A Review of Medication Reconciliation Issues and Experiences with Clinical Staff and Information Systems

Summary

Medication reconciliation was developed to reduce medical mistakes and injuries through a process of creating and comparing a current medication list from independent patient information sources, and resolving discrepancies. The structure and clinician assignments of medication reconciliation varies between institutions, but usually includes physicians, nurses and pharmacists. The Joint Commission has recognized the value of medication reconciliation and mandated implementation in 2006; however, a variety of issues have prevented simple, easy, and universal implementation. This review references issues related to the development and the implementation of medication reconciliation including: – the need of a system or standard for accurate drug identification to create a definitive ‘gold standard’ patient medication list, – identifying stakeholders of medication reconciliation within the institution and contrasting staff interest and participation with institutional resources, – observations and opportunities of integrating medication reconciliation with the electronic patient health record, and – summarizing a series of institutions experiences developing and implementing medication reconciliation. Last, as medication reconciliation becomes a regular process within medical centers, key concepts for effective implementation are discussed.

Keywords

Medication reconciliation - medical errors - patient safety - medical informatics - drug errors - pharmaceuticals

 

Conflicts of Interest

The authors have no conflicts of interest to disclose. Funding was provided in part for Dr. Waitman through NIH R01 LM007995-04. The portion of this study related to NICU medication reconciliation was reviewed and approved by the Forsyth Medical Center IRB in agreement with Wake Forest University Health Sciences IRB.

• References

• 1 Kohn KT, Corrigan JM, Donaldson MS. To err is human: Building a safer health system. Washington, DC: National Academy Press; 1999
• 2 Institute of Medicine.. Crossing the quality chasm: a new health care system for the 21st century. Washington, DC: National Academy Press; 2001
• 3 Agency for Healthcare Research and Quality.. Medical errors: The scope of the problem. Publication No. AHRQ 00-PO37. accessed 1/2/2010.
• 4 The Joint Commission.. Using medication reconciliation to prevent errors. Jt Comm J Qual Patient Saf 2006; 32: 230-232. PMID:16649655.
• 5 Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN. et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care 2003; 18: 201-205. PMID:14691892.
• 6 Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI. et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999; 282: 267-270. PMID:10422996.
• 7 Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med 2003; 163: 2014-2018. PMID:14504113.
• 8 Kaushal R, Bates DW, Abramson EL, Soukup JR, Goldmann DA. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. Am J Health Syst Pharm 2008; 65: 1254-1260. PMID:18574016.
• 9 Joint Commission on Accreditation of Healthcare Organizations.. 2005 National patient safety goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/05_hap_npsgs.htm (accessed 1/2/2010).
• 10 Joint Commission on Accreditation of Healthcare Organizations.. Medication reconciliation national patient safety goal to be reviewed, refined. http://www.jointcommission.org/PatientSafety/National PatientSafetyGoals/npsg8_review.htm (accessed 1/2/2010).
• 11 Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005; 293: 1223-1238. PMID:15755945.
• 12 US Food and Drug Administration.. Electronic Orange Book (EOB) Query data files. filename: UCM163762.zip; http://www.fda.gov/Drugs/InformationOnDrugs/ucm129689.htm accessed 08//30/2010.
• 13 Chiche L, Thomas G, Canavese S, Branger S, Jean R, Durand JM. Severe hemorrhagic syndrome due to similarity of drug names. Eur J Intern Med 2008; 19: 135-136. PMID:18249310.
• 14 Roth MT, Ivey JL. Self-reported medication use in community-residing older adults: A pilot study. Am J Geriatr Pharmacother 2005; 3: 196-204. PMID:16257822.
• 15 Beckman AG, Parker MG, Thorslund M. Can elderly people take their medicine?. Patient Educ Couns 2005; 59: 186-191. PMID:16257624.
• 16 Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Carbone C. et al. Regimen complexity and medication nonadherence in elderly patients. Ther Clin Risk Manag 2009; 5: 209-216. PMID:19436625.
• 17 Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN. et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005; 165: 424-429. PMID:15738372.
• 18 Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ 2005; 173: 510-515. PMID:16129874.
• 19 Wong JD, Bajcar JM, Wong GG, Alibhai SM, Huh JH, Cesta A. et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother 2008; 42: 1373-1379. PMID:18780806.
• 20 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280: 1339-1346. PMID:9794315.
• 21 Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M, Goodman KW, Gatewood L. et al. A national agenda for public health informatics. J Public Health Manag Pract 2001; 7: 1-21. PMID:11713752.
• 22 Hammond WE. The role of standards in creating a health information infrastructure. Int J Biomed Comput 1994; 34: 29-44. PMID:8125641.
• 23 Hammond WE. Call for a standard clinical vocabulary. J Am Med Inform Assoc 1997; 4: 254-255 PMID:9147345.
• 24 Hersh WR. Medical informatics: improving health care through information. JAMA 2002; 288: 1955-1958. PMID:12387634.
• 25 Miller RA, Gardner RM. Summary recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, The Computer-based Patient Record Institute, The Medical Library Association, The Association of Academic Health Science Libraries, The American Health Information Management Association, and The American Nurses Association. Ann Intern Med 1997; 127: 842-845. PMID:9382409.
• 26 James DG. A new immunosuppressant: tacrolimus. Postgrad Med J 1996; 72: 586. PMID:8977938.
• 27 Cimino JJ. Desiderata for controlled medical vocabularies in the twenty-first century. Methods Inf Med 1998; 37: 394-403. PMID:9865037.
• 28 Nelson SJ, Brown SH, Erlbaum MS, Olson N, Powell T, Carlsen B. et al. A semantic normal form for clinical drugs in the UMLS: early experiences with the VANDF. Proc AMIA Symp. 2002: 557-561. PMID:12463886.
• 29 Hole WT, Srinivasan S. Discovering missed synonymy in a large concept-oriented metathesaurus. Proc AMIA Symp 2000: 354-358. PMID:11079904.
• 30 Cimino JJ. Battling Scylla and Charybdis: the search for redundancy and ambiguity in the 2001 UMLS metathesaurus. Proc AMIA Symp 2001: 120-124. PMID:11825166.
• 31 Liu S, Ma W, Moore R, Ganesan V, Nelson S. RxNorm: Prescription for electronic drug information exchange. IEEE IT Professional 2005: 17-23.
• 32 Parrish F, Do N, Bouhaddou O, Warnekar P. Implementation of RxNorm as a terminology medication standard for exchanging pharmacy medication between federal agencies. AMIA Annu Symp Proc 2006; 1057. PMID:17238676.
• 33 Warnekar PP, Bouhaddou O, Parrish F, Do N, Kilbourne J, Brown SH. et al. Use of RxNorm to exchange codified drug allergy information between Department of Veterans Affairs (VA) and Department of Defense (DoD). AMIA Annu Symp Proc 2007: 781-785. PMID:18693943.
• 34 Bouhaddou O, Warnekar P, Parrish F, Do N, Mandel J, Kilbourne J. et al. Exchange of computable patient data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): terminology mediation strategy. J Am Med Inform Assoc. 2008; 15: 174-183. PMID: 18096911.
• 35 Joint Commission.. Using medication reconciliation to prevent errors. Sentinel Event Alert. 2006 Jan 25; 35.
• 36 Poon EG, Blumenfeld B, Hamann C, Turchin A, Graydon-Baker E, McCarthy PC. et al. Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network. J Am Med Inform Assoc 2006; 13: 581-592. PMID:17114640.
• 37 Turchin A, Hamann C, Schnipper JL, Graydon-Baker E, Millar SG, McCarthy PC. et al. Evaluation of an Inpatient Computerized Medication Reconciliation System. J Am Med Inform Assoc 2008; 15: 449-452. PMID:18436909.
• 38 Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS. et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch. Intern. Med 2009; 169: 771-780. PMID:19398689.
• 39 Medication Reconciliation: Finding Solutions Through Process Mapping. Joint Commission Resources Quality and Safety Network Resource Guide, Joint Commission Resources, June 26, 2008.
• 40 King AR, Russett FS, Generali JA, Grauer DW. Evaluation and implications of natural product use in preoperative patients: a retrospective review. BMC Complement Altern Med 2009; 9: 38. PMID:19825176.
• 41 Orrico KB. Sources and types of discrepancies between electronic medical records and actual outpatient medication use. J Manag Care Pharm 2008; 14: 626-631. PMID:18774872.
• 42 Lesselroth BJ, Felder RS, Adams SM, Cauthers PD, Dorr DA, Wong GJ. et al. Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID). J Am Med Inform Assoc. 2009; 16: 300-304. PMID:19261949.
• 43 Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting senior patients at hospital admission. Am J Health Syst Pharm 2006; 63: 740-743. PMID: 16595814.
• 44 Ferranti JM, Musser RC, Kawamoto K, Hammond WE. The clinical document architecture and the continuity of care record: a critical analysis. J Am Med Inform Assoc 2006; 13: 245-252.
• 45 Dolin RH, Giannone G, Schadow G. Enabling joint commission medication reconciliation objectives with the HL7 / ASTM Continuity of Care Document standard. AMIA Annu Symp Proc 2007: 186-190. PMID:18693823.
• 46 Pronovost P. Medication Reconciliation: A Practical Tool to Reduce the Risk of Medication Errors. Journal of Critical Care 2003; 18: 201-205. PMID:14691892.
• 47 Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U. S. hospitals. Health Aff (Millwood) 2004; 23: 184-190. PMID:15318579.
• 48 Cutler DM, Feldman NE, Horwitz JR. U. S. adoption of computerized physician order entry systems. Health Aff (Millwood) 2005; 24: 1654-1663. PMID: 16284040.
• 49 Lindenauer PK, Ling D, Pekow PS. et al. Physician characteristics, attitudes, and use of computerized order entry. J Hosp Med 2006; 1: 221-230. PMID: 17219503.
• 50 Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM. et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280: 1311-1136. PMID:9794308.
• 51 King WJ, Paice N, Rangrej J, Forestell GJ, Swartz R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003; 112: 506-509. PMID:12949274.
• 52 Cordero L, Kuehn L, Kumar RR, Mekhjian HS. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. J Perinatol 2004; 24: 88-93. PMID:14872207.
• 53 Bails D, Clayton K, Roy K, Cantor MN. Implementing online medication reconciliation at a large academic medical center. Jt Comm J Qual Patient Saf 2008; 34: 499-508. PMID:18792654.
• 54 Agrawal A, Wu WY. Reducing medication errors and improving systems reliability using an electronic medication reconciliation system. Jt Comm J Qual Patient Saf 2009; 35: 106-114. PMID:19241731.
• 55 Varkey P, Cunningham J, Bisping DS. Improving medication reconciliation in the outpatient setting. Jt Comm J Qual Patient Saf 2007; 33: 286-292. PMID:17503684.
• 56 Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm 1999; 56: 2444-2450. PMID:10595804.
• 57 Miller SL, Miller S, Balon J, Helling TS. Medication reconciliation in a rural trauma population. Ann Emerg Med 2008; 52: 483-491. PMID:18550221.
• 58 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-84. PMID:4136544.
• 59 Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F. et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001; 285: 2114-2120. PMID:11311101.
• 60 Isoprime Corporation.. Lisle, IL. http://www.isoprime.com/neodata/introduction.htm (accessed 1/5/2010).
• 61 Murphy EM, Oxencis CJ, Klauck JA, Meyer DA, Zimmerman JM. Medication reconciliation at an academic medical center: implementation of a comprehensive program from admission to discharge. Am J Health Syst Pharm 2009; 66: 2126-2131. PMID:19923314.
• 62 Kramer JS, Hopkins PJ, Rosendale JC, Garrelts JC, Hale LS, Nester TM. et al. Implementation of an electronic system for medication reconciliation. Am J Health Syst Pharm 2007; 64: 404-422. PMID:17299180.
• 63 Rogers G, Alper E, Brunelle D, Federico F, Fenn CA, Leape LL. et al. Reconciling medications at admission: safe practice recommendations and implementation strategies. Jt Comm J Qual Patient Saf 2006; 32: 37-50. PMID:16514938.
• 64 Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003; 12 (02) 17-23. PMID:14645891.
• 65 Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned?. JAMA 2005; 293: 2384-2390. PMID:15900009.
• 66 Winterstein AG, Hartzema AG, Johns TE, De Leon JM, McDonald K, Henshaw Z. et al. Medication safety infrastructure in critical-access hospitals in Florida. Am J Health Syst Pharm 2006; 63: 442-450. PMID:16484518.
• 67 Ash JS, Sittig DF, Campbell E, Guappone K, Dykstra RH. An unintended consequence of CPOE implementation: shifts in power, control, and autonomy. AMIA Annu Symp Proc 2006: 11-15. PMID:17238293.