistakes. Even though research in this field is an on-going activity, more studies are needed on the adoption and execution of effectual medication reconciliation by identifying best advanced practices for the process.
Medication reconciliation is a process of ascertaining and comparing the precise list of a patient’s current medication with the medication noted in the patient’s record (Franzen, Lenssen, Jaehde, & Eisert, 2014). The list should include the name, frequency, dosage and route of administration. Conversely, polypharmacy refers to taking of multiple medications at the same time to manage coexisting health problems (Woodruff, 2010). Polypharmacy mostly affects older adults and may become problematic, especially, when patients are prescribed many medications by different healthcare personnel at different places. It is, therefore, extremely important to conduct medication reconciliation for patients with polypharmacy medications so as to evade any adverse effects (Sanchez, Sethi, Santos, & Boockvar, 2014).
Literature Review
In medication reconciliation, healthcare personnel work together with care providers, families and the target patients to ensure that complete and correct medication information is communicated from pre-admission to discharge. Significantly, when care or records are transferred from one station to another, the current correct list of medication and reasons for any change should be given to the new caregiver. The important points of transition that should be given more attention include: admission to hospital, relocation from home to hospital, handover from intensive care unit to the ward and transfer from one hospital to another. Ultimately, this reduces the number of readmissions and length of stay by patients (Lehnbom, Stewart, Manias, & Westbrook, 2014).
Woodruff (2010) notes that there are, currently, about “44% of men and 57% of women older than age 65 who take five or more medications per week.” Usually, when a patient takes more drugs, the risk of drug interactions and adverse reactions increase.
Further studies show that accidental medication discrepancies at admission occur in about one-third of the patients whereas a similar percentage occurs at the time of the transfer between sites within a hospital. For these reasons, medication reconciliation is important; the healthcare provider should comprehensively and systematically review the current patients’ medication records to enable accurate assessment, recording, addition, discontinuation or changing of the right medications. Lehnbom, Stewart, Manias, & Westbrook (2014) notes that this will save lives and reduce harmful effects by preventing errors of duplication, omission, incorrect dosage and drug-drug interactions. The mistakes made in medication records may cause patients to be unresponsive to the right medication or develop more medical complications (Fuji & Abbott, 2014). Principally, the four most important components of Medical Reconciliation include correct medication information from the patient, physician, home medication list and the current medication list, so as to get a complete updated list of medication.
There are many reasons that contribute to the inadequacies of current day inpatient MedRec.
Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting (Siu HK, 2015).
Previous research has shown that many older adults without known cognitive impairment are unable to recall basic knowledge about their medical history due to memory difficulties. Clinicians treating older adults should be very cautious before relying on their patients' memories for accurate recall of their medical conditions, their drug regimens, and even the number of drugs they are taking. (Jones G1, Tabassum V, Zarow GJ, Ala TA,
2015).
Aims and Objectives
The main objective of medication reconciliation, especially for patients with polymorphic medication, is to prevent harm from medications, also known as, adverse drug events (ADEs). This reduces the risks for patients and promotes accuracy in health systems. The implementation of medical reconciliation also improves the medication safety in hospitals (Freisinger, Lám, Barki, Király, & Belicza, 2014). Nevertheless, medication reconciliation process also assists to prevent the many unplanned hospital readmissions and hospitalizations for ambulatory care-sensitive conditions. Another objective, according to Lehnbom, Stewart, Manias, & Westbrook (2014), is to reduce the overall health care costs and improve patient clinical outcomes by thoroughly reviewing the complete medication regimen of the patients so as to avoiding risky inconsistencies in medication lists. Medication reconciliation also aims at obtaining and maintaining complete and accurate information for the patients, to be utilized in other departments of the healthcare institution.
Purpose:
The main purpose of this study is to assess the impact and effectiveness of medication reconciliation among geriatric patients while they are admitted in a healthcare institution to improve their clinical outcomes.
Significance of Study
Medication reconciliation, consultation and therapy review in different settings of the healthcare system will result in reduction of emergency department visits, physician visits, hospital days, and overall cost that patients and institutions face.
Methodology
Methods:
A cross-sectional study (for period of time) for geriatric patients with polypharmacy admitted to the healthcare institution by recording and reviewing their medication history, medication orders and discharge medications.
This process involves discussion with patients/carers and using primary care records.
Within 24-48 hours of admission
The main methods used to collect information in this study are observation and gathering of information from secondary sources, for example, the patient’s medical records during the pre-admission, admission, transitions and discharge phases. Other secondary sources may include reliable and verified resources such as those from the Hospital records, personal doctors’ records, Ministry of Health, national statistics institutions and national libraries. The next methods that will be used are the interview sessions. The people who will be interviewed shall consist of patients, doctors, physicians, discharge planners, nurses, pharmacists, and other personnel in other related areas of focus (e.g. outpatient clinics, inpatient units, and procedural areas). In addition, the interviews will be performed to obtain, verify, and record the similarities and discrepancies in patients’ current prescription, home medication list and over-the-counter medications during patient admission and discharge.
Medication errors are common when patients transfer across healthcare boundaries (McCullagh M, O'Kelly P, Gilligan P. 2015)
More than 40% ofmedication errors can be traced to inadequate reconciliation (Monte AA1, Anderson P2, Hoppe JA3, Weinshilboum RM4, Vasiliou V2, Heard KJ3, 2015)
Medication errors are among the most common medical errors, and they may be related to professional practice, health care products and system, including prescribing, order communication, product labeling, packaging and compounding, dispensing, distribution, …show more content…
administration, education, monitoring and use.
Those errors can be defined as any preventable event that may cause or lead to inappropriate use or patient harm while the medication is in the control of the health care professionals or patient. However, polypharmacy in geriatrics is one of the most causes which lead to such types of errors.
This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care (Admission, Transfer and/or Discharge). This process comprises five 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; 4) make clinical decisions based on the comparison; and 5) communicate the new list to appropriate caregivers and to the patient.
Moreover, medication reconciliation has three steps, as described by the Institute for Healthcare Improvement (IHI): 1) Verification (collection of the patient’s medication history); 2) Clarification (ensuring that the medications and doses are appropriate); and; 3) Reconciliation (documentation of changes in the orders).
Lastly, medication reconciliation is a substantial process to reducing medication errors among geriatrics patients because of their high number of diseases and medications usage.
The possible causes that contribute to this phenomenon include inadequate and erroneous handoffs during patient admission, transfer and discharge. These errors may harm the patients, especially older patients; hence, medication reconciliation is necessary to correct the mistakes. Even though research in this field is an on-going activity, more studies are needed on the adoption and execution of effectual medication reconciliation by identifying best advanced practices for the process.
Medication reconciliation is a process of ascertaining and comparing the precise list of a patient’s current medication with the medication noted in the patient’s record (Franzen, Lenssen, Jaehde, & Eisert, 2014). The list should include the name, frequency, dosage and route of administration. Conversely, polypharmacy refers to taking of multiple medications at the same time to manage coexisting health problems (Woodruff, 2010). Polypharmacy mostly affects older adults and may become problematic, especially, when patients are prescribed many medications by different healthcare personnel at different places. It is, therefore, extremely important to conduct medication reconciliation for patients with polypharmacy medications so as to evade any adverse effects (Sanchez, Sethi, Santos, & Boockvar, 2014).
Literature Review
In medication reconciliation, healthcare personnel work together with care providers, families and the target patients to ensure that complete and correct medication information is communicated from pre-admission to discharge. Significantly, when care or records are transferred from one station to another, the current correct list of medication and reasons for any change should be given to the new caregiver. The important points of transition that should be given more attention include: admission to hospital, relocation from home to hospital, handover from intensive care unit to the ward and transfer from one hospital to another. Ultimately, this reduces the number of readmissions and length of stay by patients (Lehnbom, Stewart, Manias, & Westbrook, 2014).
Woodruff (2010) notes that there are, currently, about “44% of men and 57% of women older than age 65 who take five or more medications per week.” Usually, when a patient takes more drugs, the risk of drug interactions and adverse reactions increase.
Further studies show that accidental medication discrepancies at admission occur in about one-third of the patients whereas a similar percentage occurs at the time of the transfer between sites within a hospital. For these reasons, medication reconciliation is important; the healthcare provider should comprehensively and systematically review the current patients’ medication records to enable accurate assessment, recording, addition, discontinuation or changing of the right medications. Lehnbom, Stewart, Manias, & Westbrook (2014) notes that this will save lives and reduce harmful effects by preventing errors of duplication, omission, incorrect dosage and drug-drug interactions. The mistakes made in medication records may cause patients to be unresponsive to the right medication or develop more medical complications (Fuji & Abbott, 2014). Principally, the four most important components of Medical Reconciliation include correct medication information from the patient, physician, home medication list and the current medication list, so as to get a complete updated list of medication.
There are many reasons that contribute to the inadequacies of current day inpatient MedRec.
Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting (Siu HK, 2015).
Previous research has shown that many older adults without known cognitive impairment are unable to recall basic knowledge about their medical history due to memory difficulties. Clinicians treating older adults should be very cautious before relying on their patients' memories for accurate recall of their medical conditions, their drug regimens, and even the number of drugs they are taking. (Jones G1, Tabassum V, Zarow GJ, Ala TA,
2015).
Aims and Objectives
The main objective of medication reconciliation, especially for patients with polymorphic medication, is to prevent harm from medications, also known as, adverse drug events (ADEs). This reduces the risks for patients and promotes accuracy in health systems. The implementation of medical reconciliation also improves the medication safety in hospitals (Freisinger, Lám, Barki, Király, & Belicza, 2014). Nevertheless, medication reconciliation process also assists to prevent the many unplanned hospital readmissions and hospitalizations for ambulatory care-sensitive conditions. Another objective, according to Lehnbom, Stewart, Manias, & Westbrook (2014), is to reduce the overall health care costs and improve patient clinical outcomes by thoroughly reviewing the complete medication regimen of the patients so as to avoiding risky inconsistencies in medication lists. Medication reconciliation also aims at obtaining and maintaining complete and accurate information for the patients, to be utilized in other departments of the healthcare institution.
Purpose:
The main purpose of this study is to assess the impact and effectiveness of medication reconciliation among geriatric patients while they are admitted in a healthcare institution to improve their clinical outcomes.
Significance of Study
Medication reconciliation, consultation and therapy review in different settings of the healthcare system will result in reduction of emergency department visits, physician visits, hospital days, and overall cost that patients and institutions face.
Methodology
Methods:
A cross-sectional study (for period of time) for geriatric patients with polypharmacy admitted to the healthcare institution by recording and reviewing their medication history, medication orders and discharge medications.
This process involves discussion with patients/carers and using primary care records.
Within 24-48 hours of admission
The main methods used to collect information in this study are observation and gathering of information from secondary sources, for example, the patient’s medical records during the pre-admission, admission, transitions and discharge phases. Other secondary sources may include reliable and verified resources such as those from the Hospital records, personal doctors’ records, Ministry of Health, national statistics institutions and national libraries. The next methods that will be used are the interview sessions. The people who will be interviewed shall consist of patients, doctors, physicians, discharge planners, nurses, pharmacists, and other personnel in other related areas of focus (e.g. outpatient clinics, inpatient units, and procedural areas). In addition, the interviews will be performed to obtain, verify, and record the similarities and discrepancies in patients’ current prescription, home medication list and over-the-counter medications during patient admission and discharge.